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Cannabinoids in PLWHIV on Effective ART

Primary Purpose

HIV Infections

Status
Terminated
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
TN-TC11M2 oral capsules (THC 2.5 mg/CBD 2.5 mg)
TN-C200M2 oral capsules (CBD 200 mg)
Sponsored by
McGill University Health Centre/Research Institute of the McGill University Health Centre
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infections focused on measuring HIV, Cannabinoids, HIV reservoir, Microbiome, CBD, THC, Inflammation, Immune activation

Eligibility Criteria

18 Years - 99 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Participants must meet all of the following criteria within 4 weeks prior to the week 0 (Baseline 1) visit to be considered eligible for entry into the study:

    1. Documented HIV infection by Western Blot, EIA assays or viral load assays
    2. Male or female, Aged 18 or older
    3. Viral load <40 copies/ml for at least 3 years
    4. On ART for at least 3 years
    5. No cannabinoid use for at least 1 month prior to enrolment with negative baseline cannabinoid screen
    6. Able to communicate adequately in either French or English
    7. Able and willing to provide written informed consent prior to enrolment including access to relevant medical records

Exclusion Criteria:

  1. Using cannabinoid-containing products outside of the study or within 4 weeks of study commencement
  2. Pregnant, breastfeeding or planning to become pregnant during the course of the study. Female participants must undergo a pregnancy test and obtain a negative result in order to qualify for study participation.
  3. Enrolled in a separate study involving administration of medication, vitamin, supplement or herbal product.
  4. Active intravenous drug users
  5. Active substance dependence
  6. Prior history of hypersensitivity to cannabis or cannabis-containing products
  7. Known or suspected allergy to sunflower lecithin oil
  8. Active opportunistic infection or malignant condition
  9. Unintentional weight loss of 10 % or more of body weight in the last 6 months
  10. Unstable angina or acute cardiac event in the past year
  11. Active psychiatric disorder or history of psychiatric depression (other than mild depression or anxiety); On antipsychotic medication
  12. Known or suspected family history of schizophrenia or severe personality disorder
  13. Serious cardiovascular disease such as ischemic heart disease, arrhythmias, poorly controlled hypertension, or severe heart failure
  14. Anemia (Hemoglobin <100 g/L)
  15. Active liver disease or unexplained persistent elevations of serum transaminases
  16. Co-infection with Hepatitis B or C (positive HBsAg or positive anti-HBc antibodies with a detectable HBV DNA viral load or positive anti HCV antibodies with a detectable HCV RNA viral load)
  17. Alanine aminotransferase (ALT) or Aspartate aminotransferase (AST) or alkaline phosphatase >2.5 x upper limit of normal (ULN)
  18. Active AIDS event in the last month as determined by the treating physician
  19. Renal dysfunction
  20. Unstable psychological or psychiatric condition as determined by the treating physician
  21. Holding employment which requires operation of heavy machinery or which requires undergoing drug screening (i.e., pilot or police officer)
  22. Concurrent use within the past 8 week of anabolic hormones, prednisone, IL-2 or other agents known to alter immune function.

Sites / Locations

  • Chronic Viral Illnesses Service, McGill University Health Centre-Glen Site

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

1) THC and CBD combined

2) CBD alone

Arm Description

TN-TC11M2 oral capsules (THC 2.5 mg / CBD 2.5 mg)

TN-C200M2 oral capsules (CBD 200 mg)

Outcomes

Primary Outcome Measures

WHO toxicity scale
Proportions of participants in both groups without any signs of significant toxicity as determined by the WHO toxicity scale (i.e., number of participants with Grades 0-2 scores on the WHO toxicity scale) Proportion of participants in both groups without any signs of significant haematological, biochemical, hepatic, renal, cardiovascular, respiratory, gastrointestinal, neurological, musculoskeletal, dermatological or systemic toxicity (Grades 0-2) as determined by the World Health Organization Toxicity Grading Scale for Determining the Severity of Adverse events (Grades 0=no toxicity; Grade 1=mild, transient or mild discomfort vs. maximum score Grade 4=life-threatening, extreme limitation in activity, significant assistance required) Toxicity scores (Grade 0, 1, 2, 3, or 4) will be calculated and reported for each domain (hematology, biochemistry, hepatic enzymes, urinalysis, cardiovascular, respiratory, gastrointestinal, neurological, musculoskeletal, dermatological, systemic)

Secondary Outcome Measures

Change in immune cell profile
Change in CD4 count and their subsets including naïve, central memory and effector memory, Treg and Th17 cells from week 0 to week 12 Change in immune cell profile (frequencies of CD4 T cell counts and their subsets such as naïve, central memory and effector memory T cells; T regulatory cells; Th17 cells) from week 0 to week 12
Change in plasma inflammatory markers
Change in plasma inflammatory markers from week 0 to week 12 Change in concentration of plasma inflammatory markers (interferon-α, interleukin-1β, interleukin-6, interleukin-10, interleukin-17, Transforming Growth Factor-β, interferon-gamma-induced protein-10, d-dimer, C-reactive protein, lipopolysaccharide and soluble CD14) from week 0 to week 12
Change in proportion activated CD4 and CD8 T cell lymphocytes
Change in CD8+CD38+HLADR+ and CD4+CD38+HLADR+ percentages from week 0 to 12 weeks Change in proportion activated CD4 and CD8 T cell lymphocytes (CD38+HLADR+) from week 0 to 12 weeks

Full Information

First Posted
May 23, 2018
Last Updated
June 26, 2022
Sponsor
McGill University Health Centre/Research Institute of the McGill University Health Centre
Collaborators
Tilray, CIHR Canadian HIV Trials Network, Université du Québec a Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal
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1. Study Identification

Unique Protocol Identification Number
NCT03550352
Brief Title
Cannabinoids in PLWHIV on Effective ART
Official Title
Cannabinoids in People Living With HIV on Effective Antiretroviral Therapy: A Pilot Study to Assess Safety, Tolerability and Effect on Immune Activation
Study Type
Interventional

2. Study Status

Record Verification Date
June 2022
Overall Recruitment Status
Terminated
Why Stopped
expiration of study product; end of study product availability
Study Start Date
August 20, 2021 (Actual)
Primary Completion Date
May 31, 2022 (Actual)
Study Completion Date
May 31, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
McGill University Health Centre/Research Institute of the McGill University Health Centre
Collaborators
Tilray, CIHR Canadian HIV Trials Network, Université du Québec a Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this pilot study is to assess feasibility and to examine whether oral cannabinoids (capsules containing either Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) combined or CBD alone) are safe and well-tolerated in people living with HIV. Other aims are to determine whether oral cannabinoids may reduce HIV-associated inflammation. An exploratory objective is to determine whether oral cannabinoids may influence HIV persistence as well as the gastrointestinal microbiome.
Detailed Description
Adults with well-controlled HIV (viral load suppressed for at least 3 years on effective antiretrovirals) will be randomized to receive Tilray oral capsules containing either THC and CBD (THC 2.5 mg / CBD 2.5 mg; TN-TC11M2) vs. CBD alone (CBD 200 mg; TN-C200M2). Participants will titrate up the number of capsules consumed based on their own individual tolerability, to a specified maximum daily dose, for a total treatment duration of 12 weeks. Participants will be assessed regularly via history and physical exam as well as through safety blood work monitoring (hematology and chemistry profiles, liver enzymes, renal function, HIV viral loads, CD4 and CD8 counts). Effect on mood and quality of life will be determined by WHO-QOL-HIV-BREF, EQ-5D and Profile of Mood States questionnaires. Blood work for immune activation and inflammatory profiles, as well as HIV reservoir, will also be drawn at regular intervals. This pilot study will provide information on feasibility (ie, time to recruitment of participants, whether participants continue the study for the full 12 week duration and complete the follow-up visits and questionnaires, whether treatment is safe and well-tolerated). It will also provide some preliminary data on the ability of TN-TC11M2 and TN-C200M2 oral capsules to reduce inflammation and possibly influence HIV persistence.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections
Keywords
HIV, Cannabinoids, HIV reservoir, Microbiome, CBD, THC, Inflammation, Immune activation

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
10 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1) THC and CBD combined
Arm Type
Experimental
Arm Description
TN-TC11M2 oral capsules (THC 2.5 mg / CBD 2.5 mg)
Arm Title
2) CBD alone
Arm Type
Experimental
Arm Description
TN-C200M2 oral capsules (CBD 200 mg)
Intervention Type
Drug
Intervention Name(s)
TN-TC11M2 oral capsules (THC 2.5 mg/CBD 2.5 mg)
Intervention Description
Participants will start by taking 1 capsule twice daily for 1 week (5 mg THC/5 mg CBD) and increase the number of capsules as tolerated to a maximum of 6 capsules taken throughout the day by weeks 5-12 (15 mg THC/15 mg CBD total per day).
Intervention Type
Drug
Intervention Name(s)
TN-C200M2 oral capsules (CBD 200 mg)
Intervention Description
Participants will start by taking 1 capsule once daily for 1 week (200 mg CBD) and increase the number of capsules as tolerated to a maximum of 4 capsules taken throughout the day by weeks 5-12 (800 mg CBD total).
Primary Outcome Measure Information:
Title
WHO toxicity scale
Description
Proportions of participants in both groups without any signs of significant toxicity as determined by the WHO toxicity scale (i.e., number of participants with Grades 0-2 scores on the WHO toxicity scale) Proportion of participants in both groups without any signs of significant haematological, biochemical, hepatic, renal, cardiovascular, respiratory, gastrointestinal, neurological, musculoskeletal, dermatological or systemic toxicity (Grades 0-2) as determined by the World Health Organization Toxicity Grading Scale for Determining the Severity of Adverse events (Grades 0=no toxicity; Grade 1=mild, transient or mild discomfort vs. maximum score Grade 4=life-threatening, extreme limitation in activity, significant assistance required) Toxicity scores (Grade 0, 1, 2, 3, or 4) will be calculated and reported for each domain (hematology, biochemistry, hepatic enzymes, urinalysis, cardiovascular, respiratory, gastrointestinal, neurological, musculoskeletal, dermatological, systemic)
Time Frame
week 0-12
Secondary Outcome Measure Information:
Title
Change in immune cell profile
Description
Change in CD4 count and their subsets including naïve, central memory and effector memory, Treg and Th17 cells from week 0 to week 12 Change in immune cell profile (frequencies of CD4 T cell counts and their subsets such as naïve, central memory and effector memory T cells; T regulatory cells; Th17 cells) from week 0 to week 12
Time Frame
week 0-12
Title
Change in plasma inflammatory markers
Description
Change in plasma inflammatory markers from week 0 to week 12 Change in concentration of plasma inflammatory markers (interferon-α, interleukin-1β, interleukin-6, interleukin-10, interleukin-17, Transforming Growth Factor-β, interferon-gamma-induced protein-10, d-dimer, C-reactive protein, lipopolysaccharide and soluble CD14) from week 0 to week 12
Time Frame
week 0-12
Title
Change in proportion activated CD4 and CD8 T cell lymphocytes
Description
Change in CD8+CD38+HLADR+ and CD4+CD38+HLADR+ percentages from week 0 to 12 weeks Change in proportion activated CD4 and CD8 T cell lymphocytes (CD38+HLADR+) from week 0 to 12 weeks
Time Frame
week 0-12

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
99 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participants must meet all of the following criteria within 4 weeks prior to the week 0 (Baseline 1) visit to be considered eligible for entry into the study: Documented HIV infection by Western Blot, EIA assays or viral load assays Male or female, Aged 18 or older Viral load <40 copies/ml for at least 3 years On ART for at least 3 years No cannabinoid use for at least 1 month prior to enrolment with negative baseline cannabinoid screen Able to communicate adequately in either French or English Able and willing to provide written informed consent prior to enrolment including access to relevant medical records Exclusion Criteria: Using cannabinoid-containing products outside of the study or within 4 weeks of study commencement Pregnant, breastfeeding or planning to become pregnant during the course of the study. Female participants must undergo a pregnancy test and obtain a negative result in order to qualify for study participation. Enrolled in a separate study involving administration of medication, vitamin, supplement or herbal product. Active intravenous drug users Active substance dependence Prior history of hypersensitivity to cannabis or cannabis-containing products Known or suspected allergy to sunflower lecithin oil Active opportunistic infection or malignant condition Unintentional weight loss of 10 % or more of body weight in the last 6 months Unstable angina or acute cardiac event in the past year Active psychiatric disorder or history of psychiatric depression (other than mild depression or anxiety); On antipsychotic medication Known or suspected family history of schizophrenia or severe personality disorder Serious cardiovascular disease such as ischemic heart disease, arrhythmias, poorly controlled hypertension, or severe heart failure Anemia (Hemoglobin <100 g/L) Active liver disease or unexplained persistent elevations of serum transaminases Co-infection with Hepatitis B or C (positive HBsAg or positive anti-HBc antibodies with a detectable HBV DNA viral load or positive anti HCV antibodies with a detectable HCV RNA viral load) Alanine aminotransferase (ALT) or Aspartate aminotransferase (AST) or alkaline phosphatase >2.5 x upper limit of normal (ULN) Active AIDS event in the last month as determined by the treating physician Renal dysfunction Unstable psychological or psychiatric condition as determined by the treating physician Holding employment which requires operation of heavy machinery or which requires undergoing drug screening (i.e., pilot or police officer) Concurrent use within the past 8 week of anabolic hormones, prednisone, IL-2 or other agents known to alter immune function.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Cecilia Costiniuk, MD, MSc
Organizational Affiliation
McGill University Health Centre/Research Institute of the McGill University Health Centre
Official's Role
Principal Investigator
Facility Information:
Facility Name
Chronic Viral Illnesses Service, McGill University Health Centre-Glen Site
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H4A 3J1
Country
Canada

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
30659041
Citation
Costiniuk CT, Saneei Z, Routy JP, Margolese S, Mandarino E, Singer J, Lebouche B, Cox J, Szabo J, Brouillette MJ, Klein MB, Chomont N, Jenabian MA. Oral cannabinoids in people living with HIV on effective antiretroviral therapy: CTN PT028-study protocol for a pilot randomised trial to assess safety, tolerability and effect on immune activation. BMJ Open. 2019 Jan 17;9(1):e024793. doi: 10.1136/bmjopen-2018-024793.
Results Reference
derived

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Cannabinoids in PLWHIV on Effective ART

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