The purpose of this study is to determine if Maraviroc administration can decrease IRIS incidence in HIV infected patients initiating ARV therapy.
This is a randomized, double blind, placebo-controlled, multicenter study testing the utility of a CCR5 antagonist (Maraviroc) as an adjuvant to a standard HAART regimen to decrease the incidence of Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV-infected patients naïve to antiretroviral treatment. The study duration will be 60 weeks, 276 subjects (138 per arm) will be recruited. The population included will be HIV-infected patients starting antiretroviral (ARV) therapy at the participating centers in Mexico and South Africa with a CD4 T cell count \<100 cells/ul. Subjects will be randomized to receive either Maraviroc (study drug) or placebo in addition to background ARV therapy. The background antiretroviral regimen for all subjects will be: Efavirenz 600mg QD + Tenofovir 300 mg / Emtricitabine 200 mg QD; subjects will be randomized to one of the following arms: Arm A: background ARV + maraviroc 600mg po BID; Arm B: background ARV + placebo po BID. Patients will be followed for 48 weeks. The primary endpoint will be the occurrence of a defined IRIS event by week 24 of follow up. The success of the ARV therapy will also be evaluated by virologic and immunologic response at 24 and 48 weeks. Three immunology sub-studies are planned: 1) Sub-study A will be conformed by a subgroup of 40 subjects (20 from Mexico and 20 from South Africa), additional blood sampling will be performed to evaluate expression of immune activation markers; movement of central memory T cells into cell cycle and frequencies of expandable pathogen-reactive CD4+ and CD8+ T cells in circulation; 2) Sub-study B will be conformed by another subgroup of 60 subjects (all from South Africa), additional blood sampling will be performed to evaluate monocyte and CD4 T cell gene expression as related to activation-induced apoptosis and cytokine secretion.; 3) Sub-study C will evaluate the incidence of thromboembolic disease in the study patients along with baseline evaluation of possible bio-markers of pro-coagulant state.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
276
Maraviroc 600mg po BID every day from the entry visit until week 48 or until IRIS event or unacceptable toxicity develops. Efavirenz 600 mg qd every day from the entry visit until week 48 or until IRIS event or unacceptable toxicity develops. Tenofovir/Emtricitabine 300/200 mg qd from the entry visit until week 48 or until IRIS event or unacceptable toxicity develops.
Placebo tablets po BID every day from the entry visit until week 48 or until IRIS event or unacceptable toxicity develops. Efavirenz 600 mg qd every day from the entry visit until week 48 or until IRIS event or unacceptable toxicity develops. Tenofovir/Emtricitabine 300/200 mg qd from the entry visit until week 48 or until IRIS event or unacceptable toxicity develops.
NIH/NIAD
Bethesda, Maryland, United States
Center for AIDS Research. Case Western Reserve University
Cleveland, Ohio, United States
Center for Clinical Epidemiology and Biostatistics. University of Pennsylvania School of Medicine
Philadelphia, Pennsylvania, United States
Time to occurrence of an IRIS event
Time frame: The initial 24 week period of observation
Time to occurrence of a severe IRIS event
Time frame: The initial 24 week period of observation
Occurrence of either an IRIS event or death
Time frame: By 24 and 48 weeks
Proportion of subjects who develops an IRIS case
Time frame: By week 24
Proportion of subjects who develop a severe IRIS case
Time frame: Week 24
Proportion of subjects who develop a confirmed, non dermatologic IRIS case
Time frame: Week 24
Proportion of subjects who develop an unmasking or paradoxical IRIS event
Time frame: Week 24
Frequency of cardiovascular, cerebrovascular, non AIDS related neoplasia, cirrhosis, renal failure and death in both treatment arms
Time frame: During the study (from entry to week 60)
Frequency of AIDS defining events and AIDS related events in both arms of treatment
Time frame: From basline to study end
General survival
Time frame: At week 24 and 48
Survival without IRIS
Time frame: At weeks 24 and 48
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HIV-1 Immunopathogenesis Laboratory. The Wistar Institute
Philadelphia, Pennsylvania, United States
Hospital General de León
León, Guanajuato, Mexico
Hospital Civil de Guadalajara
Guadalajara, Jalisco, Mexico
Hospital General de México
Mexico City, Mexico City, Mexico
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Mexico City, Mexico City, Mexico
Hospital Central Dr. Ignacio Morones Prieto
San Luis Potosí City, San Luis Potosí, Mexico
Clinical HIV Research Unit. Themba Lethu Clinic. Helen Joseph Hospital
Johannesburg, Gauteng, South Africa
Proportion of patients with VL<50 copies/mL
Time frame: At weeks 8, 24 and 48
Changes form baseline in CD4+ cells count
Time frame: From baseline to weeks 12, 24 and 48
Safety and tolerability of the treatment regimens
Time frame: Along the study
Incidence of HIV drug resistance
Time frame: Baseline to week 60
Prevalence of CCR5 tropism
Time frame: Baseline
Prevalence of CCR5 HIV tropism
Time frame: At virological failure occurrence
Baseline predictors of IRIS
Time frame: Baseline
Genetic polymorphisms associated with the occurrence of IRIS
Time frame: Baseline
To evaluate the rol of biomarkers (CRP) in predicting or identifying IRIS and the effect of Maraviroc on this marker
Time frame: Baseline to IRIS event