Maraviroc is an antiretroviral medication that may help in improving mental function in HIV infected patients with mental problems by decreasing inflammatory tendencies. We will test this in a clinical trial of 42 HIV infected individuals with some mild to moderate mental problems who are already on HIV medications and doing well. We will add Maraviroc or a sugar pill to their HIV medications and see if mental function improves over 48 weeks. This study will be conducted at 2 sites in Hawaii and Puerto Rico.
We hypothesize that maraviroc (MVC) will lead to improved cognition as assessed by improvement in neuropsychological (NP) performance. We hypothesize that MVC therapy leads to (1) decrease in HIV infection of monocytes (MO), particularly of CD16-expressing MO and (2) phenotypic and functional secretory changes suggestive of decrease in MO immune activation, and that these changes will lead to less HIV infected activated MO trafficking to the CNS, less CNS inflammation and neuronal damage, and ultimately improved cognition. We will test this in a 48 week trial in 42 HIV infected individuals on suppressive antiretroviral therapy (ART) with mild to moderate cognitive dysfunction. These individuals will be randomized to intensify their ART in double-blind fashion to MVC vs placebo. The primary endpoint will be change in NPZglobal. Magnetic resonance spectroscopy (MRS)/magnetic resonance spectroscopic imaging (MRSI) will be conducted to assess potential alterations in inflammatory and neuronal brain chemicals.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
48
Clint Spencer Clinic, Hawaii Center for AIDS, University of Hawaii
Honolulu, Hawaii, United States
Puerto Rico Clinical and Translational Research Consortium
San Juan, Puerto Rico
Change in Neuropsychological Performance
Change in global neuro-psychological Z scores and change in various neuro-psychological Z subdomains will be assessed
Time frame: 48 weeks
Changes in monocyte subsets and function
Change in monocyte subsets based on CD14 and CD16 expression by flow cytometry; Change in inflammatory and neurotoxic mediators (sCD14, TNFalpha, sCD163 and neopterin
Time frame: 48 weeks
Change in HIV DNA content within MO subsets
Change in HIV DNA content specifically within each MO subsets
Time frame: 48 weeks
Change in brain metabolites by magnetic resonance spectroscopy
Change in neuronal and inflammatory brain metabolites globally within brain and in select brain regions
Time frame: 48 weeks
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