This study is a prospective, open-label, randomized, three-arm, dose-escalation exploratory pilot clinical trial involving HIV-1 infected participants treated with suppressive combination antiretroviral combination therapy (cART). The study will test whether combined treatment with the histone deacetylase inhibitor panobinostat and the immunomodulatory cytokine Interferon-alpha2a can reduce the residual reservoir of HIV-1 infected cells that persist during treatment with currently available antiretroviral drugs.
This study is a prospective, triple-arm, randomized, open-label, dose-escalation exploratory clinical trial involving HIV-1 infected participants treated with suppressive combination antiretroviral combination therapy (cART). The primary objective of this study is to evaluate a new strategy for reducing the residual reservoir of HIV-1 infected cells that persists despite treatment with current HIV drugs. The clinical trial is conducted in the Infectious Diseases Clinical Trials Unit (CTU) at the Massachusetts General Hospital. The study medication includes two agents: panobinostat is an oral tablet that can reverse HIV-1 latency and awaken HIV from a "sleeping" condition during which it is protected from the human immune system. The second drug is pegylated interferon-alpha2a (IFN-alpha2a), an injectable cytokine that activates the immune system. The combined use of both agents may lead to immune-mediated elimination of HIV-1 infected cells in which viral latency has been reversed by panobinostat. Participants will be randomized to receive a treatment course with panobinostat alone (Arm A, 4 participants total), panobinostat in combination with pegylated IFN-alpha2a (Arm B, 9 participants total), or pegylated IFN-alpha2a alone (Arm C, 4 participants total). Participants receiving panobinostat will undergo one week of treatment (15mg, dosed every second day on Monday, Wednesday, Friday), followed by three weeks off-treatment. Subcutaneous injections with pegylated IFN-alpha2a will be administered at the start of the week-long treatment course (simultaneously with the first dose of panobinostat for Arm B). ART will be continued during the entire treatment duration in all study participants. Participants will undergo close monitoring for side effects during the entire time of study participation. The total study duration will be 2 months.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Panobinostat will be administered orally.
Pegylated Interferon-alpha2a will be administered subcutaneously in one shot.
Massachusetts General Hospital CRS (MGH CRS)
Boston, Massachusetts, United States
Occurrence of Grade ≥ 1 Adverse Events (AEs)
Cumulative frequency and severity of Grade ≥ 1 adverse events, Grade ≥ 1 lab abnormalities or serious adverse events
Time frame: All adverse events measured from day 1 until day 28 after administration of the first dose of panobinostat and/or interferon-alpha2a was recorded.
Change in CD4 T Cell-Associated Proviral HIV-1 DNA From Baseline
Operational measurement of CD4 T cells harboring genome-intact HIV-1 DNA, determined by the IPDA assay.
Time frame: Measured through week 4 after administration of panobinostat and/or interferon-alpha2a
Change From Baseline in Histone H3 Acetylation in CD4 T Cells
CD4 T cells expressing acetylated H3, determined by flow cytometry.
Time frame: measured after last dose of PBT on day 4
Change From Baseline in Levels of CD4 T Cell-associated HIV-1 RNA
total HIV-1 RNA per ug of RNA in CD4 T cells
Time frame: measured after last dose of PBT on day 4
Change From Baseline in Frequency of Activated NKp30+ NK Cells.
the proportion of NK cells expressing NKp30
Time frame: measured after last dose of PBT on day 4
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Purpose
TREATMENT
Masking
NONE
Enrollment
17