People infected with HIV often have cognitive dysfunction even if they are on antiretroviral therapy (ART) and have undetectable viral loads. The study evaluated if the addition of maraviroc (MVC) and dolutegravir (DTG) (which are two antiretroviral \[ARV\] medications) to participants' existing ART regimens improved participants' neurocognitive performance.
HIV-infected people often have cognitive dysfunction (HIV-associated neurocognitive disorder, or HAND), which includes asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), and HIV-associated dementia (HAD), even if they are on ART and have undetectable viral loads. In this study, researchers evaluated the effectiveness of adding MVC and DTG to the current ART regimen of HIV-infected people with undetectable (\<50 copies/mL) plasma HIV-1 RNA who had neurocognitive impairment and who had been on stable ART for at least 6 months prior to study entry. The purpose of this study was to evaluate if the addition of MVC and DTG to participants' existing ART regimens improved participants' neurocognitive performance. Participants were randomly assigned to one of three arms. All participants remained on their existing ART regimens; they took their assigned study drugs in addition to their ART regimen. Study visits occurred at entry and Weeks 2, 4, 12, 24, 48, 72, and 96. Visits may have included physical examinations, blood collection, neurocognitive testing, pregnancy testing, and questionnaires. Some participants may have had an optional lumbar puncture procedure at study entry and Week 48. Participants returned for refills of study drugs on Weeks 36, 60, and 84.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
191
Administered orally as one 150 mg tablet BID OR two 300 mg tablet BID OR one 300 mg tablet BID depending upon background ARV regimen
Administered orally as one 50 mg tablet BID OR one 50 mg tablet QD depending upon background ARV regimen
Administered orally as one 50 mg tablet BID OR one 50 mg tablet QD depending upon background ARV regimen
Change in Normalized Composite Neurocognitive Test Score at Week 48 From Baseline
The normalized composite neurocognitive test score (total z-score) was defined as the average of the z-scores from the following tests: Domestic (US-based) and International Participants: * Grooved pegboard dominant * Grooved pegboard non-dominant * Hopkins Verbal Learning Test (HVLT-R) Learning trials * HVLT-R Delayed recall * HVLT-R Delayed recognition * Semantic verbal fluency Domestic only: * Stroop color naming * Stroop word reading * Stroop interference trial * Letter fluency * Trail Making A * Trail Making B * WAIS-III Symbol search * Digit Symbol International only: * Timed Gait * Finger Tapping Dominant * Finger Tapping Non-dominant * Color Trail 1 Z-scores were calculated using a demographically appropriate norming process. Higher z-scores correspond with better neurocognitive performance. Change was calculated as the total z-score at Week 48 minus the total z-score at Baseline.
Time frame: Measured at Baseline and Week 48
Number of Participants With Treatment Related Adverse Events (AEs)
Treatment Related Adverse Events were determined by the study sites indicating a relationship between an adverse event and the study treatment.
Time frame: Measured from treatment initiation through Week 96
Change in Normalized Composite Neurocognitive Test Score at Weeks 24, 72, and 96 From Baseline
The normalized composite neurocognitive test score (total z-score) was defined as the average of the z-scores from the following tests: Domestic and International Participants: * Grooved pegboard dominant * Grooved pegboard non-dominant * HVLT-R Learning trials * HVLT-R Delayed recall * HVLT-R Delayed recognition * Semantic verbal fluency Domestic only: * Stroop color naming * Stroop word reading * Stroop interference trial * Letter fluency * Trail Making A * Trail Making B * WAIS-III Symbol search * Digit Symbol International only: * Timed Gait * Finger Tapping Dominant * Finger Tapping Non-dominant * Color Trail 1 * Color Trail 2 Z-scores were calculated using a demographically appropriate norming process. Higher z-scores correspond with better neurocognitive performance. Change was calculated as the total z-score at the given time point minus the total z-score at Baseline.
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Administered orally as one 150 mg tablet BID OR two 300 mg tablet BID OR one 300 mg tablet BID depending upon background ARV regimen
UCLA CARE Center CRS
Los Angeles, California, United States
UCSD Antiviral Research Center CRS
San Diego, California, United States
Harbor-UCLA CRS
Torrance, California, United States
Whitman-Walker Health CRS
Washington D.C., District of Columbia, United States
Northwestern University CRS
Chicago, Illinois, United States
Johns Hopkins University CRS
Baltimore, Maryland, United States
Washington University Therapeutics (WT) CRS
St Louis, Missouri, United States
New Jersey Medical School Clinical Research Center CRS
Newark, New Jersey, United States
Weill Cornell Chelsea CRS
New York, New York, United States
Weill Cornell Uptown CRS
New York, New York, United States
...and 20 more locations
Time frame: Measured at Baseline and Weeks 24, 72, and 96
Change in Functional Status Scores
Functional status scores were calculated based on the instrumental activities of daily living (IADLs) forms. IADL scores were calculated as the sum of the eight IADL tasks where the task scores were equal to 1 if a participant did not need assistance with the task and equal to 0 if a participant needed some level of help with the task. The maximum possible functional status score was 8, while the minimum possible functional status score was 0, with higher functional status scores indicating a higher level of functionality.
Time frame: Measured at Baseline and Weeks 24, 48, 72, and 96
Number of Participants With Plasma HIV-1 RNA Greater Than or Equal to 50 Copies/mL
The number of participants with Plasma HIV-1 RNA greater than or equal to 50 copies/mL was assessed at each given time point.
Time frame: Measured at Weeks 24, 48, and 96
CD4+ T-cell Counts
CD4+ T-cell counts were recorded at the given time point
Time frame: Measured at Weeks 24, 48, and 96
Change in CD4+ T-cell Count
Changes in CD4+ T-cell count were calculated as the CD4+ T-cell count at a given time point minus the CD4+ T-cell count at Baseline.
Time frame: Measured at Baseline and Weeks 24, 48, and 96
CD8+ T-cell Counts
CD8+ T-cell counts were recorded at the given time point
Time frame: Measured at Weeks 24, 48, and 96
Change in CD8+ T-cell Count
Changes in CD8+ T-cell count were calculated as the CD8+ T-cell count at a given time point minus the CD8+ T-cell count at baseline.
Time frame: Measured at Baseline and Weeks 24, 48, and 96
Change in Log10 sCD14 in Plasma at Week 48 From Baseline
Changes in Log10 sCD14 in Plasma were calculated as the Log10 sCD14 in Plasma at Week 48 minus the Log10 sCD14 in Plasma at Baseline.
Time frame: Measured at Baseline and Week 48
Change in Log10 MIP-1 Beta in Plasma at Week 48 From Baseline
Changes in Log10 MIP-1 Beta in Plasma were calculated as the Log10 MIP-1 Beta in Plasma at Week 48 minus the Log10 MIP-1 Beta in Plasma at Baseline. Results below the lower limit of quantification were set to the lower limit value of 11.
Time frame: Measured at Baseline and Week 48
Change in Log10 sTNFr-II in Plasma at Week 48 From Baseline
Changes in Log10 sTNFr-II in Plasma were calculated as the Log10 sTNFr-II in Plasma at Week 48 minus the Log10 sTNFr-II in Plasma at Baseline.
Time frame: Measured at Baseline and Week 48
Change in Log10 VCAM in Plasma at Week 48 From Baseline
Changes in Log10 VCAM in Plasma were calculated as the Log10 VCAM in Plasma at Week 48 minus the Log10 VCAM in Plasma at Baseline.
Time frame: Measured at Baseline and Week 48
Change in Log10 MIP-1 Beta in Cerebrospinal Fluid (CSF) at Week 48 From Baseline
Changes in Log10 MIP-1 Beta in CSF were calculated as the Log10 MIP-1 Beta in CSF at Week 48 minus the Log10 MIP-1 Beta in CSF at Baseline.
Time frame: Measured at Baseline and Week 48
Change in Log10 IP-10 in CSF at Week 48 From Baseline
Changes in Log10 IP-10 in CSF were calculated as the Log10 IP-10 in CSF at Week 48 minus the Log10 IP-10 in CSF at Baseline.
Time frame: Measured at Baseline and Week 48
Change in Log10 Neopterin in CSF at Week 48 From Baseline
Changes in Log10 Neopterin in CSF were calculated as the Log10 Neopterin in CSF at Week 48 minus the Log10 Neopterin in CSF at Baseline.
Time frame: Measured at Baseline and Week 48
Change in Log10 NFL in CSF at Week 48 From Baseline
Changes in Log10 NFL in CSF were calculated as the Log10 NFL in CSF at Week 48 minus the Log10 NFL in CSF at Baseline.
Time frame: Measured at Baseline and Week 48