This study evaluates the safety, tolerability, pharmacokinetics, and efficacy of treating Cryptosporidiosis in HIV positive patients with Clofazimine. Half of the HIV positive patients with Cryptosporidiosis enrolled will be treated with Clofazimine while the other half will be given placebo. An additional group of HIV positive patients without Cryptosporidium infection or diarrhea will be given Clofazimine to assess the differences in pharmacokinetics between HIV positive patients with and without Cryptosporidiosis and diarrhea.
Cryptosporidiosium infection and diarrhea is a life-threatening infection in children 6-18 months and in immunocompromised patients. However, Nitazoxanide, the only drug approved for treatment of Cryptosporidiosis, showed little-to-no efficacy in HIV positive patients and low efficacy in malnourished children. Recently, Love MS et al reported that Clofazimine inhibited proliferation of both Cryptosporidium parvum and C. hominis in vitro and reduced shedding in a mouse model of acute C. parvum infection. Clofazimine has been approved for treatment of leprosy for decades and more recently for the treatment of drug-resistant Mycobacterium tuberculosis. Safety and pharmacokinetics of Clofazimine are well documented for a variety of patient populations, but not for HIV positive patients or patients with diarrhea. Thus, this clinical trial seeks to determine the efficacy of 50 or 100 mg of Clofazimine administered 3 times daily for 5 days on fecal shedding of Cryptosporidium oocysts in HIV positive patients, as well as safety, tolerability, and pharmacokinetics in this patient population.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
33
50 or 100 mg micronized Clofazimine suspended in an oil-wax base in a gelatin capsule
Oil-wax in gelatin capsule
Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW)
Blantyre, Malawi
Reduction in Cryptosporidium fecal shedding following Clofazimine administration
The reduction in the (log) number of Cryptosporidium shed in stools in the first collected stool of the day over a 6-day period and compared to placebo recipients, as measured by quantitative polymerase chain reaction (qPCR) in stool samples and analyzed by a mixed effect ANCOVA analysis in subjects treated according to protocol (ATP).
Time frame: 5 days
Pharmacokinetics (area under curve) of Clofazimine in HIV-infected subjects with Cryptosporidium and diarrhea versus HIV-infected subjects without Cryptosporidium infection or diarrhea
Clofazimine in plasma will be assessed via area under curve.
Time frame: 5 days
Peak plasma concentration of Clofazimine in HIV-infected subjects with Cryptosporidium and diarrhea versus HIV-infected subjects without Cryptosporidium infection or diarrhea
Clofazimine in plasma will be assessed via Cmax and time to reach Cmax (Tmax).
Time frame: 5 days
Pharmacokinetics (Ke) of Clofazimine in HIV-infected subjects with Cryptosporidium and diarrhea versus HIV-infected subjects without Cryptosporidium infection or diarrhea
Clofazimine in plasma will be assessed via Ke determined after the last dose on day 5.
Time frame: 5 days
Stool pharmacokinetics of Clofazimine in HIV-infected subjects with Cryptosporidium and diarrhea versus HIV-infected subjects without Cryptosporidium infection or diarrhea
The total daily amount of CFZ eliminated in stool will be assessed on Study Day 2 (2nd dose day), Study Day 5 (last dose day), and Study Day 6 (concentration of CFZ in stool before discharge).
Time frame: 5 days
Frequency and severity of solicited adverse events (AEs)
Frequency and severity of solicited AEs throughout study product administration
Time frame: 5 days
Frequency, severity, and relationship to study product of unsolicited AEs
Frequency, severity, and relationship to study product of unsolicited AEs throughout the course of the study
Time frame: 55 days
Occurrence of serious adverse events (SAEs), suspected unexpected serious adverse reactions (SUSARs), and adverse events of special interest (AESI).
Occurrence of SAEs, SUSARs, and AESIs throughout the course of the study. AESI include: QT prolongation measured via 12-lead electrocardiogram, liver toxicity, skin discoloration and other skin related AEs/abnormalities (subjects will be evaluated for discoloration of skin of the palms and of the sclera and oral mucous membranes), GI-related AEs.
Time frame: 55 days
Evaluation of time to negative ELISA signal in subjects randomized to Clofazimine versus placebo
Evaluate days required to test negative for Cryptosporidium by ELISA test in subjects randomized to Clofazimine versus placebo.
Time frame: 6 days
Characterization of the reduction in the number of diarrheal episodes following administration of CFZ relative to placebo.
To characterize the reduction in the number of diarrheal episodes following administration of CFZ relative to placebo.
Time frame: 6 days
Characterization of the stool volume following administration of CFZ relative to placebo.
To characterize the stool volume following administration of CFZ relative to placebo.
Time frame: 6 days
Characterization of the stool consistency following administration of CFZ relative to placebo.
To characterize the stool consistency based on a defined diarrheal stool grading scale following administration of CFZ relative to placebo.
Time frame: 6 days
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.