Early Human Immunodeficiency Virus (HIV) infection Infections and Infestations Human Immunodeficiency Virus (HIV)
Conditions
Interventions
Patients will receive hydroxychloroquine 400 mg/day or matching placebo to be taken once daily by mouth for 48 weeks with food.
Sponsors
Medical Research Council Clinical Trials Unit (MRC CTU) (UK)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Current information as of 11/02/2009 (amended in protocol and approved by ethics on 13/10/2008): 1. Documented HIV infection on Enzyme-Linked Immuno-Sorbent Assay (ELISA) and confirmatory test 2. Age 18 to 65 years, either sex 3. Naïve to antiretroviral therapy (ART) or off ART for at least 12 months prior to study entry 4. CD4 T-cell count greater than 400 cells/µL on screening blood test and on one other test performed within the 3 months prior to screening 5. Plasma HIV RNA viral load greater than 5000 copies/ml on screening blood test 6. Willing and able to provide written informed consent Current information as of 29/04/2008: 1. Documented HIV infection on Enzyme-Linked Immuno-Sorbent Assay (ELISA) and confirmatory test 2. Age 18 to 65 years, either sex 3. Naive to antiretroviral therapy (ART) (patients who have taken less than a total of 3 months ART in the past will be eligible, provided that they have been off ART for 1 year prior to study entry) 4. CD4 T-cell count greater than 400 cells/µL on screening blood test and on one other test performed within the 3 months prior to screening 5. Plasma HIV RNA viral load greater than 5000 copies/ml on screening blood test 6. Willing and able to provide written informed consent Initial information at time of registration: 1. Male or female patients with documented HIV infection on Enzyme-Linked Immuno-Sorbent Assay (ELISA) and confirmatory test 2. Age 18 to 60 years 3. Naive to antiretroviral therapy 4. CD4 T-cell count greater than 400 cells/µL on screening blood test and on one other test performed within three months prior to screening 5. Plasma viral load greater than 5000 copies/ml on screening blood test 6. Willing and able to provide written informed consent 7. Women of childbearing age must be willing to use contraception during the study and for a period of three months afterwards 8. Written informed consent
Exclusion criteria
Exclusion criteria: Current information as of 11/02/2009 (amended in protocol and approved by ethics on 13/10/2008): 1. History of psoriasis, porphyria cutanea tarda, epilepsy, myasthenia gravis, myopathy of any cause, cardiac arrhythmias, glucose 6-phosphate dehydrogenase (G6PD) deficiency 2. Insulin-dependent or non-insulin-dependent diabetes mellitus 3. Chronic liver disease of any cause or alcoholism 4. Primary HIV infection within 12 months prior to screening, either confirmed (previous negative HIV antibody test within 12 months), or suspected (symptoms strongly suggestive of HIV seroconversion illness within the previous 12 months and patient not known to be HIV antibody positive prior to the illness) 5. Pneumonia, meningitis, septicaemia or any other serious infection in the 2 months prior to screening 6. Any acute infection with fever and systemic symptoms within the last 24 hours 7. Any vaccinations in the 2 months prior to screening 8. Active malignancy (patients are eligible if treatment for the malignancy was completed more than 2 years prior to screening and there has been no subsequent clinical evidence of active disease) or any active immune-mediated or inflammatory disease 9. Any known suicide attempts (at any time in the past) or current or past history of depression requiring treatment within the 2 years prior to screening. Patients who have not had depression in the previous 2 years but who have had depression in the past may be included if, in the opinion of the physician, the nature of the past episode of depression and the patient?s current psychological state indicate that the risk of recurrence of depression during the trial is likely to be low. Patients who have received anti-depressant medication for reasons other than symptomatic depression can be included in the trial. 10. A woman who is currently pregnant or breastfeeding 11. A woman of child-bearing potential who is planning to become pregnant during the course of the study, or is unwilling to take adequate contraception (including barrier contraception) throughout the course of the study 12. Use of systemic corticosteroids or other immunomodulatory drugs within the 12 months prior to screening 13. Current use of medication with known serious hepatotoxic effects or known interaction with hydroxychloroquine 14. Evidence of cardiac conduction defects or cardiac arrhythmia on screening electrocardiogram (ECG) 15. Retinopathy or visual field changes detected on screening eye examination 16. Hepatitis B surface antigen (HBsAg) positive or Hepatitis C PCR positive (patients who are Hepatitis C antibody positive are allowed to participate provided that PCR is negative) 17. Any of the following laboratory abnormalities on screening blood test: 17.1. Haemoglobin less than 10.5 g/dl 17.2. Absolute neutrophil count less than 1.0 x 10^9/L 17.3. Platelet count less than 100 x 10^9/L 17.4. Alanine aminotransferase (ALT) or aspartate aminotransferase (AST), or alkaline phosphatase above 2.5 x upper limit of normal (ULN) 17.5. Serum creatinine greater than 1.5 x upper limit of normal (ULN) 17.6. Estimated creatinine clearance (Cockroft-Gault equation) below 60 ml/min 18. Inability to attend or comply with treatment or follow-up scheduling 19. Current participation in any other clinical intervention trial Current information as of 29/04/2008: 1. History of psoriasis, porphyria cutanea tarda, epilepsy, myasthenia gravis, myopathy of any cause, cardiac arrhythmias, glucose 6-phosphate deh
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Change in CD8 T-cell activation at week 48 compared to baseline in the two study groups (as shown by a percentage of the cells expressing CD38+ and HLA-DR+). | — |
Secondary
| Measure | Time frame |
|---|---|
| Current secondary outcome measures as of 29/04/2008: Efficacy outcome measures: Change from baseline to week 48 in: 1. CD4 T-cell activation (as shown by the percentage of the cells expressing CD38+ and HLA-DR+) 2. Absolute CD4 T-cell count 3. IL-6 concentration 4. HIV viral load (expressed in log^10 copies/ml) Safety outcome measure: 5. Incidence of Serious Adverse Events 6. Incidence of clinical and laboratory grade III and IV adverse events 7. Incidence of retinal changes Previous secondary outcome measures: Efficacy outcome measure: 1. Change in HIV Ribonucleic Acid (RNA) and absolute CD4 T-cell count at week 48 compared to baseline (analysis will compare change in hydroxychloroquine and placebo groups) 2. Change in CD4 T-cell activation at week 48 compared to baseline in the two study groups (as shown by a percentage of the cells expressing CD38+ and HLA-DR+) 3. Proliferation of CD4 and CD8 T-cells (as shown by Ki67 expression), assessed at the end of study 4. Quality of life; the Medical Outcomes Study (MOS)-HIV questionnaire will be used and assessed at the end of the study Safety outcome measure: 5. Clinical and laboratory toxicity monitoring, monitored at every visit | — |
Countries
United Kingdom
Outcome results
None listed