AzTrials
AzTrials

HIV InfectionPhase 2NCT01852942

Reversing Tissue Fibrosis to Improve Immune Reconstitution in HIV

A Phase 2 study testing Losartan in people with HIV Infection and HIV Infections, run by University of Minnesota at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

This study was designed to test the hypothesis that treatment of HIV infected subjects with losartan, an agent with specific anti-inflammatory and anti-fibrotic actions, will: 1. reverse existing lymphoid tissue fibrosis, 2. restore lymphoid tissue architecture, 3. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
HIV Infection, HIV Infections
What is being tested?
Losartan
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
52 participants
Where
1 siteUnited States
Study dates
Sep 2014to 16 Jul 2019
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

HIV infected participants:

  1. Inclusion Criteria: Participants must meet all of the following inclusion criteria to participate in this study:
  • HIV-1 infected. -≥ 18 years of age.
  • Baseline peripheral CD4+ T cell count 200-600 cells/mm3 for at least two measures over the 6 months prior to study enrollment. -≥ 12 months of stable ART, defined as use of a given drug regimen without disruption lasting ≥ 1 week in the period leading up to study enrollment.
  • HIV viral load (VL) < 50 copies/mL for at least two consecutive measures over the 6 months prior to study enrollment.
  • No contraindication to proposed study procedures.
  • Women of child-bearing potential must be willing to use a form of effective contraception for the duration of the study. Effective contraception includes hormonal injection, implant or oral medication, IUD, diaphragm, or cervical cap with spermicide. Condoms cannot be used as the sole form of contraception.
  1. Exclusion Criteria: Participants meeting any of the following exclusion criteria at baseline will be excluded from study participation:
  • Use of any immunomodulator within the 12 months prior to study enrollment. An immunomodulator for the purposes of this study is defined as a drug known to either diminish or augment a patient's immune system. Examples of these include, but are not limited to, systemic corticosteroids (use of topical steroids will be permitted), TNF-inhibitors, rituximab, cyclophosphamide, abatacept,cyclosporine, azathioprine, 6-mercaptopurine, methotrexate, sulfasalazine, cyclosporine, tacrolimus,sirolimus, and intravenous immune globulin.
  • Current use of an ARB or ACEi.
  • Current use of rifaximin, fluconazole or lithium given potential for drug interactions with losartan.
  • Prior reaction or intolerance to an ARB or ACEi.
  • Prior diagnosis of a chronic inflammatory disease with serologic or clinical evidence as diagnosed by a primary care physician or specialist. Examples of these include, but are not limited to, systemic lupus erythematosus, rheumatoid arthritis, scleroderma, Sjogren's syndrome, mixed connective tissue disease, psoriasis, polymyositis, dermatomyositis, vasculitis, sarcoidosis, Wegener's granulomatosis, giant cell arteritis, polyarteritis nodosa, gastrointestinal pemphigoid, eosinophilic colitis, Crohn's disease, ulcerative colitis, autoimmune hepatitis, and hepatitis C.
  • Prior diagnosis of a connective tissue disease with genetic, serologic or clinical evidence as diagnosed by a primary care physician or specialist (Marfan's syndrome, Ehlers-Danlos syndrome).
  • Baseline blood pressure < 110/70.
  • Estimated Glomerular Filtration Rate (eGFR) of < 30ml/min/1.73 m2 within 4 weeks of study initiation or history of advanced renal disease.
  • AST and/or ALT > 3 times the upper limit of normal within 4 weeks of study enrollment.
  • Potassium > 5.0 within 4 weeks of study enrollment.
  • Pregnancy.
  • In women of childbearing age, unwillingness to use birth control for the duration of the study.
  • Breast feeding.
  • Prior vaccination with an HPV vaccine, including Cervarix (GlaxoSmithKline) or Gardasil (Merck).
  • History of hypersensitivity or severe allergic reactions to yeast.

HIV-uninfected:

  1. Inclusion Criteria Participants must meet all of the following inclusion criteria to participate in this study:
  • HIV uninfected. -≥ 18 years of age.
  • No contraindication to proposed study procedures.
  1. Exclusion Criteria: Participants meeting any of the following exclusion criteria at baseline will be excluded from study participation:
  • Use of any immunomodulator within the 12 months prior to study enrollment (as defined above).
  • Current use of an ARB or ACEi.
  • Prior diagnosis of a chronic inflammatory disease with serologic or clinical evidence (as defined above).
  • Prior diagnosis of a connective tissue disease with genetic, serologic or clinical evidence as diagnosed by a primary care physician or specialist (Marfan's syndrome, Ehlers-Danlos syndrome).
  • Pregnancy.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Minnesota, Division of Infectious Diseases

    Minneapolis, Minnesota, 55455

Other trials in United States

About this study

This study was designed to test the hypothesis that treatment of HIV infected subjects with losartan, an agent with specific anti-inflammatory and anti-fibrotic actions, will:

  1. reverse existing lymphoid tissue fibrosis,
  2. restore lymphoid tissue architecture,
  3. increase the number and improve the function of peripheral and lymphatic CD4 T cells,
  4. decrease levels of systemic immune activation (IA),
  5. decrease size of the HIV reservoir, and
  6. be safe and well tolerated.
Read the detailed description

This is a randomized, double-blind, placebo-controlled trial of 50 HIV-1 infected individuals on stable ART randomized in a 1:1 ratio to losartan (50 mg orally daily titrated to 100 mg daily) vs placebo for 30 months. We plan to enroll a total of 63 HIV infected subjects to ensure that 50 complete the protocol. All HIV infected subjects will undergo biopsies of inguinal lymph node (LN) and gut associated lymphatic tissue (GALT) for primary endpoint analysis at baseline, 12 and 30 months after study enrollment. Blood will be collected at least quarterly throughout the study and an intensive blood pharmacokinetic (PK) study will be conducted at month 1. All HIV infected subjects will be vaccinated with the quadrivalent human papillomavirus (HPV) vaccine at months 23, 25 and 29.5 to measure immune function. 5 HIV uninfected control subjects will also be enrolled.

The primary endpoint is to determine the impact of losartan on lymphoid tissue fibrosis in HIV infected, ART treated adults. This will be determined by measuring the amount of collagen deposition in lymphoid tissues and the integrity of the FRCn using immunohistochemistry (IHC) and quantitative image analysis (QIA).

Being tested
Losartan, Placebo
Keywords
Infection, HIV 1, HIV, Losartan, Fibrosis, Immune Activation, Immune Reconstitution
Medical subject headings
HIV Infections, Infections, Fibrosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • LosartanDrug

    Also called Cozaar

    Participants will start with 50 mg of losartan by mouth daily. The dose will be increased to 100 mg by mouth daily after 14 days. The maximal tolerable dosage (up to 100mg by mouth daily) will be continued for a total of 30 months.

  • PlaceboDrug

    one tablet by mouth daily

Study groups in NCT01852942
Study groupRoleWhat they receive
LosartanExperimentalNot described
Receives: Drug: Losartan
Sugar PillPlacebo comparatorNot described
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Collagen Deposition in LT

    The Impact of Losartan Treatment on Lymphoid Tissue (LT) Fibrosis will be determined by measuring the amount of collagen deposition in LT using immunohistochemistry (IHC) and quantitative image analysis (QIA). LT will be obtained at baseline, month 12 and month 30.

    Measured: 30 months

  2. Integrity of the Fibroblastic Reticular Cell Network (FRCn)

    The Impact of Losartan Treatment on Lymphoid Tissue (LT) Fibrosis will be determined by measuring the Integrity of the fibroblastic reticular cell network (FRCn) using immunohistochemistry (IHC) and quantitative image analysis (QIA). LT will be obtained at baseline, month 12 and month 30.

    Measured: 30 months

Secondary outcomes (41)
  1. Frequency of CD4+ T Cells

    Impact of losartan on immune reconstitution and function will be determined by frequency of CD4+ T cells in LT using IHC.

    Measured: 30 months

  2. Frequency TUNEL+CD3+CD8+ T Cells

    Impact of losartan on immune reconstitution and function will be determined by frequency of TUNEL+CD3+CD8+ T cells in LT using IHC.

    Measured: 30 months

  3. Frequency of Cells Expressing TGF-beta and Lymphotoxin-beta

    Impact of losartan on immune reconstitution and function will be determined by frequency of cells expressing TGF-beta and lymphotoxin-beta in LT using IHC.

    Measured: 30 months

  4. Serum Concentration of IL-7

    Impact of losartan on immune reconstitution and function will be determine by serum concentrations of IL-7 measured with ELISA.

    Measured: 30 months

  5. Serum Concentration of TGF-beta

    Impact of losartan on immune reconstitution and function will be determine by serum concentrations of TGF-beta measured with ELISA.

    Measured: 30 months

  6. Immune Response to HPV Vaccination

    Impact of losartan on immune reconstitution and function will be determine by measuring the immune response to HPV vaccination using flow cytometry to identify cells stimulated by specific HPV peptides.

    Measured: 30 months

  7. Frequency of Activated T-cell Populations - Immunofluorescent Staining

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the frequency of activated T-cell populations (specifically CD3+CD4+CD38+, CD3+,CD8+CD38+,CD4+Ki67+ and CD8+Ki67+ T cells) in LT using immunofluorescence staining

    Measured: 30 months

  8. Percent of Activated T Cells in PBMCs - Flow Cytometry

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the percentage of activated T cells in peripheral blood mononuclear cells (PBMCs) using flow cytometry.

    Measured: 30 months

  9. Percent of Activated Macrophages in PBMCs - Flow Cytometry

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the percentage of activated macrophages in peripheral blood mononuclear cells (PBMCs) using flow cytometry.

    Measured: 30 months

  10. Percent of Activated Dendritic Cells in PBMCs - Flow Cytometry

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the percentage of activated dendritic cells in peripheral blood mononuclear cells (PBMCs) using flow cytometry.

    Measured: 30 months

  11. Percent of Activated T Cells in LT - Flow Cytometry

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the percentage of activated T cells in lymphoid tissues (LT) using flow cytometry.

    Measured: 30 months

  12. Percent of Activated Macrophages in LT - Flow Cytometry

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the percentage of activated macrophages in lymphoid tissues (LT) using flow cytometry.

    Measured: 30 months

  13. Percent of Activated Dendritic Cells in LT - Flow Cytometry

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the percentage of activated dendritic cells in lymphoid tissues (LT) using flow cytometry.

    Measured: 30 months

  14. Intracellular Concentration of IL-17 in PBMCs

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the intracellular levels of the inflammatory cytokine IL-17 in PBMCs using cytokine staining.

    Measured: 30 months

  15. Intracellular Concentration of IFNg in PBMCs

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the intracellular levels of the inflammatory cytokine IFNg in PBMCs using cytokine staining.

    Measured: 30 months

  16. Intracellular Concentration of IL-2 in PBMCs

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the intracellular levels of the inflammatory cytokine IL-2 in PBMCs using cytokine staining.

    Measured: 30 months

  17. Intracellular Concentration of TNF in PBMCs

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the intracellular levels of the inflammatory cytokine TNF in PBMCs using cytokine staining.

    Measured: 30 months

  18. Intracellular Concentration of IL-10 in PBMCs

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the intracellular levels of the inflammatory cytokine IL-10 in PBMCs using cytokine staining.

    Measured: 30 months

  19. Intracellular Concentration of GM-CSF in PBMCs

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the intracellular levels of the inflammatory cytokine GM-CSF in PBMCs using cytokine staining.

    Measured: 30 months

  20. Intracellular Concentration of IL-17 in LT

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the intracellular levels of the inflammatory cytokine IL-17 in lymphoid tissue (LT) using cytokine staining.

    Measured: 30 months

  21. Intracellular Concentration of IFNg in LT

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the intracellular levels of the inflammatory cytokine IFNg in lymphoid tissue (LT) using cytokine staining.

    Measured: 30 months

  22. Intracellular Concentration of IL-2 in LT

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the intracellular levels of the inflammatory cytokine IL-2 in lymphoid tissue (LT) using cytokine staining.

    Measured: 30 months

  23. Intracellular Concentration of TNF in LT

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the intracellular levels of the inflammatory cytokine TNF in lymphoid tissue (LT) using cytokine staining.

    Measured: 30 months

  24. Intracellular Concentration of IL-10 in LT

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the intracellular levels of the inflammatory cytokine IL-10 in lymphoid tissue (LT) using cytokine staining.

    Measured: 30 months

  25. Intracellular Concentration of GM-CSF in LT

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the intracellular levels of the inflammatory cytokine GM-CSF in lymphoid tissue (LT) using cytokine staining.

    Measured: 30 months

  26. Plasma Concentration of LPS

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the plasma concentration of LPS by ELISA.

    Measured: 30 months

  27. Plasma Concentration of sCD14

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the plasma concentration of sCD14 by limulus assay.

    Measured: 30 months

  28. Plasma Concentration of I-FABP

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the plasma concentration of I-FABP using ELISA.

    Measured: 30 months

  29. Plasma Concentration of IL-1b

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the plasma concentration of IL-1b using ELISA.

    Measured: 30 months

  30. Plasma Concentration of IL-1RA

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the plasma concentration of IL-1RA using ELISA.

    Measured: 30 months

  31. Plasma Concentration of IL-6

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the plasma concentration of IL-6 using ELISA.

    Measured: 30 months

  32. Plasma Concentration of TNF

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the plasma concentration of TNF using ELISA.

    Measured: 30 months

  33. Plasma Concentration of Amyloid A

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the plasma concentration of amyloid A using ELISA.

    Measured: 30 months

  34. Plasma Concentration of CRP

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the plasma concentration of CRP using ELISA.

    Measured: 30 months

  35. Plasma Concentration of D-dimer

    The Impact of Losartan on Immune Activation in HIV Infected, Treated Individuals will be determined by measuring the plasma concentration of D-dimer using ELISA.

    Measured: 30 months

  36. Frequency of HIV RNA+ and DNA+ Cells in LN - Radiolabeled ISH

    The Potential for Losartan to Reduce the Size of the Viral Reservoir will be assessed by determining the frequency of HIV RNA+ and DNA+ cells in LN using radiolabeled in situ hybridization (ISH).

    Measured: 30 months

  37. Frequency of HIV RNA+ and DNA+ Cells in LN - RNAscopeTM in Situ Technology

    The Potential for Losartan to Reduce the Size of the Viral Reservoir will be assessed by determining the frequency of HIV RNA+ and DNA+ cells in LN using RNAscopeTM in situ technology.

    Measured: 30 months

  38. Frequency of HIV RNA+ and DNA+ Cells in GALT - Radiolabeled in Situ Hybridization (ISH)

    The Potential for Losartan to Reduce the Size of the Viral Reservoir will be assessed by determining the frequency of HIV RNA+ and DNA+ cells in GALT radiolabeled in situ hybridization (ISH).

    Measured: 30 months

  39. Frequency of HIV RNA+ and DNA+ Cells in GALT - RNAscopeTM in Situ Technology

    The Potential for Losartan to Reduce the Size of the Viral Reservoir will be assessed by determining the frequency of HIV RNA+ and DNA+ cells in GALT using RNAscopeTM in situ technology.

    Measured: 30 months

  40. Concentration of Losartan and Antiretrovirals (ARVs)

    Potential Drug-drug Interactions Between Losartan and Antiretrovirals (ARVs) will be assessed by measuring levels of ARVs and losartan in plasma and peripheral blood mononuclear cells (PBMCs).

    Measured: 30 months

  41. Intracellular Concentration of Losartan and Antiretrovirals (ARVs)

    Potential Drug-drug Interactions Between Losartan and Antiretrovirals (ARVs) will be assessed by measuring intracellular concentration of losartan and ARVs in lympoidtissue.

    Measured: 30 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted14 May 2013 (estimated)
  2. Study startSep 2014
  3. Primary completion16 Jul 2019
  4. Study completion16 Jul 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
52 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01852942
Sponsor's protocol ID
1111M06585
Other IDs
13-3613, U01AI105872
Status last verified
Nov 2020
First submitted
20 Feb 2012
Last updated
11 Dec 2020
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Losartan in people with HIV Infection and HIV Infections, run by University of Minnesota at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 11 Dec 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 11 Dec 2020). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Collagen Deposition in LT (time frame: 30 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Dec 2020.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in