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HIV-1 InfectionPhase 1XTRANCT03212989

Study to Evaluate Effects of Vorinostat and HXTC on Persistent HIV-1 Infection in HIV-Infected Subjects Started on Antiretroviral Therapy (ART)

A Phase 1 study testing Vorinostat and HXTC in people with HIV-1 Infection, run by University of North Carolina, Chapel Hill 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
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Trial summary

This is a phase I, single-site, study to evaluate the effects of VOR and HIV-1 Antigen Expanded Specific T Cell Therapy (HXTC) on persistent HIV-1 Infection in HIV-infected individuals suppressed on ART. Twelve participants with durable viral suppression will be enrolled and will complete the study. Read more about this study

Who is it for?
Ages 18 to 64 years
Conditions the study is for
HIV-1 Infection
What is being tested?
Vorinostat and HXTC
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
17 participants
Where
1 siteUnited States
Study dates
27 Jun 2017to 5 Jul 2022
Phase
Phase 1
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 to 64 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • ≥ 18 years and < 65 years of age at screening
  • Ability and willingness of participant to give written informed consent. NOTE: Due to the lack of foreseeable benefit to study volunteers, the study will not enroll illiterate or mentally incompetent volunteers.
  • Confirmation of HIV-1 infection HIV infection is defined as documentation by any licensed rapid HIV test or HIV enzyme or chemiluminescence immunoassay (E/CIA) test kit at any time prior to study entry and confirmed by a licensed Western blot or a second antibody test by a method other than the initial rapid HIV and/or E/CIA, or by HIV-1 antigen, plasma HIV-1 RNA viral load.
  • NOTE: The term "licensed" refers to a US FDA-approved kit.
  • WHO (World Health Organization) and CDC (Centers for Disease Control and Prevention) guidelines mandate that confirmation of the initial test result must use a test that is different from the one used for the initial assessment. A reactive initial rapid test should be confirmed by either another type of rapid assay or an E/CIA that is based on a different antigen preparation and/or different test principle (e.g., indirect versus competitive), or a Western blot or a plasma HIV-1 RNA viral load.
  • On antiretroviral therapy for at least 24 months and on potent antiretroviral therapy for greater than or equal to 6 months prior to Screening (Visit 1).
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  • Potent ART is defined by current treatment guidelines and consists of at least 2 nucleoside/nucleotide reverse transcriptase inhibitors plus a non-nucleoside reverse transcriptase inhibitor, integrase inhibitor, or a protease inhibitor without interruption (defined as missing more than 9 total days in the 12 weeks prior to Screening.
  • Other potent fully suppressive antiretroviral combinations will be considered on a case-by-case basis. Prior changes in or elimination of medications for easier dosing schedule, intolerance, toxicity, or other reasons are permitted if an alternative suppressive regimen was maintained.
  • Ability and willingness of participant to continue ART throughout the study.
  • Able and willing to adhere to protocol therapy, schedule, and judged adherent to antiretroviral therapy (adherence defined in inclusion criterion 4.)
  • Plasma HIV-1 RNA < 50 copies/mL at two time points in the previous 12 months prior to study screening (one time point can be at screening) and never > or equal to 50 copies/mL on two consecutive time points in the last 24 months.
  • NOTE: A single unconfirmed plasma HIV RNA > or equal to 50 copies/mL but < 1000 c/mL is allowed if a subsequent assay was < 50 copies/mL; but none in the 6 months preceding the study screening visit.
  • Plasma HIV-1 RNA < 50 copies/mL at screening
  • CD4+ cell count ≥ 350 cells/mm3 at screening
  • No active HCV infection at or within 90 days of screening.
  • Note: No active hepatitis C virus (HCV) defined as negative HCV antibody (HCVAb) or if HCVAb is positive, reflex HCV RNA is negative.
  • No active hepatitis B virus (HBV) infection (measureable HBV DNA or HBV surface antigen-positive (HBVsAg+)) at or within 90 days of screening
  • Women with written documentation of any of the following:
  • prior hysterectomy OR bilateral oophorectomy (removal of both ovaries)
  • bilateral tubal ligation or non-surgical permanent sterilization
  • Women with intact uterus and ovaries who have not had a period for ≥ one year AND have a documented follicle stimulating hormone (FSH) level indicating postmenopausal status.
  • All male study volunteers must agree not to participate in a conception process (e.g. active attempt to impregnate, sperm donation, in vitro fertilization) and, if participating in sexual activity that could lead to pregnancy, the male study volunteer and his female partner must use two reliable methods of contraception (condoms, with or without a spermicidal agent; a diaphragm or cervical cap with spermicide; an intrauterine device (IUD); or hormonal-based contraception) simultaneously while receiving the protocol-specified study products and for 6 weeks after stopping the study products. Participants must use a reliable barrier method of contraception (condom, cervical cap) along with another form of contraception.
  • NOTE: For female partners who are receiving ritonavir, estrogen-based contraceptives are not reliable and an alternative method should be suggested.
  • Ability and willingness to provide adequate locator information.
  • Ability and willingness to communicate effectively with study personnel
  • Adequate vascular access for HXTC infusion and leukapheresis.
  • Able to swallow pills without difficulty.
  • Potential participant must have adequate organ function as indicated by the following laboratory values:
  • System Laboratory Value Hematological Absolute neutrophil count (ANC) ≥1,500 /microliter (mcL) Platelets ≥125,000 / mcL Hemoglobin ≥ 12 g/dL (male) and ≥ 11.0 g/dL (females) System Laboratory Value Coagulation Prothrombin Time (PT) or international normalized ratio (INR) ≤1.1x upper limit of normal (ULN) Chemistry K+ levels within normal limits (WNL) Mg++ levels(footnote 1) WNL Glucose Screening serum glucose ≤ Grade 1 (fasting or non- fasting) Albumin ≥ 3.5 g/dL or ≥ lower limit of normal (LLN) Renal Creatinine clearance determined by the Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) equation found at: https://www.qxmd.com/calculate/calculator251/egfr-using-ckd-epi eGFR (epidermal growth factor receptor) > 60 mL/min Hepatic Serum total bilirubin Total bilirubin < 1.1 times the ULN range. If total bilirubin is elevated, direct bilirubin must be < 2 times the ULN range.
  • NOTE: If participant is on an atazanavir-containing therapy, then a direct bilirubin should be measured instead of the total bilirubin and must be ≤ 1.0 mg/dL.
  • Aspartate Aminotransferase (AST) (SGOT) and Alanine Transaminase (ALT) (SGPT) < 1.25 X ULN Alkaline Phosphatase < 1.25 X ULN Lipase < 1.1 X ULN
  • Footnote 1: LLN for Mg++ per the clinical laboratory's normal range used for this study is a grade 1 event per Division of AIDS (DAIDS) Toxicity Table and is allowed for eligibility
  • ULN = upper limit of normal LLN = lower limit of normal WNL = within normal limits

Who cannot join

  • Known allergy or sensitivity to components of VOR and its analog or to components in the HXTC product.
  • Women without written documentation of menopause (absence of a period for ≥ one year and FSH level indicating menopause), hysterectomy or bilateral oophorectomy, non-surgical permanent sterilization, or bilateral tubal ligation.
  • Untreated syphilis infection (defined as a positive rapid plasma reagin (RPR) without clear documentation of treatment).
  • Note: In cases of untreated syphilis, participant may re-screen following documentation of adequate treatment of syphilis
  • All male participants expecting to father children within the projected duration of the study.
  • Receipt of compounds with Histone Deacetylase (HDAC) inhibitor-like activity, such as valproic acid within 30 days prior to screening.
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  • Use of any investigational antiretroviral agents within 30 days prior to screening.
  • If the study PI (or designee) is unable to construct a fully active alternative cART regimen based on previous resistance testing and/or treatment history.
  • Use of the following medications that carry risk of torsade des pointes: amiodarone, arsenic trioxide, astemizole, bepridil, chloroquine, chlorpromazine, cisapride, clarithromycin, disopyramide, dofetilide, domperidone, droperidol, erythromycin, halofantrine, haloperidol, ibutilide, levomethadyl, mesoridazine, methadone, pentamidine, pimozide, probucol, procainamide, quinidine, sotalol, sparfloxacin, terfenadine, thioridazine.
  • Use of any of the following within 90 days prior to screening: immunomodulatory, cytokine, or growth stimulating factors such as systemic corticosteroids, cyclosporine, methotrexate, azathioprine, anti-CD25 antibody, interferon (IFN), interleukin-2 (IL-2), coumadin, warfarin, or other Coumadin derivative anticoagulants.
  • Prior use of any HIV immunotherapy or HIV vaccine within 6 months prior to Screening, except for prior HXTC infusions.
  • Received any infusion blood product, immune globulin, or hematopoietic growth factors within 90 days prior to study screening.
  • Pregnancy or breast-feeding.
  • History or other clinical evidence of severe illness, malignancy, immunodeficiency other than HIV, or any other condition that would make the participant unsuitable for the study in the opinion of the investigator (or designee).
  • Use of topical steroids over a total area exceeding 15 cm-2 within 30 days prior to Screening.
  • Treatment for an active AIDS-defining opportunistic infection within 90 days prior to Screening.
  • Any active malignancy that may require chemotherapy or radiation therapy.
  • Compulsorily detained (involuntarily incarcerated) for treatment of either a psychiatric illness or a physical illness, e.g., infectious disease. Prisoner recruitment and participation is not permitted.
  • Known psychiatric or substance abuse disorders that would interfere with participant's ability to fully cooperate with the requirements of the trial as assessed by the study investigator (or designee).
  • History or other clinical evidence, as assessed by the study PI (or designee), of significant or unstable cardiac disease (e.g., angina, congestive heart failure, recent myocardial infarction, significant arrhythmia requiring medical or surgical therapy) or clinically significant electrocardiogram (ECG) abnormalities.
  • Unable to have a person available to drive participant home at infusion visits.
  • Participation in another investigational clinical research study (with the exception of an antiretroviral treatment trial that uses FDA approved antiretroviral agents) or use of investigational agents within 30 days prior to screening.
  • NOTE: Co-enrollment in observational only studies is permitted.
  • NOTE: Co-enrollment in the AIDS Clinical Trials Group (ACTG) 5332 REPRIEVE study (NCT023442900) and using FDA approved pitavastatin is permitted provided participant enrolled on ACTG 5332 and has taken the study provided medication ≥ 4 months.

Trial locations and contacts

1 site in 1 country.

United States1 site

  • University of North Carolina at Chapel Hill

    Chapel Hill, North Carolina, 27514

Other trials in United States

About this study

Official title: IGHID 11627 - A Phase I Study to Evaluate the Effects of Vorinostat and HIV-1 Antigen Expanded Specific T Cell Therapy (HXTC) on Persistent HIV-1 Infection in HIV-Infected Individuals Started on Antiretroviral Therapy (The XTRA Study)

This is a phase I, single-site, study to evaluate the effects of VOR and HIV-1 Antigen Expanded Specific T Cell Therapy (HXTC) on persistent HIV-1 Infection in HIV-infected individuals suppressed on ART. Twelve participants with durable viral suppression will be enrolled and will complete the study. All participants will receive the same treatment and if eligible, will be dosed with HXTC and VOR. Participants will continue their baseline ART regimen throughout the study.

Read the detailed description

Purpose: This study will test the use of special immune system cells called expanded HIV-specific T Cell (HXTC) Therapy to stimulate the immune system to respond better to HIV. HXTC Therapy will be given in combination with the drug Vorinostat (VOR) which has been shown to stimulate some cells infected with HIV to become active and start making HIV virus. The purpose of this study is to:

  1. Evaluate the safety of a series of HXTC infusions in combination with serial doses of VOR and
  2. Help scientists evaluate ways of re-activating latent (non-active) HIV virus and determine if the immune system can be made stronger to eliminate the activated HIV virus.

Participants: Men and women living with HIV, ≥ 18 and < 65 years of age, with durable viral suppression for ≥ 24 months as measured on standard HIV RNA assays. Eligible participants must be on stable combination ART (cART) and have a CD4 count ≥ 350 cells/mm3. We plan to enroll up to 12 participants at the University of North Carolina at Chapel Hill (UNC) who complete all 6 Steps of this study.

Procedures (methods):

In Step 1 and prior to initiating the two series of VOR and HXTC combined therapies, all participants will undergo study screening and enrollment where they will be required to: 1. Demonstrate a baseline measurement of the frequency of resting CD4 T cell infection ≥ 0.3 infected cells per million as determined by QVOA, as a further decrease from this low frequency of infection cannot be definitively measured given the quantitative viral outgrowth assay (QVOA) threshold.

Participants with an infectious cells per million (IUPM) measurement > or equal to 0.3 will provide whole blood cells for the manufacture of their HXTC product (Step 3). Successful manufacturing of the HIV-1 antigen expanded specific T cells will progress participants to combination treatment in Steps 4 and 5. In Steps 4 and Step 5, participants will receive two series of VOR dosing and HXTC infusions, for a total 20 doses of VOR 400 mg and 5 HXTC infusions.

In the first series (Step 4), participants will receive VOR 400 mg PO every 72 hours for 10 doses and 2 infusions of HXTC. The first HXTC infusion will be administered six hours after the first dose of VOR (HXTC #1) and the 2nd HXTC infusion (HXTC #2) will occur 6 hours after the 6th dose of VOR.

In the second series in Step 5, participants will receive an additional 10 doses of VOR 400 mg PO every 72 hours and 3 HXTC infusions. The first HXTC infusion in Step 5 (HXTC #3) will occur 6 hours after the 11th dose of VOR (1st dose in Step 5), the 2nd HXTC infusion (HXTC #4) will occur 6 hours after the 16th dose of VOR, and the 3rd HXTC infusion (HXTC #5) will occur 1 - 3 days after the 20th dose of VOR.

If there are insufficient cells manufactured to allow 5 infusions at 1 x 10-8 cells/m-2 dose, the dose will be adjusted to allow 5 infusions at a dose > or equal to 5 x 10-7 cells/m-2 but < 1 x 10-8 cells/m-2 dose.

Following the final HXTC infusion, participants move into Step 6 for a minimum of six additional visits: 21-26. The 2nd leukapheresis will occur at Visit 23 (Week 21), approximately 9 weeks after the last HXTC infusion to evaluate the effect of study treatment on the IUPM by QVOA.

All participants who receive greater than 8 doses of VOR (3200 mg) will be required to enter a study cancer registry where they will be contacted once a year for 5 years after completion of their study participation. The registry was created to monitor participants for the development of future malignancies given concern for genotoxic impact with the use of VOR.

Conditions
HIV-1 Infection
Being tested
Vorinostat, HXTC
Keywords
HIV, HXTC, Antiretroviral Therapy, HIV-Infected, Vorinostat, AIDS
Medical subject headings
Acquired Immunodeficiency Syndrome

What participants receive

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

  • VorinostatDrug

    Also called ZOLINZA, MK-0683, SAHA

    Participants meeting criteria for Step 1 (exhibit ex-vivo response to VOR) will progress to Step 2 where they will receive a single dose of VOR 400 mg followed by a leukapheresis. If an increase in cell-associated HIV RNA (ca-RNA) is observed in-vivo following the single VOR dose, they will be eligible to donate cells for the manufacture of HXTC (Step 3). Successful manufacturing of the HIV-1 antigen expanded specific T cells will progress participants to combination treatment in Steps 4 and 5. In Steps 4 and Step 5, participants will receive two series of VOR dosing and HXTC infusions, for a total 20 doses of VOR 400 mg and 5 HXTC infusions.

  • HXTCBiological

    Also called HIV-1 antigen expanded specific T-cell

    Participants meeting criteria for Step 1 (exhibit ex-vivo response to VOR) will progress to Step 2 where they will receive a single dose of VOR 400 mg followed by a leukapheresis. If an increase in cell-associated HIV RNA (ca-RNA) is observed in-vivo following the single VOR dose, they will be eligible to donate cells for the manufacture of HXTC (Step 3). Successful manufacturing of the HIV-1 antigen expanded specific T cells will progress participants to combination treatment in Steps 4 and 5. In Steps 4 and Step 5, participants will receive two series of VOR dosing and HXTC infusions, for a total 20 doses of VOR 400 mg and 5 HXTC infusions.

Study groups in NCT03212989
Study groupRoleWhat they receive
VOR + HXTC armExperimentalThis is an open label single arm study. All eligible participants receive the following interventions: * Step 2 - Single dose of Vorinostat (VOR) 400 mg PO * Step 4 - Vorinostat (VOR) 400 mg PO every 72 hrs x 10 doses and 2 HXTC infusions * Step 5 - Vorinostat (VOR) 400 mg PO every 72 hrs x 10 doses and 2 HXTC infusions
Receives: Drug: Vorinostat; Biological: HXTC

What is being measured

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

  1. Number of Participants w/ at Least One ≥ Grade 3 Adverse Event That is Possibly or Definitely Related to Vorinostat (VOR) or HIV-specific T Cell (HXTC)

    Safety data will include local and systemic signs and symptoms, laboratory measures of safety/toxicity, and all adverse and serious adverse events. Safety data will be routinely collected throughout the duration of the study.

    Measured: Up to end of study (weeks 16 through 45)

Secondary outcomes (1)

  1. Number of Participants Demonstrating an HIV-specific Immune Response to the Combination of Vorinostat (VOR) and HIV-specific T Cells (HXTC) Therapy as Well as a Change in the Frequency of Latent HIV Infection

    The change in ex vivo HIV-specific immune response from baseline was measured by interferon-gamma (IFN-γ) ELISpot throughout the study. Change in the frequency of latent HIV infection from baseline to end of study was measured using a quantitative viral outgrowth assay (QVOA). Participants that exhibited any significant changes in both of these measures were considered to have experienced a positive result.

    Measured: Up to end of study (weeks 16 through 45)

Timeline

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

  1. First posted11 Jul 2017
  2. Study start27 Jun 2017
  3. Primary completion7 Jun 2022
  4. Study completion5 Jul 2022

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 1
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
17 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03212989
Sponsor's protocol ID
17-0468
Other IDs
1R01HL132791-01
Acronym
XTRA
Status last verified
Aug 2022
First submitted
29 Jun 2017
Last updated
12 May 2023
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Gay CL, Hanley PJ, Falcinelli SD, Kuruc JD, Pedersen SM, Kirchherr J, Raines SLM, Motta CM, Lazarski C, Chansky P, Tanna J, Shibli A, Datar A, McCann CD, Sili U, Ke R, Eron JJ, Archin N, Goonetilleke N, Bollard CM, Margolis DM. The Effects of Human Immunodeficiency Virus Type 1 (HIV-1) Antigen-Expanded Specific T-Cell Therapy and Vorinostat on Persistent HIV-1 Infection in People With HIV on Antiretroviral Therapy. J Infect Dis. 2024 Mar 14;229(3):743-752. doi: 10.1093/infdis/jiad423.

    PubMed 38349333

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing Vorinostat and HXTC in people with HIV-1 Infection, run by University of North Carolina, Chapel Hill 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?

The sponsor lists 33 inclusion and 24 exclusion criteria. 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 12 May 2023. 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. 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 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

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 12 May 2023). 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?

Number of Participants w/ at Least One ≥ Grade 3 Adverse Event That is Possibly or Definitely Related to Vorinostat (VOR) or HIV-specific T Cell (HXTC) (time frame: Up to end of study (weeks 16 through 45)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03212989, which also lists 1 linked publication.

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 12 May 2023.

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