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NCT Number: NCT06626555

Clinical Trial to Evaluate the Effects of Letermovir Prophylaxis on T-cell Immune Activation in Participants With Treated HIV-1 Infection

People living with HIV (PLWH), even with an undetectable viral load (VL) on antiretroviral treatment (ART), develop health conditions, such as heart disease, diabetes, various cancers, and conditions that can affect the brain, more commonly than the general population.

These conditions occur earlier in PLWH compared to HIV negative individuals with similar lifestyles. Ongoing inflammation in the body despite antiretroviral therapy is thought to be contributing to the development of these conditions that can affect healthy ageing in PLWH.

Cytomegalovirus (CMV) is a very common infection in PLWH and is an important driver of inflammation in the body that can affect the function of the immune immune cells in the body (defense system) causing unwanted activation and damage of the gut making it more leaky. A drug with potent activity against CMV called valganciclovir has previously shown to reduce this potentially damaging inflammation in the body.

In this study, the investigators want to investigate if a new drug called Letermovir, in combination with HIV treatment, will prevent CMV from replicating (multiplying), and thereby reduce inflammation in the body. Letermovir has received approval to prevent CMV from multiplying in patients receiving bone marrow transplants. It has been shown to have a more favourable side-effect profile compared to other available drugs and is predicted to interact little with anti-HIV drugs.

The aim of this study is to find out if the letermovir is safe and effective in reducing CMV related immune activation and inflammation PLWH. These findings will be used to help us design larger studies to identify individuals who would benefit most from this treatment to prevent the development of health conditions that can affect their quality of life.

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Key information

Conditions

HIV

Age range

50 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 2

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Is HIV-1 antibody positive with a plasma HIV-1 RNA ≤50 copies/mL for greater than 12 months
  • ≥50 years of age of any gender
  • Females of childbearing potential who agree to avoid pregnancy for the duration of the trial and follow methods of contraception as detailed in section 7.1
  • Has a nadir CD4 of ≤200 cells/mm3 prior to screening
  • Has been on antiretroviral therapy for ≥ 6 months
  • Has documented CMV IgG seropositivity within one year of trial screening
  • Has an undetectable (≤168 international units/mL) CMV Deoxyribonucleic acid (DNA) within 14 days prior to randomisation
  • Laboratory parameters are not clinically significant as determined by the investigator
  • The participant (or legally acceptable representative, if applicable) has provided written informed consent for the trial and Future Biomedical Research

Exclusion criteria

  • Is HIV-1 antibody positive with a plasma HIV-1 RNA ≤50 copies/mL for greater than 12 months
  • ≥50 years of age of any gender
  • Females of childbearing potential who agree to avoid pregnancy for the duration of the trial and follow methods of contraception as detailed in section 7.1
  • Has a nadir CD4 of ≤200 cells/mm3 prior to screening
  • Has been on antiretroviral therapy for ≥ 6 months
  • Has documented CMV IgG seropositivity within one year of trial screening
  • Has an undetectable (≤168 international units/mL) CMV Deoxyribonucleic acid (DNA) within 14 days prior to randomisation
  • Laboratory parameters are not clinically significant as determined by the investigator
  • The participant (or legally acceptable representative, if applicable) has provided written informed consent for the trial and Future Biomedical Research

Main Exclusion criteria:

  • Has a history of ulcerative colitis or Crohn's disease or active colitis within 6 months prior to randomisation
  • Has a history of CMV end-organ disease within 6 months prior to randomisation
  • Has significant hypersensitivity or other contraindication to any of the components of the trial drug as described in the SmPC
  • Has a detectable HCV RNA or hepatitis B surface antigen (HBsAg) within 90 days prior to randomisation
  • Has a history of malignancy ≤5 years prior to signing informed consent
  • Is pregnant or expecting to conceive, is breastfeeding, or plans to breastfeed from the time of consent through 90 days after the last dose of trial therapy
  • Has received within 7 days prior to screening any of the following: ganciclovir; valganciclovir; foscarnet; acyclovir (≥ 3200 mg PO per day or ≥25 mg/kg IV per day); valaciclovir (≥3000 mg PO per day) or famciclovir (≥1500 mg PO per day).
  • Has used systemic immunosuppressive therapy or immune modulators within 30 days prior to treatment in this trial or is anticipated to need them during the trial

Treatment and study plan

Letermovir

Drug

Letermovir 480mg PO once daily

Primary outcomes

  1. Change in activation in global CD8 T cells in response to letermovir.

    Time frame: Baseline, weeks 4, 8, 12, 16 and 24

    To assess the effect of CMV replication inhibition with letermovir on activated (HLADR+CD38+) CD8 T cell percentage using flow cytometry analysis at specified time frames.

    Measurement: Measured by flow cytometric analysis.

Secondary outcomes

  1. Quantitative analysis of T cell subsets/detailed phenotypic profile will be performed as part of the exploratory analysis

    Time frame: Baseline, weeks 12 and 24

    Quantitative analysis of T cell subsets/detailed phenotypic profile will be performed as part of the exploratory analysis

  2. Characterization of NK profile and function in response to Letermovir

    Time frame: Baseline, weeks 4, 8, 12, 16 and 24

    To assess the effect of CMV replication inhibition with letermovir on NK cell phenotype and cytokine production (IFN-g/TNF) via flow cytometry.

    Measurement: Measured by flow cytometric analysis.

  3. High resolution characterization of cells that fall between the innate and adaptive responses

    Time frame: Baseline, weeks 12 and 24

    To assess the effect of CMV replication inhibition with letermovir on NK-like cells (CD56+CD3+) at specified time points.

    Measurement: Measured by flow cytometric analysis.

  4. Determine the extent of CMV and HIV replication in the gut of HIV-positive individuals and how impacted by intervention

    Time frame: Baseline, weeks 12 and 24

    To assess CMV DNA and HIV RNA in gut biopsies and the effect of intervention. Measurement: Measured by quantitative PCR analysis and in situ hybridisation.

  5. Assessment of integrity of the intestinal barrier and how impacted by intervention

    Time frame: Baseline, weeks 12 and 24

    To assess the influence of CMV replication inhibition with letermovir on intestinal barrier integrity in gut biopsies.

    Measurement: Measured by immunohistochemistry of biopsy samples for zonula occludens-1 (ZO-1).

  6. Assessment of markers of systemic inflammation and how impacted by intervention

    Time frame: Baseline, weeks 4, 8, 12, 16 and 24

    To assess the influence of CMV replication inhibition with letermovir on inflammatory cytokines/chemokines (IL-1, IL-6, IP10, TNF-a), sTNFRII, microbial products/activation (LPS, sCD14, CRP), intestinal damage marker (iFABP), vascular dysfunction markers (sICAM-1, sVCAM-1) in the blood of people with HIV.

    Measurement: Measured by ELISA.

Other outcomes

  1. Higher resolution analysis of specific responses to peptide level and how impacted by intervention

    Time frame: Baseline, weeks 4, 8, 12, 16 and 24

    To assess the influence of letermovir on CMV and HIV-specific T cell responses to peptide stimulation via multiparameter intracellular cytokine staining. Expression of cytokines, such as IFN-γ, TNF and IL-2, and activation markers will be measured via flow cytometry in conjunction with established phenotypic and memory markers.

    Measurement: Measured by flow cytometric analysis

  2. Standard molecular analyses of proviral and HIV transcript quantitation, both surrogate markers of persistent infection

    Time frame: Baseline, weeks 4, 8, 12, 16 and 24

    To assess the influence of CMV replication inhibition with letermovir on HIV DNA and Cell-associated RNA Measure: Measured by quantitative real-time PCR and droplet digital PCR (ddPCR).

Study contacts

Contact information is provided by the study sponsor or research team.

Dimitra Peppa

CONTACT

[email protected]

Katie Spears

CONTACT

[email protected]

+44 020 7472 6232

Sponsors and collaborators

Lead sponsor

University College, London

Other

Collaborators

  • Royal Free Hospital NHS Foundation Trust

Registry information

Official study title

Pilot, Randomized, Open-Label, Non-Active Comparator Controlled Clinical Trial to Evaluate the Effects of Letermovir Prophylaxis on T-cell Immune Activation in Participants With Treated HIV-1 Infection

Acronym: PROACTIV

Important dates

Study start
2024
Primary completion
2026
Study completion
2026
First posted
Oct 4, 2024
Registry last updated
Oct 4, 2024

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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