Colchicine to Reduce Coronary Artery Inflammation in People With HIV

Despite advances in antiretroviral therapy, people living with HIV (PWH) have an increased risk of cardiovascular disease compared with the general population. Persistent inflammation and immune activation are considered important contributors to accelerated atherosclerosis and coronary artery disease in this population. Coronary inflammation is associated with cardiovascular risk, but strategies targeting this mechanism in PWH remain limited.

Colchicine is an anti-inflammatory drug that has demonstrated cardiovascular benefits in patients with coronary artery disease by reducing inflammatory pathways involved in atherosclerosis. However, the effect of colchicine on coronary artery inflammation in PWH has not been previously evaluated. The hypothesis of this study is that colchicine may reduce coronary artery inflammation in PWH with high cardiovascular risk.

This phase II, randomized, double-blind, multicenter, placebo-controlled trial will include approximately 90 participants who will receive colchicine or placebo for 96 weeks. Changes in coronary artery inflammation will be assessed using coronary computed tomography angiography (CCTA) and the perivascular fat attenuation index (FAI), a non-invasive imaging biomarker of vascular inflammation. The study will also evaluate safety and changes in cardiovascular and inflammatory markers during follow-up.

Inclusion criteria

• PWH > 50 years old
• High cardiovascular risk measured by SCORE-2 > 5%
• Stable antiretroviral therapy (ART) in the previous six months
• Viral load < 50 copies/mililiter for at least 1 year. One blip is allowed (Viral load between 20-200 copies/mililiter with a previous and after viral load determinations < 20 copies per mililiter.
• CD4 cell count > 350 cells/mm3
• Stable dose of an intermediate or high intensity statin in the previous year (statin dose should not be modified throghout the study unless there is a robust clinical indication). In case the participant does not receive statins, all other hypolipemiants (bempedoic acid, ezetimibe) will need to be at a stable dose as well in the previous year.
• No clinical indication for a change in treatment based on European Society of Cardiology Guidelines
• Written informed consent obtained according to international guidelines and local laws
• Ability to understand the nature of the trial and the trial related procedures and to comply with them

Exclusion criteria

• Severe Heart failure defined as LVEF < 35%.
• Previous MI, stroke or coronary by-pass surgery
• History of non-cutaneus malignancy prior to enrollment
• History of inflammatory bowel disease or chronic diarrhoea
• Renal dysfunctions defined as eGFR < 50 ml/min or serum creatinine levels > 1.7 mg/dL
• Severe hepatic impairments defined as a Child-Pugh category C
• Participants with stomach ulcers or gastrointestinal bleeding
• Levels of ALT over five times the upper limit of normal OR levels of ALT over three times the upper limit of normal AND bilirrubin levels over one point five times the upper limit of normal
• Participant is receiving drugs that inhibit the CYP3A4 (e.g. Verapamil, Azithromycin, Clarithromycin, protease inhibitors, cobicistat), CYP2D6 or inhibitors of P-glycoprotein (see section 6.3.2 for more information)
• Participant needs treatment with colchicine for any indication
• Participants with highly elevated hsCRP > 10 mg/dL at screening
• Women of childbearing potential. For this trial, definitions of nonchildbearing potential includes:
• Permanent sterilisation methods including hysterectomy, bilateral salpingectomy and bilateral oophorectomy.
• Postmenopausal state, defined as no menses for 12 months without an alternative medical cause. A high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a post-menopausal state in women not using hormonal contraception or hormonal replacement therapy. However in the absence of 12 months of amenorrhea, a single FSH measurement is insufficient.
• Male participants are considered fertile after puberty unless permanently sterile by bilateral orchiectomy. To prevent pregnancies in female partners of male participants, they must agree to use highly effective contraceptive methods or have practiced sexual abstinence during the treatment period and until the end of relevant systemic exposure, defined as 5 half-lives of the IMP (9 days approximately).
• Known hypersensitivity to the active substances or any of the excipients
• Known iodine contrast allergy with prior history of anaphylaxis
• Patient without legal capacity who is unable to understand the nature, significance and consequences of the trial.