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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT03198559
Registration number
NCT03198559
Ethics application status
Date submitted
14/06/2017
Date registered
26/06/2017
Titles & IDs
Public title
Combination Latency Reversal With High Dose Disulfiram Plus Vorinostat in HIV-infected Individuals on ART
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Scientific title
Combination Latency Reversal With High Dose Disulfiram Plus Vorinostat in HIV-infected Individuals on ART (DIVA): A Single Arm Clinical Trial
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Secondary ID [1]
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MSD IIS-55750
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
HIV Infections
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Condition category
Condition code
Infection
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Acquired immune deficiency syndrome (AIDS / HIV)
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Disulfiram, (National Drug Code) NDC 0378-4141-01
Treatment: Drugs - Vorinostat, NDC 00006-0568-40
Experimental: Experimental - Participants current ART regimen:
2 grams disulfiram by mouth per day for a total of 28 days
400mg vorinostat by mouth per day on days 8, 9,10 and days 22, 23, 24
Treatment: Drugs: Disulfiram, (National Drug Code) NDC 0378-4141-01
This study will provide open label disulfiram. Participants will take 2 grams (4x500mg tablets) of disulfiram per day for a total of 28 days
Treatment: Drugs: Vorinostat, NDC 00006-0568-40
This study will provide open label vorinostat. Participants will take 400mg (4x100mg capsules) of vorinostat per day on days 8, 9, 10 and days 22, 23, 24.
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Day 11 Plasma HIV RNA Relative to Baseline
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Assessment method [1]
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The primary endpoint was to determine the change from baseline to day 11 of plasma HIV RNA levels after 11 continuous days of disulfiram with administration of vorinostat on days 8, 9 and 10 in HIV infected individuals on suppressive ART.
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Timepoint [1]
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Baseline and 11 days
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Secondary outcome [1]
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Incidence of Treatment-Emergent Adverse Events
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Assessment method [1]
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This secondary outcome was to determine the Incidence of treatment-emergent adverse events \[Safety and Tolerability\] during a 28 day course of continuous disulfiram with intermittent administration of 3 days of vorinostat on two occasions in HIV infected individuals on suppressive ART.
An adverse event is defined as any untoward medical occurrence in a clinical study participant, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. An SAE is defined as any untoward medical occurrence that; results in death, is life-threatening, requires hospitalization or prolongation of existing hospitalization, results in disability/incapacity, is a congenital anomaly/birth defect, other situations as judged by physician.
Systematic assessments of adverse events were performed at each visit, including unscheduled visits
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Timepoint [1]
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Adverse events were collected continuously throughout the study duration from day 1 on treatment until 2 months since last dose of study drug, an average duration of 3 months
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Secondary outcome [2]
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Plasma HIV RNA Relative to Baseline at Additional Time Points
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Assessment method [2]
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This secondary outcome was to determine the fold change in plasma HIV RNA levels at additional time points during and after 11 continuous days of disulfiram with administration of vorinostat on days 8, 9 and 10 in HIV infected individuals on suppressive ART.
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Timepoint [2]
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Baseline to Days 8, 15, 21, 38, 59, 196, 197. Data is reported for days where samples were collected for each participant.
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Eligibility
Key inclusion criteria
* Age 18-65 years with documented HIV-1 infection (antibody positive or detectable plasma HIV-1 RNA)
* Receiving combination ART with plasma HIV RNA <50 copies/mL for >3 years
* CD4+ T cell count >350 microliter at screening
* Able to provide informed consent
* Willing to abstain from alcohol consumption from one day before to 14 days after completing 28 days of disulfiram
* One month post influenza vaccine (from screening visit)
* Women of non-child-bearing potential defined as > 12 months of spontaneous amenorrhea and = 45 years of age, or documented medical history of one of the following: hysterectomy, bilateral oophorectomy or tubal ligation.
* Women of Child Bearing Potential (WOCBP) with a negative pregnancy test at Screening and agrees to use one of the study protocol specified methods of contraception to avoid pregnancy
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Minimum age
18
Years
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Maximum age
65
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* Current alcohol use disorder or hazardous alcohol use (>7 drinks per week for women or > 14 drinks per week for men) as determined by clinical evaluation
* Current or recent (in the last 4 days) use of metronidazole or any drug formulation that contains alcohol or that might contain alcohol, including the gelatin capsule and liquid formulations of ritonavir, ritonavir/lopinavir, amprenavir and fosamprenavir, and alcohol-containing preparations such as cough syrups, tonics etc.
* Current use of tipranavir or Maraviroc
* Current use of zidovudine, stavudine or didanosine (as disulfiram potentially has potent irreversible inhibitory effects on mitochondrial metabolism and hence could exacerbate the toxicity of these drugs)
* Concurrent use of rivaroxaban (a CYP3A metabolized medication) as the cytochrome P450 inhibitory effects of disulfiram on rivaroxaban are unknown
* Current use of warfarin
* Individuals who intend to modify antiretroviral therapy during the study period for any reason
* Significant myocardial disease (current myocarditis or reduced left ventricular ejection fraction below the lower limit of normal) or diagnosed coronary artery disease
* Significant renal disease (eGFR <50 milliliter/minute)
* History of psychosis, seizure disorder, abnormal electroencephalogram or brain damage with significant persisting neurological deficit
* Prior malignancy active within the previous 3 years except for local curable cancers that have been apparently cured, such as basal or squamous cell skin cancer, superficial bladder cancer or carcinoma in situ of the prostate, cervix or breast.
* Known hypersensitivity to disulfiram or vorinostat or contraindications to treatment with these agents
* Participation in another latency reversal study or receipt of vorinostat or disulfiram in the previous 12 months before starting the investigational treatment
* Any significant acute medical illness requiring hospitalization within preceding 8 weeks
* Hepatitis B (HBV) or hepatitis C (HCV) co-infection as determined by detection of HBsAg or HCV RNA (Individuals with prior hepatitis infection that is now cleared are eligible for enrolment)
* Receipt of immunomodulating agents (excluding immunization) or systemic chemotherapeutic agents within 28 days prior to study entry
* Current or recent gastrointestinal disease or surgery that may impact the absorption of the investigational drug
* Active substance use that in the opinion of the investigator will prevent adequate compliance with study procedures
* Women who are currently pregnant or breastfeeding
* Women of Child Bearing Potential (WOCBP) who are unwilling or unable to use an acceptable method of contraception to avoid pregnancy
* Unable or unwilling to adhere to protocol procedures
* The following laboratory values within 6 weeks before starting the investigational drug (lab tests may be repeated to obtain acceptable values before failure at screening is concluded)
* Hepatic transaminases (AST or ALT) =3 x upper limit of normal (ULN)
* Serum total bilirubin =1.5 x ULN
* eGFR <50 milliliter/min
* Hemoglobin <11.0 g/deciliter
* Platelet count =100 x10^9/L (liter)
* Absolute neutrophil count =1.5x10^9/L
* Serum potassium, magnesium, phosphorus outside normal limits
* Total calcium (corrected for serum albumin) or ionized calcium = lower normal limits
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Study design
Purpose of the study
Treatment
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Allocation to intervention
NA
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
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Phase
Phase 1
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Stopped early
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
8/08/2017
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
9/04/2019
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Sample size
Target
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Accrual to date
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Final
5
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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Department of Infectious Diseases, Alfred Hospital - Melbourne
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Recruitment postcode(s) [1]
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3004 - Melbourne
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Funding & Sponsors
Primary sponsor type
Other
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Name
University of Melbourne
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Address
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Country
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Other collaborator category [1]
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Commercial sector/industry
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Name [1]
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Merck Sharp & Dohme LLC
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Address [1]
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Country [1]
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Other collaborator category [2]
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Other
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Name [2]
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The Alfred
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Address [2]
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Country [2]
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Ethics approval
Ethics application status
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Summary
Brief summary
Antiretroviral therapy (ART) dramatically reduces Human Immunodeficiency Virus (HIV) replication leading to restoration of immune function and a near normal life expectancy, but treatment is lifelong and there is no cure. The major barrier to a cure is the persistence of long lived cluster of differentiation 4 (CD4+) T-cells that contain a "silenced" form of HIV, called HIV latency. The purpose of this research is to investigate whether it may be possible to reduce the amount of dormant HIV infection in immune cells, by "turning on" or activating the virus and hence force it out of the latently infected memory T cells. This leads to production of HIV by the cell, which will either die or will be recognized and eliminated by the immune system. As very few T cells are latently infected with HIV, the death of these cells is not expected to affect the function of the immune system and further infection of new cells is expected to be prevented by ART.
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Trial website
https://clinicaltrials.gov/study/NCT03198559
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Trial related presentations / publications
McMahon JH, Evans VA, Lau JSY, Symons J, Zerbato JM, Chang J, Solomon A, Tennakoon S, Dantanarayana A, Hagenauer M, Lee S, Palmer S, Fisher K, Bumpus N, Heck CJS, Burger D, Wu G, Zuck P, Howell BJ, Zetterberg HH, Blennow K, Gisslen M, Rasmussen TA, Lewin SR. Neurotoxicity with high-dose disulfiram and vorinostat used for HIV latency reversal. AIDS. 2022 Jan 1;36(1):75-82. doi: 10.1097/QAD.0000000000003091.
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Public notes
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Contacts
Principal investigator
Name
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Sharon R Lewin, FRACP, PhD
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Address
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The Doherty Institute, University of Melbourne
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
No plan to share individual participant data
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What supporting documents are/will be available?
No Supporting Document Provided
Type
Other Details
Attachment
Study protocol
Study Protocol and Statistical Analysis Plan
https://cdn.clinicaltrials.gov/large-docs/59/NCT03198559/Prot_SAP_000.pdf
Statistical analysis plan
Study Protocol and Statistical Analysis Plan
https://cdn.clinicaltrials.gov/large-docs/59/NCT03198559/Prot_SAP_000.pdf
Results publications and other study-related documents
Type
Citations or Other Details
Journal
McMahon JH, Evans VA, Lau JSY, Symons J, Zerbato J...
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More Details
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Results are available at
https://clinicaltrials.gov/study/NCT03198559