Minocycline for the Treatment of Decreased Mental Function in HIV-Infected Adults

Condition(s) targeted: HIV Infections

Intervention: Minocycline (Drug); Minocycline placebo (Drug)

Phase: Phase 2

Status: Recruiting

Sponsored by: National Institute of Allergy and Infectious Diseases (NIAID)

Official(s) and/or principal investigator(s):
Ned Sacktor, MD, Study Chair, Affiliation: Department of Neurology, Johns Hopkins Bayview Medical Center

The purpose of this study is to determine the effectiveness of minocycline, an antibiotic, in lessening the decreased mental function sometimes caused by anti-HIV drugs.

Official title: Phase II, Randomized, Placebo-Controlled, Double-Blind Study of Minocycline in the Treatment of HIV-Associated Cognitive Impairment

Study design: Treatment, Randomized, Double Blind (Subject, Caregiver), Placebo Control, Parallel Assignment, Safety/Efficacy Study

Primary outcome: Change in cognitive performance compared to baseline

Secondary outcome:

Change in Global Deficit Score (summary measure of neuropsychological test defects)

Change in clinical global impression by the investigator

Change in cognitive domain scores

Change in Karnofsky performance score

Toxicity and/or signs and symptoms of Grade 2 or higher

Development of a Grade 2 or higher toxicity and/or signs and symptoms

Changes in CD4/CD8 cell counts

HIV control status

Changes in Instrumental Activities of Daily Living Questionnaire

Changes in Medication Management Test (Modified)

Markers including, but not limited to, those of immune activation and oxidative stress/apoptosis

Changes in "alternate psychomotor function" (mean of standardized Trail Making Part A and Symbol Digit tests)

Changes in "alternate verbal memory" (mean of standardized trials 1 to 3 and delayed recall tests)

Changes in "alternate frontal systems" (mean of standardized Interference task and Trail Making Part B)

Detailed description: Cognitive impairment, including disabling cognitive, behavioral, and social dysfunction, continues to be a major problem faced by HIV-infected people taking antiretroviral therapy (ART). Research is needed to develop treatment that can be given alongside ART to prevent or lessen cognitive impairment caused by ART. Minocycline, an antibiotic commonly used for the treatment of acne and rheumatoid arthritis, has demonstrated anti-inflammatory and neuroprotective properties in previous studies. This study will evaluate the effectiveness of 24-week therapy with minocycline in lessening the cognitive impairment of HIV infected adults taking ART.

This study will last at least 24 weeks and has two steps. Patients will be stratified by HIV viral load and their neurocognitive state at study screening. In Step I, patients will be randomly assigned to one of two groups. Group 1 participants will receive twice-daily minocycline for 24 weeks; Group 2 participants will receive placebo. At the end of Phase I, study participants will be offered to enter Step II; all participants in Step II will receive twice-daily minocycline for an additional 24 weeks.

There will be a total of 8 study visits: 5 visits for Step I (including the entry visit) and 3 visits for Step II. Medical history will occur at all visits. Blood collection will occur at all visits. Participants who have positive nonreactive rapid plasma regain (RPR) values at screening will have mandatory lumbar punctures; for those with negative serum RPR results lumbar punctures are optional. Participants who test positive for syphilis will also have a lumbar puncture at their discretion to determine if syphilis has affected the brain. A neurological exam, other neuropsychological, dementia, and depression scale assessments, and urine collection will occur at most visits. Patients will be asked to complete a questionnaire on daily living at study entry and Weeks 12 and 24. Patients who have a lumbar puncture at Week 24 will receive a phone call 2 to 5 days after the procedure to report any adverse effects. Some participants may also have an electrocardiogram (ECG) during the study. For participants not on atazanavir some procedures and sample collections are optional.

Minimum age: 18 Years. Maximum age: 65 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- HIV infected

- Currently on a stable ART regimen for at least 16 consecutive weeks prior to study

entry. Participants whose regimens have changed with respect to dose or formulation are eligible, but patients who have changed to different drugs in the same class are not eligible. Participants taking atazanavir must also be taking ritonavir or a ritonavir-boosted drug to be eligible for this study. More information on this criterion can be found in the protocol.

- Plan to stay on current ART regimen between study screening and Week 24

- AIDS Dementia Scale (ADC) Stage greater than 0

- Cognitive impairment, as evidenced by neuropsychological tests administered at

screening

- Progressive neurocognitive decline. More information on this criterion can be found

in the protocol.

- Estimated premorbid IQ of 70 or higher indicated by an age-corrected scaled score of

5 or higher on the vocabulary section of the Wechsler Adult Intelligence Scale Revised (WAIS-R) administered at study screening

- Karnofsky performance score of 60 or higher

- Ability to sit and stand for at least 2 hours and swallow medications with an 8-ounce

glass of water

- Willing to use acceptable methods of contraception

- Willing to adhere to study schedule

Exclusion Criteria:

- Current cancers. Patients with basal cell carcinoma, in situ carcinoma of the cervix,

or Kaposi's sarcoma without evidence of visceral involvement or cancer not requiring systemic chemotherapy are not excluded.

- Severe premorbid psychiatric illness, including schizophrenia and major depression,

which, in the opinion of the investigator, may interfere with the study

- Active symptomatic AIDS-defining opportunistic infection within 45 days prior to

study entry

- Previous or current confounding neurological disorders. More information on this

criterion can be found in the protocol.

- Central nervous system infections or cancers. More information on this criterion can

be found in the protocol.

- Systemic lupus

- Thyroid disease diagnosed within 24 weeks of study entry

- Active drug or alcohol abuse that, in the opinion of the investigator, may interfere

with the study

- Serious illness requiring systemic treatment or hospitalization. Patients who

complete therapy or are clinically stable on therapy are not excluded.

- Investigational agents within 45 days prior to study entry. Patients taking expanded

access drugs or drugs used in an ACTG protocol for HIV treatment or for HIV-associated complications that are not prohibited by this protocol are not excluded.

- History of allergy/sensitivity to minocycline or other tetracyclines and their

formulations

- Any esophageal or other condition that would interfere with a patient's ability to

swallow study medication

- Participation in a previous clinical drug research trial of HIV-associated cognitive

impairment. Patients who have had an objective decline in performance as defined by the protocol are not excluded.

- Any other clinically significant condition or laboratory abnormality that, in the

opinion of the investigator, would interfere with the study

- Certain medications

- Certain abnormal laboratory values. Patients who test positive on nonreactive rapid

plasma reagin tests (RPR)are not excluded.

- Inability to undergo lumbar punctures

- Breastfeeding

UCLA-David Geffen School of Medicine, Los Angeles, California 90035, United States; Not yet recruiting
Sofia Solis, Phone: 310-557-3743, Email: ssolis@mednet.ucla.edu

University of California, San Diego, California 92103, United States; Recruiting
Jill Kunkel, RN, Phone: 619-543-8080, Email: jkunkel@ucsd.edu
Constance A. Benson, MD, Principal Investigator

UCHSC, Colorado Adult ACTU, Denver, Colorado 80262-3706, United States; Recruiting
M. G. Ray, RN, MSN, Phone: 303-372-5535, Email: graham.ray@uchsc.edu
Thomas Campbell, MD, Principal Investigator

University of Colorado Health Science Center, Denver, Colorado 80262-3706, United States; Recruiting
M. Graham Ray, RN, MSN, Phone: 303-372-5535, Email: graham.ray@uchsc.edu
Thomas B. Campbell, MD, Principal Investigator

Univ. of Hawaii at Manoa Leahi Hosp., Honolulu, Hawaii 96816-2396, United States; Active, not recruiting

2701 Feinberg School of Medicine, HIV/ACTU, Chicago, Illinois 60611, United States; Recruiting
Baiba Berzins, MPH, Phone: 312-695-5012, Email: baiba@northwestern.edu
Robert L. Murphy, MD, Principal Investigator

Johns Hopkins School of Medicine, Baltimore, Maryland 21287-8106, United States; Recruiting
Ilene P. Wiggins, RN, Phone: 410-614-2766, Email: imp@jhmi.edu

Massachusetts General Hospital, Division of Infectious Diseases, Boston, Massachusetts 02114, United States; Recruiting
Teri Flynn, RN, ANP, Phone: 617-724-0072, Email: tflynn@partners.org
Daniel R. Kuritzkes, MD, Principal Investigator

Washington University, St. Louis, Missouri 63108-2138, United States; Recruiting
Michael Klebert, RN-C, MSN, Phone: 314-454-0058, Email: mklebert@im.wustl.edu

Beth Israel Med. Ctr., ACTU, New York, New York 10003, United States; Active, not recruiting

1101 University of Rochester Medical Center, Division of Infectious Diseases, Rochester, New York 14642, United States; Recruiting
Carol Greisberger, RN, BS, Phone: 585-275-2740, Email: carol_greisberger@urmc.rochester.edu
Richard C. Reichman, MD, Principal Investigator

NYU Med Ctr, Dept of Medicine, New York, New York 10016, United States; Recruiting
Maura Laverty, RN, Phone: 212-263-6565, Email: maura.laverty@med.nyu.edu
Judith A Aberg, MD, Principal Investigator

University of North Carolina, AIDS Clinical Trials Unit, Chapel Hill, North Carolina 27514, United States; Recruiting
Cheryl J. Marcus, RN, BSN, Phone: 919-843-8761, Email: cjm@med.unc.edu
Joseph J. Eron, Jr., MD, Principal Investigator

The Reseach and Education Group - Portland CRS, Portland, Oregon 97209, United States; Recruiting
Norma Martinez, BSN, RN, Phone: 503-229-8428, Email: norma@reg.org
James H. Sampson, MD, Principal Investigator

University of Pennsylvania, ACTU, Philadelphia, Pennsylvania 19104, United States; Recruiting
Joseph Quinn, RN, Phone: 215-349-8092, Email: joseph.quinn@uphs.upenn.edu
Pablo Tebas, MD, Principal Investigator

Univ of Washington, Harborview Medical Ctr, Seattle, Washington 98104, United States; Recruiting
Jeanne Conley, RN, Phone: 206-731-8877, Email: njc@u.washington.edu
Ann C. Collier, MD, Principal Investigator

Haga clic aquí para ver información sobre este ensayo clínico en español.

Related publications:

Bell JE. An update on the neuropathology of HIV in the HAART era. Histopathology. 2004 Dec;45(6):549-59. Review.

Ferrari S, Vento S, Monaco S, Cavallaro T, Cainelli F, Rizzuto N, Temesgen Z. Human immunodeficiency virus-associated peripheral neuropathies. Mayo Clin Proc. 2006 Feb;81(2):213-9. Review.

Zink MC, Uhrlaub J, DeWitt J, Voelker T, Bullock B, Mankowski J, Tarwater P, Clements J, Barber S. Neuroprotective and anti-human immunodeficiency virus activity of minocycline. JAMA. 2005 Apr 27;293(16):2003-11.

Starting date: March 2007
Last updated: April 23, 2009