Efficacy and Safety of Two Pharmacologic Strategies on Neurocognitive Impairment in HIV Infection. The TRIANT-TE Study

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Fundacio Lluita Contra la SIDA
ClinicalTrials.gov Identifier:
NCT01348282
First received: April 18, 2011
Last updated: March 31, 2014
Last verified: March 2014
  Purpose

The current project proposes the comparison of two pharmacologic strategies as adjunctive treatments for the improvement of HIV-associated neurocognitive disruption, additionally to use of HAART. The investigators propose the use of the compound that has shown greatest benefits in this context to date, the lithium, versus the use of a well-tolerated and promising drug in other pathologies with neurocognitive affectation, such as Alzheimer or Parkinson diseases, which is the rivastigmine. In those other diseases, this second compound has recently offered a good tolerability, but also benefits on attention, memory and other neurocognitive areas. Both study groups, patients on therapy with lithium and patients on therapy with rivastigmine, will be compared to a control group, which will not initiate any other treatment (therefore only continuing antiretroviral therapy). The investigators are aware that this proposal will offer new relevant data for the study of neurocognitive improvement in HIV infection, as well will allow a better knowledge of clinical management of HIV-infected patients with CNS disease, an aspect that is a common clinical concern today.


Condition Intervention Phase
Neurocognitive Disturbance
HIV Infection
Drug: Lithium
Drug: Rivastigmine
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Exploratory Controlled Prospective Randomized Trial to Compare the Efficacy and Safety of Two Different Pharmacology Strategies on Neurocognitive Impairment in HIV Infection. The TRIANT-TE Study

Resource links provided by NLM:


Further study details as provided by Fundacio Lluita Contra la SIDA:

Primary Outcome Measures:
  • Percentage of persons with neurocognitive impairment in the different study groups [ Time Frame: From screening to month 12 ] [ Designated as safety issue: No ]
    The main variable to consider is the existence of HIV-associated neurocognitive impairment. Therefore, the percentage of persons with neurocognitive impairment in different study groups will be the main variable that will report on the improvement associated with new treatments.


Secondary Outcome Measures:
  • Adverse events associated with the initiation of therapy and toxicity parameters [ Time Frame: Week 2, month 1, 3, 6, 9, 12 ] [ Designated as safety issue: Yes ]
  • Emotional variables [ Time Frame: Baseline, month 3, 6, 12. ] [ Designated as safety issue: No ]
    Depression and anxiety symptoms will be assessed by HADS questionnaire.

  • Functional variables [ Time Frame: Baseline, month 3, 6, 12. ] [ Designated as safety issue: No ]
    A total of six scales assessing functional interference regarding activities of daily living, as well as self-reported neurocognitive functioning, will be measured.

  • Quality of life variables [ Time Frame: Baseline, month 3, 6, 12. ] [ Designated as safety issue: No ]
    Four dimensions concerning quality of life, evaluated by MOS-HIV questionnaire, and satisfaction scales, based on treatments and clinical status, will be evaluated.

  • Demographics [ Time Frame: Baseline ] [ Designated as safety issue: No ]

Enrollment: 33
Study Start Date: May 2011
Study Completion Date: March 2014
Primary Completion Date: March 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Lithium
Lithium group: Patients who will initiate therapy with lithium, in tablets, beginning a 2-daily 400 mg dose, and changing further adjusting the dose according to drug levels in serum.
Drug: Lithium
lithium, in tablets, beginning a 2-daily 400 mg dose, and changing further adjusting the dose according to drug levels in serum.
Active Comparator: Rivastigmine
rivastigmine, in transdermal patch administration, beginning a once-daily 4.6 mg dose, and changing further increasing the dose up to once-daily 9.5 mg.
Drug: Rivastigmine
rivastigmine, in transdermal patch administration, beginning a once-daily 4.6 mg dose, and changing further increasing the dose up to once-daily 9.5 mg.
No Intervention: Control group
Patients who will not initiate treatment

Detailed Description:

Adjunctive treatments based on neurocognitive improvement for HIV-infected patients with CNS disruption have consisted essentially of neurostimulant or neuroprotective treatments. Reports published to date have involved valproic acid, peptide T, CPI-1189, selegiline, memantine, minocycline and lithium. Regarding valproic acid, two trials have confirmed lack of benefit using this compound on HIV-associated neurocognitive decline. In case of peptide T, CPI-1189, selegiline, memantine and minocycline, although their potential mechanisms on brain follow different pathways, trend towards improvement on neurocognitive functioning has been observed. Nonetheless, results on those trials are particularly based on a short term and, moreover, mild connections with benefits on neurocognitive and functional measures have been established. The lithium has been the compound showing clearest benefits on this regard. Two reports have consistently demonstrated benefits on neurocognitive performance using this neuroprotective agent, both in patients with HIV and showing impairment previously. However, lithium is well known to be a drug not easily incorporated in routine practice, at least further than in a psychiatry context. In addition, adverse events related to their use are relatively frequent, and therefore clinical follow-up must be especially controlled. Besides, lithium concentrations are also a concerning aspect considering its use, and drug plasma levels are recommended to be performed throughout the therapy application.

For all these reasons, the current project proposes the comparison of two pharmacologic strategies as adjunctive treatments for the improvement of HIV-associated neurocognitive disruption, additionally to use of HAART. The investigators propose the use of the compound that has shown greatest benefits in this context to date, the lithium, versus the use of a well-tolerated and promising drug in other pathologies with neurocognitive affectation, such as Alzheimer or Parkinson diseases, which is the rivastigmine. In those other diseases, this second compound has recently offered a good tolerability, but also benefits on attention, memory and other neurocognitive areas. Furthermore, in the case of this project, rivastigmine is suggested to be used through a transdermal system patch, a fact that can provide suitability and comfortability with regard to the selected administration method. Both study groups, patients on therapy with lithium and patients on therapy with rivastigmine, will be compared to a control group, which will not initiate any other treatment (therefore only continuing antiretroviral therapy). The investigators are aware that this proposal will offer new relevant data for the study of neurocognitive improvement in HIV infection, as well will allow a better knowledge of clinical management of HIV-infected patients with CNS disease, an aspect that is a common clinical concern today.

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age ranged from 20 to 75 years old
  • Correct understanding of study objectives
  • Written consent signed
  • HIV infection confirmed by Western Blot or two ELISA tests
  • Existence of an HIV-associated neurocognitive disorder according to the diagnosis classification offered by Antinori and cols (Neurology, 2007)
  • Being on antiretroviral treatment.
  • Spanish/Catalan speaker.

Exclusion Criteria:

  • To be on a treatment that may interact pharmacologically with any of the new drugs used in study arms.
  • Breastfeeding, pregnancy or fertile women willing to be pregnant.
  • Renal failure or severe cardiovascular disease.
  • Weakness, dehydration or severe sodium depletion.
  • Sick sinus syndrome or cardiac conduction disturbances (sinoatrial block or atrioventricular block).
  • Active duodenal or gastric ulcer.
  • Urinary obstruction.
  • Epilepsy.
  • Chronic obstructive pulmonary disease (COPD).
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01348282

Locations
Spain
Fundació LLuita contra la SIDA
Badalona, Barcelona, Spain, 08916
Sponsors and Collaborators
Fundacio Lluita Contra la SIDA
  More Information

No publications provided

Responsible Party: Fundacio Lluita Contra la SIDA
ClinicalTrials.gov Identifier: NCT01348282     History of Changes
Other Study ID Numbers: TRIANT-TE
Study First Received: April 18, 2011
Last Updated: March 31, 2014
Health Authority: Spain: Ministry of Health

Keywords provided by Fundacio Lluita Contra la SIDA:
Neurocognitive Impairment
Controlled Randomized Trial
Coadjunctive Treatments
Lithium; Rivastigmine
Antiretroviral Therapy
HIV Infection

Additional relevant MeSH terms:
HIV Infections
Acquired Immunodeficiency Syndrome
Cognition Disorders
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Slow Virus Diseases
Delirium, Dementia, Amnestic, Cognitive Disorders
Mental Disorders
Lithium
Lithium Carbonate
Rivastigmine
Antipsychotic Agents
Tranquilizing Agents
Central Nervous System Depressants
Physiological Effects of Drugs
Pharmacologic Actions
Central Nervous System Agents
Therapeutic Uses
Psychotropic Drugs
Antimanic Agents
Antidepressive Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Cholinesterase Inhibitors

ClinicalTrials.gov processed this record on September 14, 2014