Imaging immune activation in HIV using PET-MR technology

Imaging Immune Activation in HIV Infection

This study is testing a new imaging technique to see how the immune system reacts in people with HIV by using a special tracer and advanced scanning technology.

Quick facts

• Phase: PHASE2
• Study type: Interventional
• Enrollment: 30 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: CellSight Technologies, Inc. (industry)
• Locations: 1 site (San Francisco, California)
• Trial ID: NCT03684655 on ClinicalTrials.gov

What this trial studies

This clinical trial involves administering a microdose of the PET imaging agent [18F]F-AraG to HIV-infected individuals, followed by whole-body positron emission tomography-magnetic resonance (PET-MR) imaging. The study aims to explore the anatomical distribution of the tracer in both treated and untreated HIV patients. It will enroll up to 30 participants, focusing on those with varying treatment histories, including individuals not on antiretroviral therapy. The primary goal is to assess the tracer's localization in relation to immune activation and inflammation associated with HIV infection.

Who should consider this trial

Good fit: Ideal candidates include adults over 18 years old with HIV infection, whether they are on antiretroviral therapy or not.

Not a fit: Patients who are not HIV-infected or those who have stable HIV with no significant immune activation may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could enhance understanding of immune activation in HIV, potentially leading to improved treatment strategies.

How similar studies have performed: While the use of PET imaging in HIV research is emerging, this specific approach with [18F]F-AraG is novel and has not been extensively tested in prior studies.

Eligibility criteria

Inclusion Criteria:

1. Age \>18 years
2. Ability to read and understand written informed consent document
3. HIV infection, and Initiated a combination ART regimen, or, has never received ART, or, has received ART in the past, but has not been taking for a least 1 week prior to study imaging.

   (Of note, per Department of Health and Human Services (DHHS) guidelines, the protocol team will strongly recommend that all HIV+ participants initiate ART who not done so already, both for their own health and to prevent the transmission of HIV infection.)
4. Laboratory evaluations obtained within 60 days prior to entry. i. Platelet count ≥100,000/mm3 ii. ANC \>1500/mm3 iii. Aspartate aminotransferase (AST) \<2 x ULN iv. Alanine aminotransferase (ALT) \<2 x ULN v. CD4+ T cell count \>100 cells/mm3 for HIV infected individuals vi. Calculated creatinine clearance (CrCl) ≥60 mL/min as estimated by the Cockcroft-Gault equation: For men, (140 - age in years) x (body weight in kg) ÷ (serum creatinine in mg/dL x 72) = CrCl (mL/min)\*

   * For women, multiply the result by 0.85 = CrCl (mL/min)

Exclusion Criteria:

1. Exclusion criteria will include any contra-indication to MRI, including permanent pacemaker, implantable metallic device/ prosthetic, aneurysm clip, non-removable piercing, or severe claustrophobia
2. Any medical condition that would compromise the imaging acquisition, in the opinion of the investigator
3. Individuals who have received systemic immune modifying therapy within 60 days of study enrollment (excluding HIV DNA vaccine).
4. Participants who are pregnant (female participants of childbearing age will be tested prior to injection of imaging agent at entry visit/initial visit - positive test will exclude from further participation in the study)
5. Participants who are breastfeeding
6. Female participants of reproductive potential (defined as women who have not been post-menopausal for at least 24 consecutive months (i.e., who have had menses within the preceding 24 months), or women who have not undergone surgical sterilization, specifically hysterectomy and/or bilateral oophorectomy or bilateral salpingectomy) must have a negative urine or serum pregnancy test with a sensitivity of at least 25 mIU/mL performed at the entry/initial visit, and again within 24 hours prior to PET imaging. Females of reproductive potential will need to be on 2 forms of birth control (excluding withdrawal or timing methods).
7. Participants who have had prior allogeneic stem cell or solid organ transplant
8. Screening absolute neutrophil count \<1,500 cells/mm3, platelet count \<100,000 cells/mm3, hemoglobin \< 8 mg/dL, estimated creatinine clearance \<60 mL/minute, aspartate aminotransferase \>2 x ULN, alanine aminotransferase \>2 x ULN.
9. Serious illness requiring hospitalization or parental antibiotics within the preceding 3 months
10. Current HIV-related opportunistic infection such as pneumocystis pneumonia, disseminated microbacterial infection, invasive cryptococcal disease, candidal esophagitis (limited oral thrush acceptable) and cerebral toxoplasmosis
11. Previously diagnosed myelodysplasia syndrome. or history of lymphoproliferative disease prior to study entry
12. History of congestive heart failure as defined by physician documentation in the medical record at any time prior to screening that required medication for heart failure or that required medical management within 1 year prior to study entry
13. Active Hepatitis C virus (HCV) infection. Prior history of treated HCV infection with sustained virological response will be allowed.
14. Active systemic autoimmune diseases.
15. Routine clinical vaccination within 14 days of study entry

Where this trial is running

San Francisco, California

• University of California, San Francisco — San Francisco, California, United States (RECRUITING)

Study contacts

• Principal investigator: Timothy J Henrich, MD — University of California, San Francisco
• Study coordinator: Timothy J Henrich, MD

Conditions: HIV Infections, HIV infection, Positron Emission Tomography, F-AraG, Magnetic Resonance Imaging