MK-0518 Intensification And HDAC Inhibition In Depletion Of Resting CD4+ T Cell HIV Infection
Condition: HIV Infections
MeSH terms: Infections; Communicable Diseases; HIV Infections; Acquired Immunodeficiency Syndrome
Intervention: Raltegravir; valproic acid
Intervention description: raltegravir 400mg po BID; valproic acid 1000mg - 2000mg daily
Intervention MeSH terms: Raltegravir Potassium; Valproic Acid
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 6.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: latent HIV; resting CD4+ T cell; valproic acid (VPA); Raltegravir (MK-0518) intensification; HIV replication; treatment experienced

Summary:

      The purpose of this research study is to see if HIV that persists despite current antiviral
      therapy can be targeted by new treatments. We will see if adding Raltegravir (MK-0518) and
      Valproic acid (VPA) to current ART can decrease the amount of latent HIV.
    

Eligibility criteria:

        Inclusion Criteria:

          -  HIV-1 infection

          -  Men and women age ≥18 years.

          -  Ability and willingness of subject or legal guardian/representative to give written
             informed consent.

          -  Karnofsky performance status >70.

          -  Willing to adhere to protocol therapy and judged adherent to antiretroviral therapy,
             and can comply with time requirements for protocol-specified visits and evaluations.

          -  On potent antiretroviral therapy, defined as at least 2 nucleoside reverse
             transcriptase inhibitors (NRTIs) plus at least 1 protease inhibitor (PI) or
             non-nucleoside reverse transcriptase inhibitor (NNRTI), without changes in the 24
             weeks immediately prior to entry. Prior changes in or elimination of medications for
             easier dosing schedule, intolerance, or toxicity are permitted.

          -  Have no contraindications to valproic acid (VPA) therapy (pregnancy, bleeding
             disorders, history of pancreatitis, history of hepatitis).

          -  Have adequate vascular access for leukopheresis

          -  Plasma HIV-1 RNA never > 50 copies/ml on two consecutive occasions for ≥ 6 months.

          -  CD4 cell count > 300 cells/µl.

          -  Screening serum fasting glucose below 120 mg/dl, creatinine no more than 1.5 times the
             upper limit of the normal range, serum AST, ALT, and total bilirubin less than 2 times
             the upper limit of the normal range, and fasting triglycerides < 400mg/dl.

          -  Female study volunteers who are not of reproductive potential or whose male partner(s)
             has undergone successful vasectomy with documented azoospermia or has documented
             azoospermia for any other reason, are eligible without requiring the use of
             contraception.

          -  All women of reproductive potential must have a negative urine beta-HCG pregnancy test
             performed at screening, day 0, week 4, week 8, week 12, and every scheduled study
             visit thereafter.

          -  All study volunteers must agree not to participate in a conception process and, if
             participating in sexual activity that could lead to pregnancy, the female study
             volunteer/male partner must use two reliable methods of contraception simultaneously
             while receiving the protocol-specified medications and for 6 weeks after stopping the
             medications. Subjects must use a reliable barrier method of contraception along with
             another form of contraception. For women receiving ritonavir, estrogen-based
             contraceptives are not reliable and an alternative method should be used.

        Exclusion Criteria:

          -  Receiving zidovudine (AZT). Due to the inhibition of zidovudine metabolism mediated by
             Valproic acid (VPA) a theoretical increase risk of zidovudine-induced anemia exists.

          -  Using drugs known to interact with valproate or raltegravir (MK-0518)

          -  Pregnant or nursing.

          -  Anemic (Hemoglobin < 10gm/dl)

          -  Seropositive for hepatitis C RNA or hepatitis B surface antigen within 90 days prior
             to entry.

          -  Have signs or symptoms of hepatic decompensation

          -  Received blood transfusions or hematopoetic growth factors within 90 days.

          -  Use of any of the following within 90 days prior to entry: systemic cytotoxic
             chemotherapy, investigational agents, immunomodulators.

          -  Active drug or alcohol use or dependence.

          -  Serious illness requiring systemic treatment or hospitalization until subject either
             completes therapy or has been clinically stable on therapy, in the opinion of the site
             investigator, for at least 90 days prior to entry.

          -  Compulsorily detained (involuntarily incarcerated) for treatment of either a
             psychiatric illness or a physical illness, e.g., infectious disease.

          -  Treatment for an active AIDS-defining opportunistic infection within 90 days prior to
             screening.

        For this pilot study of no direct benefit to subjects, non-English speaking patients are
        excluded. In the future, if this study is expanded to include a larger sample size, this
        exclusion criterion may be removed.