Downmodulating Monocyte Activation for HIV-1 Associated Neurocognitive Disorders (HAND)
Condition: HIV Dementia
MeSH terms: AIDS Dementia Complex
Intervention: Atorvastatin (generic Lipitor); placebo
Intervention description: Atorvastatin is an FDA approved prescription drug which is frequently used to lower cholesterol levels.It is available in the form of tablets ranging in dose from 10-80mg.; A substance containing no medication and prescribed or given to reinforce a patient's expectation to get well.
Intervention MeSH terms: Atorvastatin
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Double (Participant, Investigator)
Enrollment: 11.0
Sex: All
Minimum age: 18 Years
Maximum age: 60 Years
Healthy volunteers: No
Keywords: HIV; monocytes; CD16+; statins; mcp1; inflammation

Summary:

      HIV associated neurological disorders (HAND), are a major problem even in ART treated people.
      HAND results from chronic inflammation which is largely attributed to expansion and
      activation of monocytes. These activated monocytes, some of which also carry virus to the
      brain, invade the CNS and release cytokines / chemokines resulting in further recruitment of
      monocytes, as well as release viral proteins which injure neurons and cause activation of
      other brain cells. Persistent monocyte/macrophage activation is thus a potential critical
      target for adjunctive therapy to treat or prevent HAND. The investigators therefore propose
      to study the effects of a statin drug (Atorvastatin), which has anti-inflammatory functions,
      on the monocyte activation status in ART treated HIV+ individuals.

      The investigators objectives are based on the hypothesis that Atorvastatin treatment will
      reduce the inflammatory and activated phenotype and function of monocytes which have been
      linked to HIV associated neuropathogenesis and occur in HIV infected subjects despite ART. In
      this study the investigators propose to

      1) define the effect of Atorvastatin on monocyte activation in HIV infected / ART treated
      subjects in a double blind, placebo controlled crossover study
    

Eligibility criteria:

        Inclusion Criteria:

          1. Chronic HIV-1 infected individuals on HAART (with no change in treatment within 4
             weeks of study entry) and willing to continue therapy for the duration of the study.

          2. HIV viral load less than 200 copies/ml for more than 6 months at time of screening.

          3. Nadir CD4 count less than 350 and current CD4 counts greater than 100 cells/ul.

          4. Hs-CRP levels above 2mg/L.

          5. Willingness to use a method of contraception during the study period.

          6. Willingness to comply with study evaluations for LP sub-study.

          7. Karnofsky performance score of 80 or higher.

          8. If female, willing to undergo pregnancy testing on a monthly basis and not
             breastfeeding.

          9. Hemoglobin greater than or equal to 9.0 g/dL for female and 10.0 g/dL for male
             subjects.

         10. men and women 18 years or older.

        Exclusion Criteria:

          1. Concomitant use of fibric acid derivatives or other lipid lowering agents including
             patients on statins and Ezetimibe.

          2. Use of any anti-inflammatory drugs (OTC or prescription) on a daily basis.

          3. Pregnancy or breastfeeding

          4. Active drug use or alcohol abuse/dependence which in the opinion of researchers will
             interfere with the patients' ability to participate in the study.

          5. Allergy or hypersensitivity to Atorvastatin or any of its components.

          6. History of myositis or rhabdomyolysis with use of any statins.

          7. Patients who are on concurrent immunomodulatory agents, including systemic
             corticosteroids (nasal or inhaled) will be ineligible for 3 months after completion of
             therapy with the agent.

          8. History of inflammatory muscle disease such a poly or dermatomyositis.

          9. Serious intercurrent illness requiring systemic treatment and/or hospitalization
             within 30 days of entry.

         10. Evidence of active opportunistic infections requiring treatment or neoplasms that
             require chemotherapy during study period.

         11. CPK greater than 3 times the ULN.

         12. Known active liver disease or AST/ALT greater than 3 times the ULN.

         13. Renal insufficiency, indicated by serum creatinine greater than 2mg/dL.

         14. Absolute neutrophil counts less than 1000/ul; hemoglobin less than 10g/dL for males
             and less than 9g/dL for females; platelet counts less than 100,000/mm3.

         15. Documented HCV infection.

         16. NYHA class III or IV congestive heart failure.

         17. Active IV drug use within 1 year prior to entry.

         18. For LP sub-study, allergy to Lidocaine.

         19. Coronary artery disease or equivalent including Diabetes mellitus.