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Can Valacyclovir Delay the Need for Initiation of Human Immunodeficiency Virus (HIV) Treatment in HIV-Infected Individuals With Asymptomatic Herpes Simplex Virus Type 2? (VALIDATE)
This study is not yet open for participant recruitment.
Verified by Canadian HIV Trials Network, March 2009
First Received: March 11, 2009   Last Updated: April 6, 2009   History of Changes
Sponsors and Collaborators: Canadian HIV Trials Network
Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz
Information provided by: Canadian HIV Trials Network
ClinicalTrials.gov Identifier: NCT00860977
  Purpose

The purpose of this study is to determine whether medication to suppress herpes simplex virus type 2 (HSV-2) infection can slow the rate of HIV disease progression and delay the need for initiating HAART in HIV, HSV-2 co-infected individuals.


Condition Intervention Phase
HIV Infection
Herpesvirus 2, Human
HIV Infections
Drug: valacyclovir
Drug: Placebo
Phase IV

Study Type: Interventional
Study Design: Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Parallel Assignment, Efficacy Study
Official Title: VALacyclovir In Delaying Antiretroviral Treatment Entry

Resource links provided by NLM:


Further study details as provided by Canadian HIV Trials Network:

Primary Outcome Measures:
  • Time from baseline until reaching the primary endpoint, a composite of either a CD4 cell count ≤350 cells/mm3 measured on two consecutive occasions at least 1 month apart, or initiation of HAART for any reason, whichever occurs first. [ Time Frame: 5 years ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Annual rate of change in CD4 count, calculated as the slope of patients' CD4 count change / time [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  • Annual rate of change in the CD4 cell count percentage, calculated as the slope of the patient's CD4 count percentage change over time [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  • Log10 plasma HIV viral load [ Time Frame: 12, 24 and 36 months of follow-up ] [ Designated as safety issue: No ]
  • Treatment-emergent adverse events and laboratory abnormalities [ Time Frame: 5 years ] [ Designated as safety issue: Yes ]
  • Frequency of episodes of HSV reactivations at any anatomic site [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  • Proportion of microbiologically confirmed flares of HSV during the trial that are caused by laboratory-confirmed acyclovir-resistant HSV [ Time Frame: 5 years ] [ Designated as safety issue: No ]

Estimated Enrollment: 480
Study Start Date: September 2009
Estimated Study Completion Date: August 2014
Estimated Primary Completion Date: August 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Placebo: Placebo Comparator
Odourless placebo tablet identical to valacyclovir in appearance and taste, to be taken twice daily
Drug: Placebo
Odourless placebo tablet identical to valacyclovir in appearance and taste, to be taken twice daily
Valacyclovir: Experimental
oral valacyclovir 500mg twice daily
Drug: valacyclovir
oral valacyclovir 500mg twice daily

Detailed Description:

Highly active antiretroviral therapy (HAART) has drastically reduced the morbidity and mortality associated with HIV infection, and transformed HIV from an invariably fatal disease into a manageable, chronic condition.

However, the inconvenience, high cost, potential side effects, and significant risk of developing drug-resistant HIV associated with taking daily, lifelong HAART make the potential delay of HAART initiation an extremely desirable goal for HIV-infected individuals.

Suppression of herpes simplex virus (HSV)-2 co-infection may provide a novel therapeutic strategy for achieving this goal. HSV-2 is among the most common co-infections seen in persons infected with HIV, with rates of up to 52-95%. This co-infection is associated with increased blood levels of HIV, a major predictor of HIV disease progression, even when the person has no herpes symptoms. Medications such as valacyclovir that suppress herpes can also decrease blood levels of HIV, but the potential long-term clinical benefits of this drug have not been adequately studied. It is thus hypothesized that valacyclovir could slow HIV disease progression and prolong the period of time before a co-infected person needs to initiate HAART. This research has been designed to answer this important question through a randomized, placebo-controlled, multi-centre clinical trial.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • adults aged over 18 years
  • documented HIV-1 infection
  • documented HSV-2 seropositivity
  • maximum 2 episodes recurrent symptomatic HSV recurrences per year
  • neither currently using nor anticipated to require chronic anti-HSV therapy during the study
  • antiretroviral naïve (no more than 14 days of total prior ARV exposure)
  • CD4 count within the 400-900 cells/mm3 range (inclusive) on two consecutive occasions, with at least one measurement within 4 weeks of initiating trial
  • does not meet recommendations for initiating ARV therapy according to current guidelines

Exclusion Criteria:

  • pregnant
  • receiving chemotherapy or chronic steroid therapy
  • estimated creatinine clearance <30 mL/min
  • active opportunistic infection
  • medical condition likely to cause death within 24 months
  • enrolled in a therapeutic vaccine or immunotherapy trial
  • enrolled in another trial investigating the impact of another intervention on HIV disease progression
  • HIV elite controller
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00860977

Contacts
Contact: Sharon L Walmsley, MD FRCPC MSc 416-340-4800 ext 3871 sharon.walmsley@uhn.on.ca
Contact: Darrell HS Tan, MD FRCPC 416-340-4800 ext 2240 darrell.tan@gmail.com

Locations
Brazil
Instituto de Pesquisa Clínica Evandro Chagas
Rio de Janeiro, Brazil
Canada, Ontario
University Health Network
Toronto, Ontario, Canada, M5G 2N2
Sponsors and Collaborators
Canadian HIV Trials Network
Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz
Investigators
Principal Investigator: Sharon L Walmsley, MD FRCPC MSc University Health Network, Toronto
Principal Investigator: Darrell HS Tan, MD FRCPC University Health Network, Toronto
  More Information

Additional Information:
No publications provided

Responsible Party: CIHR Canadian HIV Trials Network ( Dr Sharon Walmsley, Dr Darrell Tan )
Study ID Numbers: CTN-240, ISRCTN66756285
Study First Received: March 11, 2009
Last Updated: April 6, 2009
ClinicalTrials.gov Identifier: NCT00860977     History of Changes
Health Authority: Canada: Health Canada

Keywords provided by Canadian HIV Trials Network:
HIV
Herpes simplex virus type 2
Genital herpes
Treatment Naive

Study placed in the following topic categories:
Herpes Simplex
Anti-Infective Agents
Sexually Transmitted Diseases, Viral
Skin Diseases
Herpes Genitalis
Acquired Immunodeficiency Syndrome
Antiviral Agents
Immunologic Deficiency Syndromes
Herpesviridae Infections
Valacyclovir
Virus Diseases
Skin Diseases, Infectious
HIV Infections
Sexually Transmitted Diseases
DNA Virus Infections
Retroviridae Infections

Additional relevant MeSH terms:
Herpes Simplex
Anti-Infective Agents
Communicable Diseases
RNA Virus Infections
Sexually Transmitted Diseases, Viral
Slow Virus Diseases
Skin Diseases
Immune System Diseases
Acquired Immunodeficiency Syndrome
Infection
Antiviral Agents
Pharmacologic Actions
Immunologic Deficiency Syndromes
Herpesviridae Infections
Valacyclovir
Skin Diseases, Viral
Virus Diseases
Skin Diseases, Infectious
HIV Infections
Therapeutic Uses
Sexually Transmitted Diseases
Lentivirus Infections
DNA Virus Infections
Retroviridae Infections

ClinicalTrials.gov processed this record on September 10, 2009