Chidamide in Combination With ART for Reactivation of the Latent HIV-1 Reservoir
Chidamide in Combination With ART for Reactivation of the Latent HIV-1 Reservoir
HIV replication can be effectively suppressed and acquired immunodeficiency syndrome(AIDS)
 can be prevented with highly active antiretroviral therapy (HAART). However, HIV-infected
 people must remain on treatment continuously to avoid viral rebound and progression to AIDS.
 HIV persistence is thought to stem primarily from the presence of integrated copies of the
 proviral genome within long-lived cells. Because active viral gene expression causes cell
 death due to viral cytopathic effects and the immune response, long-lived cells likely harbor
 transcriptionally silent, latent provirus. HIV-1 persistence in long-lived cellular
 reservoirs remains a major barrier to a cure. HDACi have the potential to activate ("Kick")
 these latently infected cells. This will make the HIV infected cells visible to the immune
 system; the immune response and antiretrovirals(ARVs) will be able to attack and eliminate
 ("Kill") the infected cells. This study is subsequent to our NCT02513901. The purpose of this
 study is to verify the efficacy of multi-dose Chidamide in combination with antiretroviral
 therapy in HIV-infected adults with suppressed viral load in a randomized controlled clinical
 trial.
Sixty participants will be recruited and stratified by their CD4 cell count(30 for <500
 cells/μL and 30 for ≥500 cells/μL). Each layer was 1:1 randomly divided into Chidamide group
 or Placebo-controlled group.Chidamide and Placebo will be administrated 10mg each time, twice
 a week, interval not less than 3 days. Chidamide and Placebo intervention will last 12
 consecutive weeks. All participants will keep their antiretroviral therapy during this study.

 This study will last for 96 weeks, involving 16 study visits(Screening, Week 0, 2, 4, 8, 12,
 14, 16, 20, 24, 36, 48, 60, 72, 84, 96) for every participant. At the screening visit,
 participants will give a medical history and will undergo a physical exam; blood samples will
 be collected. If participants agree, their blood samples may be stored for future research.
Inclusion Criteria:

 -  Documented HIV-1 infection

 -  Currently receiving cART and having received cART for a minimum of 24 months, HIV-1
 plasma RNA <20 copies/mL for at least 1.5 year (excluding viral load blips)

 -  CD4 T cell count >350 cells/mm3

 -  Able, willing to give written informed consent and to adhere to therapy and to comply
 with time requirements for study visits and evaluations

 -  Adequate vascular access for leukapheresis

 Exclusion Criteria:

 -  Acute HIV-1 infection

 -  Received blood transfusions or hematopoetic growth factors within 3 months receipt of
 compounds with HDAC inhibitor-like activity, such as valproic acid within the last 1
 month. Potential participants may enroll after a 30-day washout period.

 -  Any significant acute medical illness in the past 8 weeks

 -  Any evidence of an active AIDS-defining opportunistic infection

 -  Hepatitis B or C infection as indicated by the presence of Hepatitis B surface antigen
 (HBsAg) or hepatitis C virus RNA (HCV-RNA) in blood

 -  Patient has the following laboratory values within 3 weeks before starting the
 investigational drug

 1. Hepatic transaminases (AST or ALT) ≥3 x upper limit of normal (ULN)

 2. Serum total bilirubin ≥1.5 ULN

 3. Serum creatinine levels ≥1.5 x ULN, or calculated creatinine clearance ≤60 ml/min

 4. Platelet count ≤100 x109/L

 5. Absolute neutrophil count ≤1.5x109/L

 6. Serum potassium, magnesium, phosphorus outside normal limits

 7. Total calcium (corrected for serum albumin) or ionized calcium ≤lower normal
 limits

 -  A personal history of clinically significant cardiac disease, symptomatic or
 asymptomatic arrhythmias, syncopal episodes, or additional risk factors for Torsades
 de pointes (e.g. heart failure)

 -  History of malignancy or transplantation, including skin cancers or Kaposi sarcoma

 -  History of diabetes mellitus

 -  Known hypersensitivity to the components of chidamide or its analogues

 -  Pregnancy or breast feeding, or expecting to father children within the projected
 duration of the study

 -  Known psychiatric or substance abuse disorders that would interfere with cooperation
 with the requirements of the trial