Effects of hydroxychloroquine on immune activation and disease progression among HIV-infected patients not receiving antiretroviral therapy: a randomized controlled trial

Abstract

Context: Therapies to decrease immune activation might be of benefit in slowing HIV disease progression.

Objective: To determine whether hydroxychloroquine decreases immune activation and slows CD4 cell decline.

Design, setting, and patients: Randomized, double-blind, placebo-controlled trial performed at 10 HIV outpatient clinics in the United Kingdom between June 2008 and February 2011. The 83 patients enrolled had asymptomatic HIV infection, were not taking antiretroviral therapy, and had CD4 cell counts greater than 400 cells/μL.

Intervention: Hydroxychloroquine, 400 mg, or matching placebo once daily for 48 weeks.

Main outcome measures: The primary outcome measure was change in the proportion of activated CD8 cells (measured by the expression of CD38 and HLA-DR surface markers), with CD4 cell count and HIV viral load as secondary outcomes. Analysis was by intention to treat using mixed linear models.

Results: There was no significant difference in CD8 cell activation between the 2 groups (-4.8% and -4.2% in the hydroxychloroquine and placebo groups, respectively, at week 48; difference, -0.6%; 95% CI, -4.8% to 3.6%; P = .80). Decline in CD4 cell count was greater in the hydroxychloroquine than placebo group (-85 cells/μL vs -23 cells/μL at week 48; difference, -62 cells/μL; 95% CI, -115 to -8; P = .03). Viral load increased in the hydroxychloroquine group compared with placebo (0.61 log10 copies/mL vs 0.23 log10 copies/mL at week 48; difference, 0.38 log10 copies/mL; 95% CI, 0.13 to 0.63; P = .003). Antiretroviral therapy was started in 9 patients in the hydroxychloroquine group and 1 in the placebo group. Trial medication was well tolerated, but more patients reported influenza-like illness in the hydroxychloroquine group compared with the placebo group (29% vs 10%; P = .03).

Conclusion: Among HIV-infected patients not taking antiretroviral therapy, the use of hydroxychloroquine compared with placebo did not reduce CD8 cell activation but did result in a greater decline in CD4 cell count and increased viral replication.

Trial registration: isrctn.org Identifier: ISRCTN30019040.

Figure 1. Trial Profile

Figure 2. Change in CD4 Cell Count During the Trial by Treatment Group

Changes from baseline are based on empirical data, supplemented by individual predicted values for missing data obtained using a linear mixed model. Bars indicate 95% CIs around mean values.

Figure 3. Change in Viral Load

Changes from baseline are based on empirical data, supplemented by individual predicted values for missing data obtained using a linear mixed model. Bars indicate 95% CIs around mean values.