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Making an Early Diagnosis of Talaromycosis Using a Novel Antigen Test

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04033120
Recruitment Status : Not yet recruiting
First Posted : July 25, 2019
Last Update Posted : September 25, 2020
Sponsor:
Collaborators:
Oxford University Clinical Research Unit, Vietnam
National Hospital for Tropical Diseases, Hanoi, Vietnam
Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
The University of Hong Kong
Information provided by (Responsible Party):
Duke University

Brief Summary:
This is a research study to determine whether a new antigen detection test called Mp1p EIA can make an early diagnosis of talaromycosis from the blood and urine of patients. Talaromycosis is a life-threatening infection caused by a fungus endemic in Southeast Asia commonly found in patients with advanced HIV disease called Talaromyces marneffei.

Condition or disease
AIDS/HIV - RelatedDisease Associated With AIDS

Detailed Description:

This study aims to determine the diagnostic and prognostic values and the clinical impact of Talaromyces marneffei antigenemia (TmAg) in patients with advanced HIV disease using a novel enzyme immunoassay (EIA) detecting Tm-specific cell wall mannoprotein Mp1p. The data generated will be used to inform the design of future diagnostic clinical trials to test the utility of screening and providing pre-emptive antifungal therapy to prevent disease and reduce HIV mortality in Southeast Asia.

The primary objective is to screen for TmAg and determine its diagnostic and prognostic performance in symptomatic and asymptomatic HIV-infected patients with a CD4 count ≤100 cells/mm3.

We will test the following hypotheses:

  1. In symptomatic hospitalized patient Cohort 1, the sensitivity of the Mp1p EIA will be higher than conventional culture method while simultaneously specificity is higher than 95% for diagnosing culture-confirmed talaromycosis over a six-month follow up period
  2. In asymptomatic outpatient Cohort 2, there will be at least 30% difference in risk of talaromycosis development in TmAg-positive patients compared to TmAg-negative patients over a twelve-month follow up period
  3. TmAg concentration predicts development of talaromycosis

Secondary Objectives include:

  1. To assess the impact of presence of TmAg on clinical outcomes, including development of culture-confirmed talaromycosis, incidence of state III and IV AIDS events, subsequent hospitalizations, and death over six- to twelve-month follow up periods
  2. To compare the diagnostic values of the Mp1p EIA when performed in plasma, sera, and urine samples and when performed in these matrices in combination

    We will test the following hypotheses:

  3. To model the health economic benefits of screening and pre-emptive treatment for pre-clinical infection
  4. To assess impact on clinic outcomes of screening all patients for cryptococcosis and histoplasmosis
  5. To collect additional blood samples and store left-over samples for future research to validate infectious disease diagnostics and research to understand genetic susceptibility to infectious diseases relevant to HIV population

Participants in the study, will be asked questions about their medical and travel history. Participants will have blood and urine collected for the Mp1p EIA test to look for early talaromycosis infection and for other tests to look for common HIV-associated infections including tuberculosis, cryptococcosis, and histoplasmosis. They will be examined by a study doctor at least once weekly if they are in the hospital and will be followed in clinic monthly for between 6 and 12 months.

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Study Type : Observational
Estimated Enrollment : 1400 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Making an Early Diagnosis of Talaromycosis - a Strategy to Reduce Morbidity and Mortality in Advanced HIV Disease in Southeast Asia
Estimated Study Start Date : November 2020
Estimated Primary Completion Date : May 2024
Estimated Study Completion Date : May 2024

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS

Group/Cohort
Cohort 1

Cohort 1: Symptomatic hospitalized patients: 900 patients admitted to the participating hospitals whom doctors suspect to have an infection and will perform TmAg testing alongside routine diagnostics and the following additional diagnostics:

  1. MycoF/lytic blood culture system
  2. Fujifilm lateral flow urine lipoarabinomannan (LF-LAM) test for tuberculosis
  3. Cryptotoccoal antigen in sera (CrAg) LFA for cryptococcosis
  4. Histoplasma antigen in urine (HAg) LFA for histoplasmosis

We will follow patients closely for early diagnosis and treatment of culture confirmed talaromycosis over a six-month follow up period

Cohort 2

Cohort 2: Asymptomatic outpatients: 500 patients registered at the outpatient clinics at the participating hospitals whom doctors do not suspect of having an active infection and will perform TmAg testing alongside the following diagnostics:

  1. CrAg LFA for cryptococcosis
  2. HAg LFA for histoplasmosis

We will follow patients closely for early diagnosis and treatment of culture confirmed talaromycosis over a twelve-month follow up period.




Primary Outcome Measures :
  1. Incidence of microscopy and/or culture-confirmed talaromycosis [ Time Frame: over six to twelve months ]
    Cumulative incidence of microscopic and or culture-confirmed talaromycosis over six to twelve months will be recorded


Secondary Outcome Measures :
  1. Incidence of other major HIV-associated opportunistic infections [ Time Frame: over six to twelve months ]
    Opportunistic infections to be recorded include: tuberculosis, cryptococcosis, and histoplasmosis

  2. Incidence of stage III and IV AIDS events [ Time Frame: over six to twelve months ]
    Cumulative incidence of HIV stage III and IV event according to WHO criteria

  3. Hospitalizations in the subsequent six to twelve months [ Time Frame: over six to twelve months ]
    Cumulative incidence of hospitalizations

  4. Mortality in the subsequent six months (Cohort 1) and twelve months (Cohort 2) [ Time Frame: over six to twelve months ]
    All cause mortality will be recorded

  5. Incidence of loss to follow up [ Time Frame: over six to twelve months ]
    Loss of follow up is defined as missing >3 consecutive clinic visits


Biospecimen Retention:   Samples With DNA
Blood and urine samples


Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
HIV-infected patients age ≥18 years with advanced HIV disease who have a CD4 count ≤100 cells/mm3 within the past 3 months, who are admitted to hospitals with a suspected infection (Cohort 1) or who are asymptomatic and registered in HIV outpatient clinic (Cohort 2) in Vietnam
Criteria

Inclusion Criteria:

  1. HIV-1 infection (at least 2 of 3 HIV antibody tests are positive), AND
  2. HIV-infected age ≥18 years, AND
  3. CD4 count ≤100 cells/mm3 within the past 3 months, AND
  4. Antiretroviral therapy (ART) naïve OR recent ART ≤3 months OR suspected or confirmed treatment failure on ART ≥12 months (defined as poor treatment adherence, treatment interruption, or having a confirmed HIV RNA ≥1,000 copies)
  5. Cohort 1: suspected to have an active infection
  6. Cohort 2: not suspected to have or being evaluated for an active infection

Exclusion Criteria:

  1. Unlikely to attend regular clinic visits
  2. History of recent talaromycosis or histoplasmosis infection currently on antifungal therapy

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04033120


Contacts
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Contact: Thuy Le, MD, PhD 919-668-5053 thuy.le@duke.edu
Contact: Rogier van Doorn, MD, PhD +84 4 3576 4320 rvandoorn@oucru.org

Locations
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Vietnam
Hospital for Tropical Diseases
Ho Chi Minh City, Ward 1 District 5, Vietnam
Contact: Nguyen Van Vinh Chau, MD, PhD    84.8.923.5804    chaunvv@oucru.org   
Contact: Vo Trieu Ly, MD    84.8.923.5804    drtrieuly@gmail.com   
National Hospital for Tropical Diseases
Hà Nội, Vietnam
Contact: Nguyen Van Kinh, MD PhD    84.4.3576.4320    kinhnv@nhtd.vn   
Contact: Vu Quoc Dat, MD    84.4.3576.4320    datvq@oucru.org   
Sponsors and Collaborators
Duke University
Oxford University Clinical Research Unit, Vietnam
National Hospital for Tropical Diseases, Hanoi, Vietnam
Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
The University of Hong Kong
Investigators
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Principal Investigator: Thuy Le, MD Duke University
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Responsible Party: Duke University
ClinicalTrials.gov Identifier: NCT04033120    
Other Study ID Numbers: Pro00102384
First Posted: July 25, 2019    Key Record Dates
Last Update Posted: September 25, 2020
Last Verified: May 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Duke University:
HIV
talaromycosis
endemic mycoses
opportunistic infections
penicilliosis
Southeast Asia