Scully EP, Aga E, Tsibris A, Archin N, Starr K, Ma Q, Morse GD, Squires KE, Howell BJ, Wu G, Hosey L, Sieg SF, Ehui L, Giguel F, Coxen K, Dobrowolski C, Gandhi M, Deeks S, Chomont N, Connick E, Godfrey C, Karn J, Kuritzkes DR, Bosch RJ, and Gandhi RT
Background: Biological sex and the estrogen receptor alpha (ESR1) modulate human immunodeficiency virus (HIV) activity. Few women have enrolled in clinical trials of latency reversal agents (LRAs); their effectiveness in women is unknown. We hypothesized that ESR1 antagonism would augment induction of HIV expression by the LRA vorinostat., Methods: AIDS Clinical Trials Group A5366 enrolled 31 virologically suppressed, postmenopausal women on antiretroviral therapy. Participants were randomized 2:1 to receive tamoxifen (arm A, TAMOX/VOR) or observation (arm B, VOR) for 5 weeks followed by 2 doses of vorinostat. Primary end points were safety and the difference between arms in HIV RNA induction after vorinostat. Secondary analyses included histone 4 acetylation, HIV DNA, and plasma viremia by single copy assay (SCA)., Results: No significant adverse events were attributed to study treatments. Tamoxifen did not enhance vorinostat-induced HIV transcription (between-arm ratio, 0.8; 95% confidence interval [CI], .2-2.4). Vorinostat-induced HIV transcription was higher in participants with increases in H4Ac (fold increase, 2.78; 95% CI, 1.34-5.79) vs those 9 who did not (fold increase, 1.04; 95% CI, .25-4.29). HIV DNA and SCA plasma viremia did not substantially change., Conclusions: Tamoxifen did not augment vorinostat-induced HIV RNA expression in postmenopausal women. The modest latency reversal activity of vorinostat, postmenopausal status, and low level of HIV RNA expression near the limits of quantification limited assessment of the impact of tamoxifen. This study is the first HIV cure trial done exclusively in women and establishes both the feasibility and necessity of investigating novel HIV cure strategies in women living with HIV., Clinical Trials Registration: NCT03382834., Competing Interests: Potential conflicts of interest. Merck and Co provided vorinostat for use in this study; K. E. S., B. J. H., and G. W. are employees of Merck. This article was written in C. G.’s capacity as a US government employee, but the views expressed here should not be construed to represent the views of the Department of State or the NIH. E. A., R. J. B., R. T. G., and N. A. report other grants outside of the submitted work from the NIH/NIAID paid to their institution. E. C. reports grants or contracts from the NIAID ACTG for salary support and grants or contracts from NIDA–R01, NIAID–PO1, and NIAID–COVPN; consulting fees from Seagen; and participation on a data safety monitoring board or advisory board for Adagio Therapeutics. D. R. K. reports support for ACTG trials from Gilead and Merck and grant for research from ViiV outside of the submitted work; consulting fees from Gilead, GlaxoSmithKline, Janssen, Merck, and ViiV; speaker fees from Gilead and Janssen; participation on a data safety monitoring board or advisory board for GlaxoSmithKline and ViiV; and received drugs for ACTG trials from Gilead, Janssen, Merck, and ViiV. L. H. reports being employed by a federal contractor who supports research conducted in the ACTG under a grant from the NIAID outside of the submitted work. J. K. reports support for the current article paid to their institution from the NIH Center for AIDS Research (NIH P30 AI036219 and amfAR #109348-59-RGRL) and reports receiving no payments for patent UC2019 0093182 (Method of Quantifying HIV Reservoirs by Induced Transcription Based Sequencing). E. P. S. reports grants or contracts outside of the submitted work from the NIH and Doris Duke Foundation; consulting fees paid to self in 2019 for a Merck Global Advisory meeting; payment or honoraria from Practice Point CME, Vindico CME, IAS-USA, and Mediahuset CME; and a Merck donation of drug for this study provided to the ACTG for use in the study. S. F. S. reports grants or contracts paid to their institution from Gilead (Lederman, PI). A. T. reports payments made to their institution outside of the submitted work from NIH/NIAID, NIH/NIDA, and Merck; consulting fees paid to self from Gilead Sciences for serving as a reviewer for Gilead’s Research Scholars Program in HIV; and payments made to self from DalCor Pharmaceuticals for participation on a data safety monitoring board or advisory board. F. G. reports purchasing shares in Merck in March 2021. G. W. and K. E. S. report employer support for attending meetings and/or travel from Merck and stock or stock options made to self from Merck. K. S. reports support for travel to a meeting from ACTG and being on the Community Scientific Subcommittee in the ACTG in 2019. N. C. reports a grant to their laboratory from EMD Serono outside of the submitted work and consulting fees to self for 1 meeting from Gilead (Canada). R. T. G. reports being on a scientific advisory board for Merck. S. D. reports grants or contracts from amfAR, NIH, and Gilead outside of the submitted work; consulting fees from GlaxoSmithKline/ViiV, Immunocore, Scientific Advisory Board for BryoLogyx, Enochian Biosciences, and Tendel; and research collaboration from Merck. B. J. H. reports employer support from Merck for attending meetings and/or travel and being a committee member for the International AIDS Society Industrial Collaboratory Working Group. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)