Study to Evaluate Safety and Toxicity of Polyphenon E (EGCG) in HIV-1-Infected Individuals

HIV-1 infection ultimately results in impaired specific immune function by virtue of the
initial binding of the HIV-1 virion envelope glycoprotein 120 (gp120) to the CD4 receptor in
complex with a chemokine receptor on the T-cell surface1. Even though gp120 elicits
virus-neutralizing antibodies, HIV-1 eludes the immune system and leads to the onset of
AIDS. Ever since the discovery of the virus as the causative agent, there has been an
intense effort to develop therapeutic methods to inhibit or prevent infection.2-4 CD4, a
cell surface glycoprotein expressed on T cells, plays an important role in the recognition
of antigens by T cells and in their activation.5 It also acts as a receptor for HIV-1 as
gp120 binds to it via its D1 domain and, uses this interaction to infect CD4+ T cells.5
Therefore, there has been interest in finding molecules that block the binding of gp120 to
CD4 (entry inhibitors) as a way of reducing HIV-1 infectivity.

Studies have demonstrated evidence of high affinity binding of EGCG to the CD4 molecule with
a Kd of 10nM with subsequent inhibition of gp120 binding to human CD4+ T cells. EGCG binds
in the same molecular pocket on CD4, as does HIV-1-gp120 at physiologically relevant
concentrations.

This is a phase I, placebo-controlled, dose-blinded, randomized study of Polyphenon® E as
monotherapy in participants who are HIV-1-infected with a CD+ T lymphocyte count of at least
250 cells/mm3 and are ARV-naïve or ARV-experienced. There will be three treatment arms, each
consisting of 8 evaluable participants. Two participants in each study arm will be
randomized to receive placebo. Dosing will be escalated sequentially contingent on the
safety profile of previous doses. Safety data from all participants receiving Polyphenon® E
in the preceding arm will be evaluated and considered acceptable prior to escalation to the
next higher dose. PK analyses will be also performed as each arm is completed. If at least 4
subjects on active drug in each arm have evaluable PK data, subjects will not be replaced.
As the inability to achieve adequate EGCG concentrations that are necessary to inhibit HIV-1
replication is a major concern in this study, it is necessary to confirm EGCG
pharmacokinetics in the event that the primary outcome measure of virologic response is not
observed for each arm. For each PK visit on Study Days 1 and 14, a total of 10 blood samples
will be obtained per subject. If only a few samples cannot be used (this depends on the
individual subject's pharmacokinetic profile, although one or two unevaluable samples will
not likely cause a subject's data to be unevaluable), PK analyses can still be performed and
will not require subjects to be deemed unevaluable and replaced.

Inclusion Criteria:

- HIV-infected individual as having at least two of the following in any combination
obtained from 2 different samples: Positive HIV rapid test or ELISA and Western Blot;
HIV RNA PCR>10,000 copies/ml; positive HIV DNA PCR; neutralizable HIV p 24 antigen

- Asymptomatic HIV-1 infected individuals who are either antiretroviral-naive or
treatment-experienced. Subjects must have not been on ARV treatment for at least 12
weeks prior to enrollment and not have plans to start ARV treatment within 8 weeks of
study initiation.

- Male or female 18 to 65 years of age. Males must use barrier methods of contraception
Females must be willing to abide by protocol specified methods to avoid becoming
pregnant. Women of childbearing potential must use an adequate form of birth control
determined by the investigator (e.g., oral contraceptives, double-barrier methods,
hormonal injectable or implanted contraceptives, tubal ligation, or vasectomy).

- HIV-1 RNA >1,000 copies/mL at Screening.

- In the opinion of the investigator, subject has a stable CD4+ T lymphocyte count
while off ARV and 250 cells/mm3 at Screening.

- Participants should have no clinically significant findings on screening evaluations
(clinical, laboratory, or EKG).

- Be able to comprehend and willing to sign an ICF.

- Be able to comply with the protocol requirements.

- Have life expectancy > 6 months.

- Laboratory values obtained during screening must be within normal limits or meet the
following requirements (Safety Labs):

- ANC 1000/mm3

- Hemoglobin 9.0 g/dL

- Glucose (nonfasting) <116 mg/dL

- Bilirubin 1.5 x upper limit of normal (ULN)

- Liver function tests (AST & ALT) 1.25 x ULN at screening and baseline

- GGT < 5.0 x ULN

- Negative hepatitis panel obtained less than or equal to 6 months prior to Study Entry

- Creatinine 1.3 x ULN

- Creatine phosphokinase (CPK) 5 x ULN unless further evaluation determines it to be
due to exercise

- Urine protein 2+

- Prothrombin time (PT)1.25 x ULN

- Lipase 1.2 x ULN

Exclusion Criteria:

- Current or recent (<3 months) history of opportunistic infection that,

- Acute illness within 1 week of the baseline visit.

- Participant is not able to comply with the dosing schedule and protocol evaluations.

- Participant is anticipated to begin ARV treatment during participation in the study.

- Pregnancy, breastfeeding or postpartum (less than 3 months).

- Diagnosis of diabetes.

- Any condition which could compromise participant safety or adherence to the protocol.

- Documented positive test for hepatitis B surface antigen, hepatitis B surface
antibody (with the exception of participants who received hepatitis B vaccination and
have hepatitis B surface antibody), hepatitis B core antibody, and hepatitis C
antibody.

- Any grade 3 or 4 laboratory abnormality noted at screening according to the DAIDS
grading scale (Appendix A), except for the following:

- Grade 3 or 4 triglyceride elevations.

- Grade 3 cholesterol elevation.

- Grade 3 non-fasting glucose elevation.

- Participant has a malabsorption syndrome possibly affecting drug absorption (e.g.
Crohn's disease or chronic pancreatitis).

- Participant has received an HIV prophylactic or therapeutic vaccination within 6
months prior to the first dose of study medication.

- Investigational therapy within 30 days prior to the Baseline visit.

- Radiation therapy or systemic cytotoxic chemotherapeutic agents within 12 weeks prior
to the baseline visit or have not recovered from side effects from such therapy prior
to the first dose of study medication.

- Positive urine screen for drugs of abuse at Screening, unless the investigator deems
that the result is associated with a prescribed medication or inhaled use of THC.

- Inability to avoid all tea/tea products (including herbal, caffeinated,
decaffeinated, iced tea), apples, chocolate, broad beans (fava beans), plums, prunes,
cherries, fruit juices containing apples, cherries, or plums, dietary supplements,
and herbal products for 1 week prior to the baseline visit and for the duration of
the study.

- Inability to limit caffeine intake to not exceed 12 oz. of caffeinated beverage per
day (if espresso, no more than 1 oz. or 1 shot) beginning 2 days prior and for the
duration of the study.

- Prior exposure to TNX-355 (an investigational anti-HIV agent that binds to the CD4+ T
lymphocyte surface).

- Participant has used proton pump inhibitors starting 14 days before Study Day 1 and
is unable to avoid taking proton pump inhibitors for the duration of the study.

- Participant has used H2 blockers starting 24 hours before Study Day 1 and is unable
to avoid taking H2 blockers for the duration of the study.