Modulation of Immune Activation by Aspirin

Inclusion Criteria:

- HIV-1 infection.

- Currently on continuous ART for ≥48 weeks prior to study entry. NOTE: This is defined
as continuous active therapy with no treatment interruption longer than 7 consecutive
days and a total duration off-treatment of no more than 14 days during the 48 weeks
prior to entry.

- No change in ART regimen within the 12 weeks prior to study entry (except as noted
below).

NOTE: Modifications of ART dosing during within the 12 weeks prior to entry are permitted.
In addition, the change in formulation (eg, from standard formulation to fixed dose
combination or single tablet regimen) or dosing (eg, from once a day to twice a day) is
allowed within 12 weeks prior to entry. Within-class single drug substitution (eg, switch
from nevirapine to efavirenz or from atazanavir to darunavir), are not allowed within 12
weeks prior to entry. No other changes in ART in the 12 weeks prior to entry are
permitted.

- Screening HIV-1 RNA must be <50 copies/mL and performed by any FDA-approved assay at
any US laboratory that has a CLIA certification or its equivalent within 45 days
prior to study entry.

- Maintain ART-mediated viral suppression for at least 48 weeks prior to study entry
defined as:

A. At least one HIV-1 RNA test result obtained at any time point greater than 48 weeks
prior to study entry must be BLQ and must be performed by any FDA-approved assay at a
CLIA-certified laboratory or its equivalent.

AND

B. All HIV-1 RNA tests reported during the 48 weeks prior to study entry must be BLQ and
must be performed by any FDA-approved assay at a CLIA-certified laboratory or its
equivalent.

NOTE: A single RNA "blip" of ≤500 copies/mL is permissible if RNA levels most recent
before and after (may include the screening HIV-1 RNA test) are below the level of
quantification (BLQ) for the assay. If the RNA level after the blip is the screening HIV-1
RNA test, the result must be <50 copies/mL.

- The following laboratory values obtained within 45 days prior to study entry by any
US laboratory that has a CLIA certification or its equivalent.

- Absolute neutrophil count (ANC) ≥750/mm3

- Hemoglobin ≥9.0 g/dL for female subjects and ≥10.0 g/dL for male subjects

- Platelet count >100,000/mm3

- Prothrombin time (PT) <1.2 x upper limit normal (ULN)

- Partial thromboplastin time (PTT) <1.5 x ULN

- Calculated creatinine clearance (CrCl) ≥30 mL/min, as estimated by the
Cockroft-Gault formula NOTE: Calculation for the Cockcroft-Gault equation is
available at https://www.fstrf.org/apps/cfmx/apps/common/Portal/index.cfm

- Aspartate aminotransferase (AST) (SGOT) ≤2 x ULN.

- Alanine aminotransferase (ALT) (SGPT) ≤2 x ULN.

- Alkaline phosphatase ≤2 x ULN.

- Total bilirubin ≤2.5 x ULN. If the subject if taking an indinavir- or
atazanavir-containing regimen at the time of screening, a total bilirubin of ≤5
x ULN is acceptable.

- Female study volunteers of reproductive potential (pre-menopausal women who have not
had a sterilization procedure (eg, hysterectomy, bilateral oophorectomy, tubal
ligation, or salpingectomy) must have a negative serum or urine pregnancy test
performed within 24 hours prior to study entry. Women are considered menopausal if
they have not had a menses for at least 12 months and have a FSH (follicle
stimulating hormone) of greater than 40 IU/L or, if FSH testing is not available,
they have had amenorrhea for 24 consecutive months.

If the female volunteer is not of reproductive potential (women who are menopausal,
defined as not having had a menses for at least 12 months with an FSH of greater than 40
IU/L, or if FSH testing is not available, have had amenorrhea for 24 consecutive months,
or women who have undergone surgical sterilization, (eg, hysterectomy, bilateral
oophorectomy, tubal ligation or salpingectomy)), she is eligible without requiring the use
of a contraceptive method. Acceptable documentation of sterilization is subject reported
history of hysterectomy, bilateral oophorectomy, tubal ligation, tubal micro-insert,
menopause, or the partner with vasectomy/azoospermia.

- If participating in sexual activity that could lead to pregnancy, the female study
volunteer must be willing to use contraception while receiving protocol-specified
medication(s) and for the washout period of 4 weeks. At least one of the following
methods MUST be used:

- Condoms (male or female), with or without a spermicidal agent

- Diaphragm or cervical cap with spermicide

- Intrauterine device (IUD)

- Hormone-based contraceptive

As hormone-based contraceptives (oral, transdermal, or subdermal) can affect coagulopathy
biomarkers, subjects who plan on using such a contraceptive during the study must be
taking the same product for ≥4 weeks prior to screening and be encouraged to continue
throughout the duration of the study, if medically feasible.

- No documented opportunistic infections within 24 weeks prior to study entry

- Karnofsky performance score >/= 70 within 45 days prior to study entry

- Ability and willingness of subject or legal guardian/representative to provide
written informed consent.

- Willingness to refrain from the use of aspirin or any aspirin-related product (other
than the study drug), including NSAIDs, from time of screening visit through the end
of the 16 week trial.

NOTE: Acetaminophen-based products may be used before and during the trial when analgesics
are required.

- Completion of the pre-entry FMD assessment NOTE: The FMD must be performed at the
site and confirmed as acceptable by the University of Wisconsin Atherosclerosis
Imaging Research Program (UW AIRP) core lab prior to study entry.

- Confirmation of the availability of the stored pre-entry fasting specimens (plasma
and serum); the site must confirm that these specimens have been entered into the
Laboratory Data Management System (LDMS).

Exclusion Criteria:

- Current malignancy (except non-melanoma cancer of the skin not requiring systemic
chemotherapy or radiation therapy).

NOTE: Carcinoma in situ of the cervix or anus is not considered exclusionary.

- Prior history of malignancy if the subject is not disease free for 24 or more weeks
prior to study entry.

- Current use or indication for use of non-steroidal anti-inflammatory drugs (NSAIDs)
or aspirin that cannot be interrupted for clinical reasons. Examples of clinical
reasons include, but are not limited to, known and documented cardiovascular disease
(history of MI, coronary artery bypass graft surgery, percutaneous coronary
intervention, stroke, transient ischemic attack, peripheral arterial disease with ABI
<0.9 or claudication).

- Current diagnosis of diabetes with HbA1c ≥8% within 24 weeks prior to screening.

- Changes in lipid-lowering or antihypertensive medication within 90 days prior to
study entry or expected need to modify these medications during the study.

NOTE: Lipid-lowering medication includes: statins, fibrates, niacin (dose ≥250 mg daily),
and fish-oil/omega 3 fatty acids (dose >1000 mg of marine oils daily).

- Known cirrhosis

- Known chronic active hepatitis B NOTE: Active hepatitis B is defined as hepatitis B
surface antigen positive and hepatitis B DNA positive within 24 weeks prior to study
entry; subjects with hepatitis B virus (HBV) DNA BLQ for greater than 24 weeks prior
to study entry are eligible.

- Known chronic active hepatitis C NOTE: Active hepatitis C is defined as a detectable
plasma HCV RNA level within 24 weeks prior to study entry; subjects with HCV RNA BLQ
for greater than 24 weeks prior to study entry are eligible.

- Known inflammatory conditions, such as, but not limited to, rheumatoid arthritis
(RA), systemic lupus erythematosus (SLE), sarcoidosis, inflammatory bowel disease
(IBD), chronic pancreatitis, autoimmune hepatitis, Adult Stills disease, Rheumatic
heart disease, bursitis.

- Breastfeeding or pregnant

- Previous intolerance or allergy to aspirin or any aspirin products.

- Frequent use of aspirin or aspirin products (NSAIDs), defined as an average of 2 or
more times per week in the last 12 weeks prior to study entry.

- Immunosuppressant use, such as, but not limited to, systemic or potentially systemic
glucocorticoids (including injected, ie, intra-articular, nasal or inhaled steroids),
azathioprine, tacrolimus, mycophenolate, sirolimus, rapamycin, methotrexate, or
cyclosporine within 45 days prior to study entry.

- Use of any systemic antineoplastic or immunomodulatory treatment, investigational
vaccines, interleukins, interferons, growth factors, or intravenous immunoglobulin
(IVIG) within 45 days prior to study entry.

NOTE: Routine standard of care, including hepatitis A and/or B, human papilloma virus,
influenza, pneumococcal, and tetanus vaccines are permitted if administered at least 7
days before study entry and before biomarker/peripheral blood mononuclear cell (PBMC)
blood collections.

- Concurrent use of prohibited medications as per section 5.4

- Heavy alcohol use as defined by the National Institute on Alcohol Abuse and
Alcoholism (NIAAA)
http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

- Alcohol or drug use or dependence that, in the opinion of the site investigator,
would interfere with adherence to study requirements.

- Current use of anticoagulation therapy or conditions requiring use of anticoagulants,
use such as, but not limited to warfarin (Coumadin), rivaroxaban (Xarelto),
clopidogrel (Plavix), dabigatran (Pradaxa), apixaban (Eliquis), heparin, ticlopidine
(Ticlid), Presugrel (Effient).

- History of coagulopathy, deep venous thrombosis, pulmonary embolism.

- Known active or recent (not fully resolved within 4 weeks prior to study entry)
invasive bacterial, fungal, parasitic, or viral infections.

NOTE: Recurrent herpes simplex virus (HSV) is not exclusionary. Subjects on antiviral
prophylaxis for HSV or VZV are encouraged to remain on treatment for the duration of the
study if medically feasible.

- Serious illness or trauma requiring systemic treatment and/or hospitalization within
4 weeks prior to study entry.

- History of bleeding conditions such as peptic ulcer disease, hemophilia, von
Willebrand disease, idiopathic thrombocytopenic purpura.

- History of thrombotic disorders such as protein C or S deficiency.

- History of gastrointestinal (GI) bleeding within the past 6 months prior to study
entry.

- History of intracranial hemorrhage.