Kaletra and Viread in Antiretroviral Naïve Patients

• Proportion of patients with <400copies/ml [ Time Frame: 4,8, and 12 weeks ] [ Designated as safety issue: No ]
• Review virologic response to assess rate of viral decline. [ Time Frame: weeks 4, 8, 12, 16, and 24 ] [ Designated as safety issue: No ]
• Proportion of patients with <50 copies/ml HIV-1 RNA [ Time Frame: at weeks 4, 8, 12, 16, 24, 32, 40, and 48 ] [ Designated as safety issue: No ]
• Change from baseline CD4 counts [ Time Frame: at weeks 4, 8, 12, 16, 24, 32, 40, and 48 ] [ Designated as safety issue: No ]
• Time to virologic failure. [ Time Frame: Week 48 ] [ Designated as safety issue: No ]
• Tolerability and adverse events. [ Time Frame: 48 weeks ] [ Designated as safety issue: Yes ]
• Change from baseline fasting total cholesterol and fasting triglyceride levels. [ Time Frame: 48 weeks ] [ Designated as safety issue: Yes ]
• Characterize adherence rates for this therapeutic regimen by the use of Medication Electronic Monitoring Systems (MEMS) caps. [ Time Frame: 48 weeks ] [ Designated as safety issue: No ]
• Characterize adherence rates for this therapeutic regimen by use of pharmacy refill records. [ Time Frame: 48 weeks ] [ Designated as safety issue: No ]
• Assess genotypic changes in patients with virologic failure. [ Time Frame: 48 weeks ] [ Designated as safety issue: No ]
• Assess lopinavir trough levels in patients failing to obtain virologic suppression. [ Time Frame: 48 weeks ] [ Designated as safety issue: No ]

Once daily antiretroviral therapy with Viread (tenofovir DF, 300mg) plus Kaletra (LPV/r, 800mg/200mg) will be effective in suppressing and maintaining suppression of HIV RNA to <50 copies/ml in antiretroviral naïve patients through 48 weeks of therapy.

This study is a phase IV prospective, open-label, controlled treatment protocol consisting of once daily Kaletra dosed at 800mg lopinavir with 200mg ritonavir in four combination tablets plus Viread dosed as 300 mg tenofovir DF. This will be a single site, multi-investigator, study for 48 weeks. Consecutive eligible patients will be enrolled into the study to reach the enrollment goal of 30 patients. Eligible patients will be identified and screened during routine initial or follow-up visits at the Internal Medicine Specialty Services Clinic. This clinic serves as the HIV/AIDS specialty care clinic and is a subdivision of the Department of Internal Medicine, Oklahoma State University Center for Health Sciences College of Osteopathic Medicine. The study site currently serves >700 persons living with HIV in northeast Oklahoma with four to five antiretroviral naïve patients seen each week.

Patients meeting all inclusion criteria will receive routine standard of care for our program as prescribed by the DHHS guidelines. Patients will have a Complete Blood Count (CBC), Complete Metabolic Profile (CMP), fasting lipid profile, CD4 count, HIV-1 RNA level, and other prescribed or indicated laboratory preformed at baseline and throughout the study as described in the Visits and Evaluations section of this protocol. All of the aforementioned laboratory tests will be performed at the Diagnostic Laboratories of Oklahoma, a division of Quest Diagnostics. Any antiretroviral resistance testing will be performed at Virologic Labs, Inc. Adherence will be assessed at discontinuation of the study and when indicated for evaluation of virologic failure by Memory Electronic Monitoring Systems caps and pharmacy refill data. Patients will be monitored at each study visit for tolerability and adverse events. Patients who develop a study related Grade 1 or 2 Adverse Events (Aes) may continue the study. Those who develop Grade 3 or 4 AEs will have study medications discontinued. Patients with asymptomatic elevations of triglyceride or Low Density Lipoprotein (LDL) cholesterol levels may be treated with appropriate lipid lowering therapy at the investigators discretion.

Inclusion Criteria:

1. Male or female patients >18 years of age with documented HIV-1 infection
2. Naïve to antiretroviral therapy
3. Able and willing to provide written informed consent
4. No CD4 restriction
5. HIV-1 RNA levels >5000 c/mL

6. Female patients must meet these additional criteria

   1. Non-childbearing potential
   2. Negative serum pregnancy test at screen
   3. Willingness to abstain from sexual intercourse or use double barrier contraception

Exclusion Criteria:

1. Presence of any of the following:

   1. Aminotransferases >3xULN
   2. Hemoglobin concentration <8.0g/dl
   3. Absolute neutrophil count <800 cells/cubic mm
   4. Platelet count <50,000 cells/cubic mm
   5. Acute illness, or an acute illness ≤7 days
   6. Presence of Opportunistic Infection, or an OI within 30 days of screening
   7. Acute or chronic active Hepatitis B
   8. Hepatitis C
   9. Creatinine Clearance <50 mL/min
2. Pregnant or breast-feeding women
3. Presence of any illness, physical or behavioral conditions (i.e., substance abuse, excluding cannabis) that will impair the patient's ability participate
4. Patient who, in the opinion of the investigator, will be unlikely to complete the study protocol and adhere to the study drug regimens
5. Concurrent use of medications that may potentially interact with study medications including: astemizole, terfenadine, rifampin, dihydroergotamine, ergonovine, ergotamine, methylergonovine, cisapride, St. John's wort, lovastatin, simvastatin, pimozide, midazolam, triazolam, adefovir, cidofovir, acyclovir, ganciclovir, and valganciclovir.
6. Patient suffers from a serious medical condition that may in the opinion of the investigator compromise his or her safety.