Immune Reconstitution of Lopinavir/Ritonavir-Based vs Efavirenz-based HAART in Advanced HIV Disease
The ideal anti-HIV medications for patients with advanced HIV disease is unknown. There is evidence that anti-HIV regimens that contain protease inhibitors can enhance immune function better than regimens that do not contain protease inhibitors. This is a study that will determine the difference in immune enhancement capabilities between an anti-HIV regimen that contains the protease inhibitor - lopinavir-ritonavir, and a regimen that contains efavirenz. Both medications are recommended as first line treatments for HIV-infected patients. This study will recruit HIV-positive patients that need to start anti-HIV treatment because their CD4+ T-cells are below 200. The usual threshold for starting treatment is a CD4+ T-cell less than 350. Subjects will be randomized to treatment with either an anti-HIV regimen that contains lopinavir-ritonavir or a regimen that contains efavirenz. The study will determine the difference in immune reconstitution over 24 weeks of treatment with study medications. Among the immune parameters that will be measured is the ability of each subject to respond to vaccination with the tetanus-diphtheria vaccine and the 23-valent pneumococcal vaccine. Both vaccines are also recommended for HIV-positive patients but HIV-positive patients tend to have a lower response rate to these vaccines.
Acquired Immune Deficiency Syndrome
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||A Phase 4 Study of the Effect on Immune Reconstitution of a Lopinavir/Ritonavir-Based Versus an Efavirenz-based HAART Regimen in Antiretroviral-Naïve Subjects With Advanced HIV Disease|
- Rates of ex vivo CD4+ T-cell apoptosis [ Time Frame: 24 weeks after treatment initiation ] [ Designated as safety issue: No ]
- CD4+ T-cell change [ Time Frame: 12, 24 and 48 weeks after treatment initiation ] [ Designated as safety issue: No ]
- Naive, central memory and effector memory CD4+ and CD8+ T-cell frequency [ Time Frame: 4, 12 and 24 weeks after treatment initiation ] [ Designated as safety issue: No ]
- activated and regulatory CD4+ and CD8+ T-cell frequencies [ Time Frame: 4, 12 and 24 weeks after treatment initiation ] [ Designated as safety issue: No ]
- Response to immunization with pneumococcus polysaccharide and tetanus-diphtheria vaccines [ Time Frame: 4 weeks after treatment initiation ] [ Designated as safety issue: No ]
|Study Start Date:||October 2008|
|Study Completion Date:||January 2011|
|Primary Completion Date:||December 2010 (Final data collection date for primary outcome measure)|
Active Comparator: 1
Lopinavir 400 mg/ritonavir 100 mg BID + emtricitabine 200 mg/tenofovir 300 mg QD
Lopinavir 400 mg/ritonavir 100 mg fixed dose combination BID + emtricitabine 200 mg/tenofovir 300 mg fixed dose combination QD
Active Comparator: 2
Efavirenz 600 mg/emtricitabine 200 mg/tenofovir 300 mg QD
Efavirenz 600 mg/emtricitabine 200 mg/tenofovir 300 mg fixed dose combination QD
Other Name: Atripla
DESIGN: ICE-001 is a phase IV, randomized, two-arm unblinded study, comparing the effect on immune reconstitution of open-label ritonavir (RTV)-enhanced lopinavir (LPV) to efavirenz (EFV), in combination with daily emtricitabine (FTC)/tenofovir (TDF) as initial therapy for HIV-1 infection in HIV-infected treatment naïve subjects with CD4+ T-cells less than 200 cells/ml.
DURATION: Subjects will participate in ICE-001 for approximately 48 weeks after starting study treatment.
SAMPLE SIZE: ICE-001 will enroll 60 subjects (30 per treatment arm).
POPULATION: HIV-1-infected, antiretroviral (ARV) drug-naïve (≤7 days of ARV treatment at anytime prior to study entry) men and women between18 to 60 years of age with plasma HIV-1 RNA levels >1000 copies/mL and CD4+ T-cell counts < 200 cells/ml obtained within 90 days prior to study entry.
STRATIFICATION: Subjects will be stratified at screening based on plasma HIV-1 RNA levels <100,000 and ≥100,000 copies/mL.
REGIMEN: At entry subjects will be randomized to one of the following:
- ARM A: LPV 400 mg/RTV 100 mg BID + FTC 200 mg/TDF 300 mg QD
- ARM B: EFV 600 mg QD/FTC 200 mg/TDF 300 mg fixed dose combination QD
The objective is to determine the differences in the degree of immune reconstitution in HIV-infected patients with a CD4+ T-cell count < 200 cells/ml who initiated treatment with LPV/RTV + FTC/TDF compared to EFV/FTC/TDF.
Study visits will occur at screening, pre-entry, entry and weeks 1, 4, 8, 12, 24 and 48 after study entry. Study medications will be provided at entry after randomization. At most study visits, clinical assessments, including histories, physical exams and determination of drug adherence, will occur. Blood for hematologic and metabolic safety assessments and for the assessment of immune parameters will be obtained. Immune parameters that will be measured include levels of T-cell apoptosis, maturation and activation. Frequencies of various T-cell subsets and other lymphocyte populations will also be done. Response to vaccination with tetanus-diphtheria vaccine and 23-valent pneumococcal polysaccharide vaccine (both given at week 8) will be measured.
|United States, Illinois|
|Rush University Medical Center|
|Chicago, Illinois, United States, 60612|
|Mt. Sinai Hospital|
|Chicago, Illinois, United States, 60608|
|Howard Brown Health Center|
|Chicago, Illinois, United States, 60613|
|University of Chicago Hospital|
|Chicago, Illinois, United States, 60637|
|University of Illinois Medical Center|
|Chicago, Illinois, United States, 60612|
|Study Chair:||Allan R. Tenorio, M.D.||Rush University Medical Center|