Study of Options for Second-Line Effective Combination Therapy (SELECT)
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Purpose
The study is being done with people who are taking their first anti-HIV drug regimen (including an Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI), a type of anti-HIV drug) but the drugs in this regimen are not doing a good job of fighting their HIV infection.
The main purpose of this study is to compare two other anti-HIV drug regimens to see how well they fight HIV. The study will also see how well participants tolerate the drug regimens and how safe they are.
The study will determine whether taking the combination of lopinavir/ritonavir (LPV/r) plus raltegravir (RAL) works as well as what usually is used for second-line therapy: LPV/r plus the best-available nucleoside (nucleotide) reverse transcriptase inhibitor (NRTI) combination. Testing a regimen that does not include any NRTI is important because NRTIs may no longer work for patients who received them as part of their first treatment regimen.
| Condition | Intervention | Phase |
|---|---|---|
|
HIV-1 Infection |
Drug: Lopinavir/ritonavir Drug: Raltegravir Drug: Emtricitabine/tenofovir disoproxil fumarate Drug: Abacavir/lamivudine/zidovudine Drug: Abacavir/lamivudine Drug: Lamivudine/zidovudine Drug: Abacavir Drug: Zidovudine Drug: Lamivudine |
Phase 3 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Multicenter Study of Options for Second-Line Effective Combination Therapy (SELECT) |
- Time to virologic failure [ Time Frame: At or after study Week 24 ] [ Designated as safety issue: No ]The primary endpoint is time to virologic failure. Virologic failure is defined as confirmed viral load >400 copies/mL at or after week 24.
- Change in CD4+ cell count from baseline [ Time Frame: Weeks 48 and 96 ] [ Designated as safety issue: No ]CD4+ cell count at baseline, weeks 48, 96 and at virologic failure
- HIV-1 drug resistance mutations in gag, protease, reverse transcriptase, and integrase in participants with virologic failure at baseline and at time of virologic failure [ Time Frame: Through to week 96 ] [ Designated as safety issue: No ]
- Time to first Grade 3 or higher Adverse Event (AE) that is at least one grade higher than baseline [ Time Frame: Through to week 96 ] [ Designated as safety issue: Yes ]
- Time to discontinuation of randomized treatment for toxicity [ Time Frame: Through to week 96 ] [ Designated as safety issue: Yes ]Time to discontinuation of randomized treatment for toxicity (including participant decision to discontinue for low grade toxicity); within class NRTI changes are not considered an endpoint.
- Time to new AIDS-defining events, death and targeted serious non-AIDS-defining events [ Time Frame: Through to week 96 ] [ Designated as safety issue: Yes ]
- Duration of hospitalizations [ Time Frame: Through to week 96 ] [ Designated as safety issue: No ]
- Changes in fasting total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and glucose from baseline [ Time Frame: Weeks 48 and 96 ] [ Designated as safety issue: No ]
| Estimated Enrollment: | 600 |
| Study Start Date: | January 2012 |
| Estimated Study Completion Date: | April 2015 |
| Estimated Primary Completion Date: | May 2014 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Arm A: LPV/r plus RAL
Participants will be administered LPV/r plus RAL orally twice daily until the participant reaches 96 weeks of follow-up.
|
Drug: Lopinavir/ritonavir
Lopinavir 400mg/ritonavir 100mg (given as two LPV 200mg/RTV 50mg fixed-dose combination tablets) orally twice daily, with or without food, until the participant reaches 96 weeks of follow-up.
Other Names:
|
|
Experimental: Arm B: LPV/r plus best available NRTIs
Participants will be administered LPV/r orally twice daily, plus NRTI options provided by the study, to include the best available NRTIs (listed below) until the participant reaches 96 weeks of follow-up-
|
Drug: Lopinavir/ritonavir
Lopinavir 400mg/ritonavir 100mg (given as three LPV 133.3 mg/RTV 33.3 mg fixed-dose combination soft gelatin capsules) orally twice daily, with food until the participant reaches 96 weeks of follow-up.
Other Names:
Drug: Raltegravir
Raltegravir 400 mg tablet orally twice daily, with or without food, until the participant reaches 96 weeks of follow-up.
Other Names:
Drug: Emtricitabine/tenofovir disoproxil fumarate
Emtricitabine 200 mg/tenofovir disoproxil fumarate 300mg fixed-dose combination tablet orally once daily, with or without food, until the participant reaches 96 weeks of follow-up.
Other Names:
Drug: Abacavir/lamivudine/zidovudine
Abacavir 300 mg/lamivudine 150 mg/zidovudine 300 mg fixed-dose combination tablet orally twice daily, with or without food, until the participant reaches 96 weeks of follow-up.
Other Names:
Drug: Abacavir/lamivudine
Abacavir 600 mg/lamivudine 300 mg fixed-dose combination tablet orally once daily, with or without food, until the participant reaches 96 weeks of follow-up.
Other Names:
Drug: Lamivudine/zidovudine
Lamivudine 150 mg/zidovudine 300 mg fixed-dose combination tablet orally twice daily, with or without food, until the participant reaches 96 weeks of follow-up.
Other Names:
Drug: Abacavir
Abacavir 300 mg tablet orally twice daily or 600 mg (given as two 300 mg tablets) once daily, with or without food, until the participant reaches 96 weeks of follow-up.
Other Names:
Drug: Zidovudine
Zidovudine 300 mg tablet orally twice daily, with or without food, until the participant reaches 96 weeks of follow-up.
Other Names:
Drug: Lamivudine
Lamivudine 150 mg tablet orally twice daily, with or without food, until the participant reaches 96 weeks of follow-up.
Other Names:
|
Show Detailed Description
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- HIV-1 infected
- Confirmation of first-line virologic failure
- Certain laboratory values obtained within 45 days prior to study entry. More information on this criterion can be found in the study protocol.
- Negative pregnancy test within 48 hours prior to study entry.
- Must refrain from participating in a conception process, and, if participating in sexual activity that could lead to pregnancy, must use at least one acceptable type of contraceptive. More information on this criterion can be found in the study protocol.
- Karnofsky performance score >/= 70 within 45 days prior to study entry.
- Ability and willingness of participant or legal guardian/representative to provide informed consent.
- No intention to relocate away from current geographical area of residence for the duration of study participation.
Exclusion Criteria:
- Use of any immunomodulator, HIV vaccine, or other investigational therapy within 45 days prior to study entry, with the exception of a tapering course of corticosteroids as acute therapy for pneumocystis jiroveci pneumonia (PCP) or acute asthma/chronic obstructive pulmonary disease flare and/or prednisone at a daily dose of <10 mg (physiologic replacement dose).
- If the potential participant has had resistance testing, evidence of broad NRTI cross-resistance that, in the opinion of the investigator, would not allow selection of an effective NRTI combination if the participant were randomized to the LPV/r + best available NRTIs arm.
- Prior exposure to a Protease Inhibitor.
- Known history of congenital long QT syndrome, hypokalemia, or planned use of other drugs that prolong the QT interval.
- Pregnancy or breast-feeding.
- Known history of chronic hepatitis B virus (HBV) infection or current HBV infection defined by the presence of hepatitis B surface antigen in serum or plasma.
- Active tuberculosis (TB) requiring treatment with rifampicin.
- Previously diagnosed malignancies other than basal cell carcinoma and cutaneous Kaposi sarcoma.
- Requirement for taking any medications that are prohibited with the study drugs. More information on this criterion can be found in the study protocol, section 5.4.
- Known allergy/sensitivity or any hypersensitivity to components of study drugs or their formulation.
- Active drug or alcohol use or dependence or other condition that, in the opinion of the site investigator, would interfere with adherence to study requirements.
- Serious illness requiring systemic treatment and/or hospitalization until candidate either completes therapy or is clinically stable on therapy, in the opinion of the site investigator, for at least 7 days prior to study entry.
Contacts and Locations| Malawi | |
| University of North Carolina Lilongwe CRS (12001) | Recruiting |
| Lilongwe, Malawi | |
| Contact: Mina Hosseinipour, MD 265-1 758 938 mina_hosseinipour@med.unc.edu | |
| Principal Investigator: Francis Martinson, MPH, PhD, MBChB | |
| South Africa | |
| Soweto ACTG CRS (12301) | Recruiting |
| Johannesburg, South Africa | |
| Contact: Reinet Lourens, BScN (271) 198-99709 lourensr@phru.co.za | |
| Principal Investigator: Lerato Mohapi, MD | |
| Univ. of Witwatersrand CRS (11101) | Recruiting |
| Johannesburg, South Africa | |
| Contact: Pauline C Vunandlala, BS 27 11 717 2810 idsyndicate@witshealth.co.za | |
| Principal Investigator: Ian M Sanne, MD, FCP | |
| Study Chair: | Alberto M La Rosa, MD | Asociacion Civil Impacta Salud y Educacion - Miraflores, CRS |
| Study Chair: | Ann C Collier, MD | Univ. of Washington Clinical HIV Research Program (CHIRP) |
More Information
Publications:
| Responsible Party: | AIDS Clinical Trials Group |
| ClinicalTrials.gov Identifier: | NCT01352715 History of Changes |
| Other Study ID Numbers: | ACTG A5273, 1U01AI068636 |
| Study First Received: | January 12, 2011 |
| Last Updated: | December 4, 2012 |
| Health Authority: | United States: Federal Government |
Additional relevant MeSH terms:
|
HIV Infections Lentivirus Infections Retroviridae Infections RNA Virus Infections Virus Diseases Sexually Transmitted Diseases, Viral Sexually Transmitted Diseases Immunologic Deficiency Syndromes Immune System Diseases Zidovudine Lamivudine Tenofovir Tenofovir disoproxil Abacavir Lamivudine, zidovudine drug combination |
Ritonavir Lopinavir Emtricitabine Antimetabolites Molecular Mechanisms of Pharmacological Action Pharmacologic Actions Reverse Transcriptase Inhibitors Nucleic Acid Synthesis Inhibitors Enzyme Inhibitors Anti-Retroviral Agents Antiviral Agents Anti-Infective Agents Therapeutic Uses Anti-HIV Agents HIV Protease Inhibitors |
ClinicalTrials.gov processed this record on May 19, 2013