Treatment De-Intensification and Residual HIV-1 in Youth

Study Description

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Brief Summary:

This laboratory-based sub-study of ATN 061 and ATN 071 will examine the effect of early treatment followed by treatment de-intensification to atazanavir/ritonavir (ATV/r) monotherapy on steady-state frequencies of replication-competent CD4+ T cell Human Immunodeficiency Virus (HIV)-1 reservoirs or cell-associated infectivity (CAI) and persistent low-level viremia (LLV), and their contribution to successful long-term control of HIV-1 replication among HIV-1 infected adolescents and young adults.

Condition or disease	Intervention/treatment
HIV-1; HIV Infections	Other: Blood draw

Study Design

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Study Type :	Observational
Actual Enrollment :	34 participants
Observational Model:	Case-Control
Time Perspective:	Prospective
Official Title:	Treatment De-Intensification and Residual HIV-1 in Adolescents and Young Adults: A Sub-Study of ATN 061 and ATN 071.
Study Start Date :	February 2009
Actual Primary Completion Date :	October 2011
Actual Study Completion Date :	October 2011

Groups and Cohorts

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Group/Cohort	Intervention/treatment
Experimental; 25 evaluable subjects from the experimental arm of ATN 061 who undergo de-intensification to boosted atazanavir (ATV) with VL suppression of < 100 copies/ml and CD4+ T cells > 350 cells/mm3 at week 48 and maintain VL suppression to < 400 copies/ml with stable CD4+ T cell counts after week 48.	Other: Blood draw; This sub-study does not involve additional treatment of any ATN 061 or ATN 071 study subjects. The only intervention involved is the requirement for whole blood collection (40 ml and 60 ml) to be drawn at the same time as four ATN 061 study visits (36, 48, 56, and 80 weeks) for subjects co-enrolled into ATN 061. When these time points coincide with ATN 061 Central Laboratory samples, the 60 ml blood sample will not be collected. For subjects co-enrolled into ATN 071, there are also two samples of whole blood collection (40 ml and 60 ml) required to be drawn at four time points but at weeks 36, 48, 56, and 80 after the initiation of HAART.
Control; 25 evaluable subjects from ATN 071 will also be enrolled. These subjects will have initiated HAART according to current DHHS guidelines (CD4+ T cells < 350 cells/mm3), had viral load suppression to < 100 copies/ml at 24 through 48 weeks on HAART and maintained suppression to < 400 copies/ml through week 80.	Other: Blood draw; This sub-study does not involve additional treatment of any ATN 061 or ATN 071 study subjects. The only intervention involved is the requirement for whole blood collection (40 ml and 60 ml) to be drawn at the same time as four ATN 061 study visits (36, 48, 56, and 80 weeks) for subjects co-enrolled into ATN 061. When these time points coincide with ATN 061 Central Laboratory samples, the 60 ml blood sample will not be collected. For subjects co-enrolled into ATN 071, there are also two samples of whole blood collection (40 ml and 60 ml) required to be drawn at four time points but at weeks 36, 48, 56, and 80 after the initiation of HAART.

Outcome Measures

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Primary Outcome Measures :

1. Steady-state frequencies of replication-competent CD4+ T cell HIV-1 reservoirs in participants starting HAART before DHHS guidelines (CD4+ T cell levels < 350 cells/mm3) vs. those initiating HAART by current DHHS guidelines. [ Time Frame: 80 weeks ]
2. Quantitative changes in LLV between 6.5 and 50 copies/ml in participants starting early therapy & de-intensifying to ATV/r monotherapy vs. those initiating HAART at CD4+ T cell levels < 350 cells/mm3 & maintaining standard HAART. [ Time Frame: 80 weeks ]
3. Quantitative changes in viral diversity during HAART in participants initiating early therapy & de-intensifying to ATV/r monotherapy vs those initiating HAART at CD4+ T cell levels < 350 cells/mm3 & maintaining standard HAART. [ Time Frame: 80 weeks ]
4. Effect of viral diversity in replication-competent CD4+ T cell reservoirs & low viremia variants before de-intensification on successful control of HIV-1 replication during ATV/r maintenance in participants starting HAART before DHHS guidelines. [ Time Frame: 80 weeks ]

Secondary Outcome Measures :

1. To examine the contribution of LLV genotypes, through analysis of the Gag/protease and RT, among subjects who developed rebound viremia above 50 copies/ml during treatment de-intensification to ATV/r. [ Time Frame: 80 weeks ]

Biospecimen Retention:   Samples With DNA

Whole blood

Eligibility Criteria

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Ages Eligible for Study:	18 Years to 24 Years (Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No
Sampling Method:	Non-Probability Sample

Study Population

Twenty-five subjects enrolled in Arm A of ATN 061 who started highly-active antiretroviral therapy (HAART) at CD4+ T cells > 350 cells/cubic millimeter (mm3) and are undergoing treatment de-intensification at week 48 of HAART.

Twenty-five "control" subjects initiating HAART based on current Department of Health and Human Services (DHHS) guidelines at CD4+ T cell levels < 350 cells/mm3 and maintained on standard HAART.

Criteria

081 participants must first be enrolled in either ATN 061 or ATN 071 and meet the eligibility criteria of those protocols in addition to those below.

Inclusion Criteria:

061 Participants

• Currently on treatment with an ATV/r-based HAART regimen (ATV/r, FTC, TDF is the preferred regimen);
• HIV-1 viral load < 100 copies at week 24;
• CD4+ T cell count > 350 cells/mm3 at week 24; and

• Able to provide informed consent for the sub-study and adhere to the protocol.

  071 Participants

• Initiated HAART according to current DHHS guidelines (CD4+ T cells < 350 cells/ mm3);
• Currently on treatment with a PI-containing HAART regimen; subjects taking a protease inhibitor OTHER than ATV/r must receive approval by the team via the ATN QNS;
• Plasma HIV-1 viral load < 100 copies at week 24 on HAART; measurement to be collected from clinical care results contained in the medical record at the clinical site within +/- 30 days of week 24 on therapy;
• CD4+ T cell count > 350 cells/mm3 at week 24 on HAART; measurement to be collected from clinical care results contained in the medical record at the clinical site within +/- 30 days of week 24 on therapy; and
• Able to provide informed consent for the sub-study and adhere to the protocol.

General Exclusion Criteria:

• Currently enrolled in the Standard Care Arm of ATN 061;
• Pregnancy or breast feeding;
• Severe (Grade ≥ 3) anemia or other conditions that would not allow adequate blood volume to be drawn;
• Active treatment for systemic infections;
• Treatment with immune modulators, including immunosuppressive or immune modulating therapy (IL-2, intravenous gammaglobulin, and therapeutic or other experimental vaccines including HIV-1 vaccine given for primary prevention at any time (short courses (<14 days) of prednisone for reactive airway disease (RAD) are permitted);
• Active hepatitis B infection as defined by Hepatitis B antigen (Ag) positive;
• Disallowed Medications (see Section 5.3.2);
• Active drug or alcohol use or dependence that, in the opinion of the site personnel, would interfere with adherence to the study; or

• History of chronic renal insufficiency or Grade 3 or greater serum creatinine.

  061-Specific Exclusion Criteria

• History of an Acquired Immunodeficiency Syndrome (AIDS)-defining illness;
• Meets any ATN 061 exclusion criteria for de-intensification; or

• Meets any ATN 061 premature study discontinuation criteria.

  071-Specific Exclusion Criteria: None

Contacts and Locations

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Locations

United States, California
Children's Hospital of Los Angeles
Los Angeles, California, United States, 90027
University of California at San Francisco
San Francisco, California, United States, 94118
United States, District of Columbia
Children's National Medical Center
Washington, District of Columbia, United States, 20010
Howard University - IMPAACT Site
Washington, District of Columbia, United States, 20060
United States, Florida
Children's Diagnostic and Teatment Center
Fort Lauderdale, Florida, United States, 33316
University of Miami School of Medicine
Miami, Florida, United States, 33101
University of South Florida College of Medicine
Tampa, Florida, United States, 33606
United States, Illinois
John Stroger Jr. Hospital of Cook County
Chicago, Illinois, United States, 60612
Children's Memorial Hospital
Chicago, Illinois, United States, 60614
United States, Louisiana
Tulane Medical Center
New Orleans, Louisiana, United States, 70112
United States, Maryland
University of Maryland
Baltimore, Maryland, United States, 21201
Johns Hopkins University - IMPAACT Site
Baltimore, Maryland, United States, 21287
United States, New York
Montefiore Medical Center
Bronx, New York, United States, 10467
Mount Sinai Medical Center
New York, New York, United States, 10128
United States, Pennsylvania
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States, 19104
United States, Tennessee
St. Jude Children's Research Hospital
Memphis, Tennessee, United States, 38105
Puerto Rico
University of Puerto Rico
San Juan, Puerto Rico, 00927

Sponsors and Collaborators

University of North Carolina, Chapel Hill

National Institute on Drug Abuse (NIDA)

National Institute of Mental Health (NIMH)

Investigators

Study Chair:	Deborah Persaud, M.D.	Adolescent Trials Network

More Information

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Additional Information:

ATN website 

Responsible Party:	University of North Carolina, Chapel Hill
ClinicalTrials.gov Identifier:	NCT00867854 History of Changes
Other Study ID Numbers:	ATN 081
First Posted:	March 24, 2009
Last Update Posted:	February 28, 2017
Last Verified:	March 2016

Keywords provided by University of North Carolina, Chapel Hill:

de-intensification; HAART; monotherapy; persistent low-level viremia (LLV); treatment experienced

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