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Comparing Standard-Dose Versus Adjusted-Dose Lopinavir/Ritonavir Therapy in HIV-Infected Persons With Drug Resistance
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Purpose
| Condition | Intervention | Phase |
|---|---|---|
| HIV Infections | Drug: Lopinavir/ritonavir Drug: Ritonavir Drug: Saquinavir Drug: Tenofovir disoproxil fumarate Drug: Amprenavir | Phase 2 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | A Phase II, Randomized, Open-Label Study Comparing Fixed-Dose Versus Concentration-Adjusted Lopinavir/Ritonavir Therapy in HIV-Infected Subjects on Salvage Therapy |
| Estimated Enrollment: | 118 |
| Primary Completion Date: | March 2003 (Final data collection date for primary outcome measure) |
Antiretroviral drugs may fail to suppress HIV unless there are adequate amounts of those drugs in the blood. By monitoring the amounts of drugs in the blood and adjusting doses to achieve optimal drug concentrations, response to antiretroviral drugs may improve, especially in patients who have failed previous regimens. This study is designed to evaluate drug monitoring and dose adjustment of protease inhibitors (PIs) in heavily treatment-experienced patients.
Patients will be randomized to receive either a standard dose of LPV/r (Arm A) or a concentration-adjusted dose of LPV/r (Arm B). Concentration-adjusted dosing means that the dose of ritonavir or lopinavir may be increased based on the amount of lopinavir measured in the blood and the results of a drug resistance test. All patients start the study taking LPV/r, tenofovir disoproxil fumarate (TDF), 0 to 2 additional nucleoside reverse transcriptase inhibitors (NRTIs), and saquinavir (SQV) or amprenavir (APV). Only LPV/r, TDF, and SQV will be provided by the study. Other medications taken as part of the antiretroviral regimen must be obtained outside the study.
Patients in Arm A will take the usual approved dose of LPV/r for the first 24 weeks. At Week 24, patients with high viral loads will come to the clinic for a 12-hour LPV blood level measurement to see if the level of LPV needs to be increased. If it does, an additional capsule of ritonavir will be added to the regimen to boost the level of LPV.
Patients in Arm B will have a series of blood draws over a 12-hour period in the clinic, around 14 days after starting the study, to find out if their LPV level needs to be increased. If the LPV level needs to be raised, an additional capsule of ritonavir will be added to the regimen to boost the level of LPV. Patients who had their ritonavir dose adjusted will return to have another 12-hour blood draw around Week 5. If the LPV level still needs to be changed, an additional capsule of LPV/r will be added to the regimen. A third 12-hour blood draw will be performed around Week 8 if a second dose adjustment was necessary.
During the study, patients will visit the clinic weekly through Week 6, again at Week 8, then every 4 weeks thereafter through Week 32. Patients will have blood drawn at certain visits to test for LPV level, viral load, CD4 count, fasting lipids and glucose, and drug resistance.
Eligibility| Ages Eligible for Study: | 18 Years to 70 Years (Adult, Senior) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- HIV-infection
- Viral load >= 5000 copies/ml within 45 days prior to study entry
- Documented reduction in LPV sensitivity based on results obtained within 45 days prior to study entry
- Prior experience with 2 or more NRTIs for at least 6 months each
- At least 12 weeks of stable antiretroviral treatment that includes at least one PI prior to study entry and may include TDF and/or T-20 for 8 weeks or more immediately prior to study entry
- Negative pregnancy test within 14 days prior to study entry
- Agree not to become pregnant or to impregnate and to use an acceptable form of contraception while receiving study drugs and for 4 weeks after stopping study drugs
Exclusion Criteria:
- Pregnant or breast-feeding.
- Certain drugs within 14 days prior to study entry
- Nonnucleoside reverse transcriptase inhibitors (NNRTIs) within 14 days prior to study entry
- History of intolerance to LPV/r, RTV, or TDF and/or their components
- Drug or alcohol use that, in the opinion of the investigator, would interfere with the study
- Require therapy and/or hospitalization due to a serious infection or medical illness that is potentially life-threatening within 14 days prior to study entry
- Any condition that, in the opinion of the investigator, would compromise ability to participate in the study
- Unexplained fever for 7 consecutive days or chronic diarrhea within 30 days prior to study entry
- Cancer requiring chemotherapy
- Any immune system drugs, HIV vaccine, or other experimental therapy within 30 days prior to study entry
- Plan to use any PI other than APV, SQV, or LPV/r in the initial study treatment
Contacts and LocationsPlease refer to this study by its ClinicalTrials.gov identifier: NCT00046033
| United States, Florida | |
| Univ of Miami | |
| Miami, Florida, United States, 33136-1013 | |
| United States, Hawaii | |
| Univ of Hawaii | |
| Honolulu, Hawaii, United States, 96816-2396 | |
| United States, New York | |
| NYU/Bellevue | |
| New York, New York, United States, 10016 | |
| United States, Ohio | |
| Case Western Reserve Univ | |
| Cleveland, Ohio, United States, 44106 | |
| United States, Pennsylvania | |
| Univ of Pittsburgh | |
| Pittsburgh, Pennsylvania, United States, 15213-2582 | |
| United States, Texas | |
| Univ of Texas, Galveston | |
| Galveston, Texas, United States, 77555-0435 | |
| Study Chair: | Deborah McMahon, M.D. | University of Pittsburgh |
More Information
Publications:
| ClinicalTrials.gov Identifier: | NCT00046033 History of Changes |
| Other Study ID Numbers: |
ACTG A5135 |
| Study First Received: | September 18, 2002 |
| Last Updated: | February 28, 2011 |
Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):
|
Dose-Relationship, Drug HIV Protease Inhibitors Salvage Therapy |
Viral Load RNA, Viral Drug Therapy, Combination |
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 Ritonavir Lopinavir Saquinavir Amprenavir Tenofovir HIV Protease Inhibitors |
Protease Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Anti-HIV Agents Anti-Retroviral Agents Antiviral Agents Anti-Infective Agents Cytochrome P-450 CYP3A Inhibitors Cytochrome P-450 Enzyme Inhibitors Reverse Transcriptase Inhibitors Nucleic Acid Synthesis Inhibitors Antibiotics, Antitubercular Antitubercular Agents Anti-Bacterial Agents |
ClinicalTrials.gov processed this record on August 16, 2017