Anti-HIV Treatment Interruptions in HIV Infected Adults in South Africa
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Purpose
HIV infected people often must take anti-HIV drugs for long periods, leading to long-term drug exposure and toxicity. Interruptions in anti-HIV therapy, also known as structured treatment interruptions (STIs), may have few negative health effects and may be helpful to the overall long-term health of HIV-infected people. The purpose of this study is to determine if sequential short-term STIs of antiretroviral therapy (ART) in HIV infected individuals in a resource-constrained environment can retain the immune reconstitution benefits of continuous treatment while potentially lessening rates of toxicity associated with continuous therapy strategies and at the same time, lessen costs associated with ART.
| Condition | Intervention |
|---|---|
|
HIV Infections |
Behavioral: Structured treatment interruption Drug: Lamivudine Drug: Lopinavir/Ritonavir Drug: Stavudine Biological: Rabies de novo antigen |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | A Randomized Clinical Trial Assessing Continuous HAART Versus Interrupted HAART in a Resource Poor Clinic |
- To compare intermittent ART to continuous therapy by comparing endpoint CD4 counts between Groups 1 and 2 [ Time Frame: Throughout study ] [ Designated as safety issue: Yes ]
- Response to rabies vaccination and booster [ Time Frame: Weeks 16, 22, and 92 ] [ Designated as safety issue: Yes ]
- Comparison of treatment-associated toxicity and safety of 2 to 8 weeks of antiretroviral therapy (ART) interruption versus continuous ART [ Time Frame: Throughout study ] [ Designated as safety issue: Yes ]
- Determine the outcome of immune reconstitution by monitoring changes in T-cell subsets and the ability to maintain cell-mediated responses against various antigens [ Time Frame: Before and after intermittent strategy ] [ Designated as safety issue: Yes ]
- Viral evolution and genotypic changes that confer drug resistance [ Time Frame: During intermittent and continuous treatment ] [ Designated as safety issue: Yes ]
- Effect of treatment interruption on cardiovascular adverse experiences risk factors [ Time Frame: From Weeks 0 to 144 ] [ Designated as safety issue: Yes ]
| Enrollment: | 30 |
| Study Start Date: | March 2007 |
| Study Completion Date: | March 2010 |
| Primary Completion Date: | March 2010 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: 1
Highly active antiretroviral therapy (HAART) consisting of lamivudine, lopinavir/ritonovir, and stavudine for 16 weeks with three structured treatment interruptions for 2, 4, and 8 weeks each; rabies vaccine at Weeks 16, 17, 22 and 92.
|
Behavioral: Structured treatment interruption
Interruptions in treatment will last 2, 4, and 8 weeks in between 16-week periods of ART
Other Name: STI
Drug: Lamivudine
300 mg tablet taken orally daily
Drug: Lopinavir/Ritonavir
400 mg lopinavir/100 mg ritonavir tablet taken orally twice daily
Drug: Stavudine
Dosage dependent on weight
Biological: Rabies de novo antigen
Vaccine injected intramuscularly
|
|
Active Comparator: 2
Continuous HAART consisting of lamivudine, lopinavir/ritonovir, and stavudine throughout the study; rabies vaccine at Weeks 16, 17, 22 and 92.
|
Drug: Lamivudine
300 mg tablet taken orally daily
Drug: Lopinavir/Ritonavir
400 mg lopinavir/100 mg ritonavir tablet taken orally twice daily
Drug: Stavudine
Dosage dependent on weight
Biological: Rabies de novo antigen
Vaccine injected intramuscularly
|
Detailed Description:
Long-term toxicity and the high cost of medications are two problems faced by HIV infected people taking ART. Previous studies in HIV-infected patients suggest that ART with STIs may decrease drug exposure and lessen long-term drug toxicity, while not sacrificing viral suppression and patient health. This study will determine if ART with STIs can maintain the same level of immune function in HIV-infected people as continuous ART. This study will recruit patients in South Africa.
This study will last 3.5 years. At study entry, all participants will begin daily ART consisting of lamivudine, lopinavir/ritonavir, and stavudine. At Month 6, only participants who have responded well to ART (CD4 count greater than 450 cells/uL and viral load less than 50 copies/ml at Month 6) will be randomly assigned to one of two groups. Group 1 participants will participate in STIs during therapy, and Group 2 participants will receive continuous therapy. People in Group 1 will have treatment interruptions of 2, 4, and 8 weeks of duration in between 16-week periods of ART. Group 1 participants will re-initiate therapy if their CD4 count drops below 350 cells or evidence of clinical disease progression is present. Group 2 participants will continue taking ART throughout the study.
At screening, participants will undergo medical history assessment, a physical exam, and magnetic resonance imaging (MRI) and dual energy x-ray absorptiometry (DEXA) scans. There will be at least 22 study visits occurring approximately every 8 weeks, each lasting 45 to 60 minutes. At each study visit, participants will be required to bring any remaining pills with them so adherence can be assessed and will undergo medical assessments. Blood collection will occur at nearly all visits. For female participants, urine collection will occur at all visits. Participants will receive rabies vaccinations at Weeks 16, 17, and 22. A visit at Week 92 will include an MRI and participants will receive a rabies vaccine booster.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- HIV infected
- CD4 count of 200 to 350 cells/mm3 within 60 days of starting study treatment
- Antiretroviral naive. Participants who have received antiretrovirals through postexposure prophylaxis or short course therapy to prevent mother-to-child transmission are eligible for this study.
- Willing to adhere to study treatment
- Willing to be followed for the duration of this study
Exclusion Criteria:
- History of AIDS-defining illness (CDC category C). Patients with a history of pulmonary tuberculosis are not excluded.
- Newly diagnosed AIDS-defining opportunistic infection or other condition requiring acute therapy at study entry
- Previous therapy with agents with significant myelosuppressive, neurotoxic, pancreatotoxic, hepatotoxic, or cytotoxic potential within 30 days prior to study entry
- History of immunomodulatory therapy within 4 weeks prior to screening, or cannot abstain from immunomodulators during the study
- Previously received rabies vaccine
- Current alcohol or drug abuse that, in the opinion of the investigator, may interfere with the study
- Diarrhea (more than 6 stools per day for 7 consecutive days) within 30 days prior to study entry
- Active or suspected acute hepatitis within 30 days of study entry
- Bilateral peripheral neuropathy of Grade 2 or higher at screening
- Inability to tolerate oral medication
- Any clinical condition that, in the opinion of the investigator, would interfere with the study
- Pregnancy or breastfeeding
Contacts and LocationsPlease refer to this study by its ClinicalTrials.gov identifier: NCT00100646
| South Africa | |
| University of the Witwatersrand | |
| Johannesburg, South Africa | |
| Principal Investigator: | Luis J. Montaner, DVM, MSc, DPhil | The Wistar Institute | |
| Principal Investigator: | Ian M. Sanne, MBBCH, FCP(SA), DTM&H | University of the Witwatersrand |
More Information
Additional Information:
Publications:
| Responsible Party: | Luis Montaner, Professor and Director, HIV-1 Immunopathogenesis Laboratory, The Wistar Institute |
| ClinicalTrials.gov Identifier: | NCT00100646 History of Changes |
| Other Study ID Numbers: | 1R01AI051986-01A2, R01 AI 51986, Protocol 2411209, 1 R01 AI051986-01A2, R01 A151986-01 |
| Study First Received: | January 4, 2005 |
| Last Updated: | August 26, 2014 |
| Health Authority: | United States: Federal Government |
Keywords provided by The Wistar Institute:
|
Treatment Interruption Treatment Naive |
Additional relevant MeSH terms:
|
Lamivudine Lopinavir Anti-HIV Agents Anti-Infective Agents Anti-Retroviral Agents Antiviral Agents Enzyme Inhibitors |
HIV Protease Inhibitors Molecular Mechanisms of Pharmacological Action Nucleic Acid Synthesis Inhibitors Pharmacologic Actions Protease Inhibitors Reverse Transcriptase Inhibitors Therapeutic Uses |
ClinicalTrials.gov processed this record on March 03, 2015