The Switch Study: The Role of Lamivudine/Emtricitabine (3TC/FTC) in Antiretroviral Regimens - Full Text View

Purpose

In this study the researchers will be enrolling patients who are failing their current antiretroviral regimen who also have resistance to 3TC or FTC. Patients will have their current antiretroviral regimen changed based on resistance testing and also be randomly assigned to either include, or not include 3TC/FTC in this new regimen. The purpose of the research is to investigate whether the change in therapy results in a decrease in the amount of virus particles and an increase in the CD4 cell count. In addition the researchers are investigating the relationship between the existence of resistance and the rate of decrease in viral load, and also to determine if continuing 3TC/FTC (despite being resistant to the medications) has any effect on the rate of decrease of viral load, or effect on CD4 counts.

Condition	Intervention
HIV Infections	Drug: 3TC and FTC


Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	The Role of 3TC/FTC in Partially Suppressive Antiretroviral Regimens: The Switch Study

Resource links provided by NLM:

MedlinePlus related topics: HIV/AIDS

Drug Information available for: Lamivudine

U.S. FDA Resources

Further study details as provided by Stanford University:

Primary Outcome Measures:

To evaluate the role of lamivudine, (3TC), and emtricitabine, (FTC), in salvage regimens in patients with prior 3TC/FTC use, documented resistance to 3TC/FTC, and ongoing viremia as assessed by:
Impact on the initial rate of change in HIV-1 viral load after removing 3TC/FTC from the failing regimen, and
Overall change from baseline in HIV-1 viral load at 24 weeks (HIV-VL AUC 24 wks).

Secondary Outcome Measures:

To evaluate the impact of continued versus discontinued 3TC/FTC on the prevalence, frequency and dynamics of the M184V/I amino acid substitution over 24 weeks.
To determine the proportion of patients failing and/or not responding to therapy after 24 weeks as defined by failure to achieve HIV-1 viral load less than 400 copies/ml and/or less than 50 copies/ml
To assess the changes from baseline in absolute CD4 (and CD8) cell counts at 24 weeks.


Estimated Enrollment:	40
Study Start Date:	January 2005
Study Completion Date:	August 2005

Detailed Description:

In this randomized, open-label, controlled trial, HIV-infected patients who are failing 3TC/FTC-containing highly active antiretroviral therapy, (HAART), will be offered individual treatment selection based on best clinical judgment and genotypic HIV-RNA resistance analysis. Patients who meet entry criteria will first be randomized to either continue or discontinue 3TC/FTC while they remain on their current therapy. HIV-1 viral load will be measured 4 times over a period of 14 days to determine the virologic response to this change. At day 14, each patient's regimen will be optimized to a new combination based on a genotype test taken at study entry. Patients will then start on the new salvage regimen, including or not including 3TC/FTC based on their initial randomization. Additional HIV-1 viral load measurements will be obtained to determine the virologic response to the new salvage regimen over 24 weeks.

Eligibility


Ages Eligible for Study:	18 Years and older (Adult, Senior)
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

HIV-1 seropositive patients >= 18 years of age
Willingness and ability to understand and sign a written informed consent and comply with the protocol procedure
Prior treatment with nucleoside reverse transcriptase inhibitors (NRTI's), non-nucleoside reverse transcriptase inhibitors (NNRTI's) and protease inhibitor (PI)-containing regimens
On a stable PI and 3TC or FTC -containing regimen for >= 2 months
Plasma HIV-1 RNA >5000 copies/ml
CD4 >100
Documented M184V or I on genotype within 3 months of study entry
At least 3 PI-associated resistance mutations on genotype within 3 months of study entry, (including known resistance mutations at codons 10, 30, 46, 50, 54, 71, 82, 84, and 90)

Exclusion Criteria:

In the opinion of the investigator a patient that is either unwilling or unable to be adherent to antiretroviral drugs
Requirement for concomitant treatment with medicines that interfere with the therapy prescribed in the study
Patients who have never taken 3TC or FTC, or with no prior documentation of the M184V mutation
Active hepatitis B infection
Vaccination within 2 weeks of entering the study
An acute opportunistic illness within 4 weeks of entering the study; chronic infections will not be excluded
Use of immunomodulatory medications such as IL-2
Planned use of enfuvirtide, (T20) in salvage regimen, (in T20 naïve subjects)

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00152061

Locations


United States, California
Santa Clara Medical Center, PACE Clinic
San Jose, California, United States, 95128

Sponsors and Collaborators

Stanford University

Santa Clara Valley Health & Hospital System

University of California, Davis

Investigators


Principal Investigator:	Andrew Zolopa, MD	Stanford University

More Information


Responsible Party:	Stanford University
ClinicalTrials.gov Identifier:	NCT00152061 History of Changes
Other Study ID Numbers:	74009 IRB protocol 74009 SPO number 25036
Study First Received:	September 8, 2005
Last Updated:	June 18, 2013
Health Authority:	United States: Institutional Review Board

Keywords provided by Stanford University:


HIV Antiretroviral Drug Resistance 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

ClinicalTrials.gov processed this record on September 29, 2016