Immune Reconstitution of Lopinavir/Ritonavir-Based vs Efavirenz-based HAART in Advanced HIV Disease - Full Text View

Purpose

The ideal anti-HIV medications for patients with advanced HIV disease is unknown. There is evidence that anti-HIV regimens that contain protease inhibitors can enhance immune function better than regimens that do not contain protease inhibitors. This is a study that will determine the difference in immune enhancement capabilities between an anti-HIV regimen that contains the protease inhibitor - lopinavir-ritonavir, and a regimen that contains efavirenz. Both medications are recommended as first line treatments for HIV-infected patients. This study will recruit HIV-positive patients that need to start anti-HIV treatment because their CD4+ T-cells are below 200. The usual threshold for starting treatment is a CD4+ T-cell less than 350. Subjects will be randomized to treatment with either an anti-HIV regimen that contains lopinavir-ritonavir or a regimen that contains efavirenz. The study will determine the difference in immune reconstitution over 24 weeks of treatment with study medications. Among the immune parameters that will be measured is the ability of each subject to respond to vaccination with the tetanus-diphtheria vaccine and the 23-valent pneumococcal vaccine. Both vaccines are also recommended for HIV-positive patients but HIV-positive patients tend to have a lower response rate to these vaccines.

Condition	Intervention	Phase
Acquired Immune Deficiency Syndrome	Drug: Lopinavir 400 mg/ritonavir 100 mg Drug: Efavirenz	Phase 4


Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	A Phase 4 Study of the Effect on Immune Reconstitution of a Lopinavir/Ritonavir-Based Versus an Efavirenz-based HAART (Highly Active Antiretroviral Therapy) Regimen in Antiretroviral-Naïve Subjects With Advanced HIV Disease

Resource links provided by NLM:

MedlinePlus related topics: HIV/AIDS

Drug Information available for: Emtricitabine Efavirenz Ritonavir Lopinavir

U.S. FDA Resources

Further study details as provided by Rush University Medical Center:

Primary Outcome Measures:

CD4+ (Cluster of Differentiation 4) T-cell Apoptosis [ Time Frame: 24 weeks from treatment initiation (baseline and week 24) ] [ Designated as safety issue: No ]
Change in the percentage of naive CD4 T-cells undergoing apoptosis as measured by propidium iodide staining. This is a lab test that measures the percentage of naive CD4 T-cells that are undergoing cell death. The change in this measure is obtained by determining the difference between the percentage of naive CD4 T-cells undergoing apoptosis at week 24 of treatment and the percentage undergoing apoptosis at baseline.

Secondary Outcome Measures:

CD4+ T-cell Change [ Time Frame: 24 weeks after treatment initiation (baseline and week 24) ] [ Designated as safety issue: No ]
This measures the change in CD4+ T-cells from baseline to week 24 of treatment.
Naive, Central Memory and Effector Memory CD4+ and CD8+ (Cluster of Differentiation 8) T-cell Frequency [ Time Frame: 4, 12 and 24 weeks after treatment initiation ] [ Designated as safety issue: No ]
Activated and Regulatory CD4+ and CD8+ T-cell Frequencies [ Time Frame: 4, 12 and 24 weeks after treatment initiation ] [ Designated as safety issue: No ]
Response to Immunization With Pneumococcus Polysaccharide and Tetanus-diphtheria Vaccines [ Time Frame: 4 weeks after treatment initiation ] [ Designated as safety issue: No ]
Response to immunization with pneumococcus polysaccharide and tetanus-diphtheria vaccines was not done due to small sample size


Enrollment:	15
Study Start Date:	October 2008
Study Completion Date:	January 2011
Primary Completion Date:	December 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: ARM A/Lopinar/ritonavir Subjects randomized to Arm A initiated Lopinavir 400 mg/ritonavir 100 mg BID + emtricitabine 200 mg/tenofovir 300 mg QD	Drug: Lopinavir 400 mg/ritonavir 100 mg Lopinavir 400 mg/ritonavir 100 mg fixed dose combination BID + emtricitabine 200 mg/tenofovir 300 mg fixed dose combination QD Other Names: Kaletra Truvada
Active Comparator: ARM B/Efavirenz Subjects randomized to Arm B initiated Efavirenz 600 mg/emtricitabine 200 mg/tenofovir 300 mg QD	Drug: Efavirenz Efavirenz 600 mg/emtricitabine 200 mg/tenofovir 300 mg fixed dose combination QD Other Name: Atripla

Detailed Description:

DESIGN: ICE-001 is a phase IV, randomized, two-arm unblinded study, comparing the effect on immune reconstitution of open-label ritonavir (RTV)-enhanced lopinavir (LPV) to efavirenz (EFV), in combination with daily emtricitabine (FTC)/tenofovir (TDF) as initial therapy for HIV-1 infection in HIV-infected treatment naïve subjects with CD4+ T-cells less than 200 cells/ml.

DURATION: Subjects will participate in ICE-001 for approximately 48 weeks after starting study treatment.

SAMPLE SIZE: ICE-001 will enroll 60 subjects (30 per treatment arm).

POPULATION: HIV-1-infected, antiretroviral (ARV) drug-naïve (≤7 days of ARV treatment at anytime prior to study entry) men and women between18 to 60 years of age with plasma HIV-1 RNA levels >1000 copies/mL and CD4+ T-cell counts < 200 cells/ml obtained within 90 days prior to study entry.

STRATIFICATION: Subjects will be stratified at screening based on plasma HIV-1 RNA levels <100,000 and ≥100,000 copies/mL.

REGIMEN: At entry subjects will be randomized to one of the following:

ARM A: LPV 400 mg/RTV 100 mg BID + FTC 200 mg/TDF 300 mg QD
ARM B: EFV 600 mg QD/FTC 200 mg/TDF 300 mg fixed dose combination QD

The objective is to determine the differences in the degree of immune reconstitution in HIV-infected patients with a CD4+ T-cell count < 200 cells/ml who initiated treatment with LPV/RTV + FTC/TDF compared to EFV/FTC/TDF.

Study visits will occur at screening, pre-entry, entry and weeks 1, 4, 8, 12, 24 and 48 after study entry. Study medications will be provided at entry after randomization. At most study visits, clinical assessments, including histories, physical exams and determination of drug adherence, will occur. Blood for hematologic and metabolic safety assessments and for the assessment of immune parameters will be obtained. Immune parameters that will be measured include levels of T-cell apoptosis, maturation and activation. Frequencies of various T-cell subsets and other lymphocyte populations will also be done. Response to vaccination with tetanus-diphtheria vaccine and 23-valent pneumococcal polysaccharide vaccine (both given at week 8) will be measured.

Eligibility


Ages Eligible for Study:	18 Years to 60 Years (Adult)
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

HIV-1 infection
The absence of exclusionary resistance mutations on a genotypic resistance assay
Antiretroviral (ARV) drug-naïve
Screening HIV-1 RNA >1000 copies/mL
Screening CD4+ T-cell count < 200 cells/ml
Laboratory values obtained within 30 days prior to study entry.
- Absolute neutrophil count (ANC) >500/mm3
- Hemoglobin >8.0 g/dL
- Platelet count >40,000/mm3
- AST (SGOT), ALT (SGPT), and alkaline phosphatase <5 x ULN
- Total bilirubin <2.5 x ULN
- Calculated creatinine clearance ≥60 mL/min (by Cockcroft-Gault equation)
For women of reproductive potential, negative serum or urine pregnancy test within 48 hours prior to initiating study medications.
Contraception requirements
Men and women age >18 years and < 60 years.
Ability and willingness of subject or legal guardian/representative to give written informed consent.

Exclusion Criteria:

Currently breast-feeding.
Use of immunomodulators, vaccines, growth hormone, systemic cytotoxic chemotherapy, or investigational therapy within 30 days prior to study entry.
Known allergy/sensitivity to study drugs, pneumococcal polysaccharide vaccine, tetanus-diphtheria vaccine
Receipt of pneumococcal polysaccharide vaccine or tetanus-diphtheria vaccine in the past 5 years.
Active drug or alcohol use or dependence
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 14 days prior to study entry.
Requirement for any current medications that are prohibited with any study treatment.
Evidence of any major resistance-associated mutation on any genotype or evidence of significant resistance on any phenotype performed at any time prior to study entry
Current or anticipated imprisonment or involuntary incarceration in a medical facility for psychiatric or physical (e.g., infectious disease) illness
History of, or current bipolar disorder, major depression, schizophrenia or other psychotic disorders

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: NCT00775606

Locations


United States, Illinois
Rush University Medical Center
Chicago, Illinois, United States, 60612
University of Illinois Medical Center
Chicago, Illinois, United States, 60612
Howard Brown Health Center
Chicago, Illinois, United States, 60613
University of Chicago Hospital
Chicago, Illinois, United States, 60637

Sponsors and Collaborators

Rush University Medical Center

University of Chicago

University of Illinois at Chicago

Ruth M. Rothstein CORE Center

Abbott

Gilead Sciences

Investigators


Study Chair:	Allan R. Tenorio, M.D.	Rush University Medical Center

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Pitrak DL, Novak RM, Estes R, Tschampa J, Abaya CD, Martinson J, Bradley K, Tenorio AR, Landay AL. Short communication: Apoptosis pathways in HIV-1-infected patients before and after highly active antiretroviral therapy: relevance to immune recovery. AIDS Res Hum Retroviruses. 2015 Feb;31(2):208-16. doi: 10.1089/aid.2014.0038. Epub 2014 Nov 11.


Responsible Party:	Allan Tenorio, MD, MD, Rush University Medical Center
ClinicalTrials.gov Identifier:	NCT00775606 History of Changes
Other Study ID Numbers:	ICE-001
Study First Received:	October 17, 2008
Results First Received:	June 28, 2013
Last Updated:	May 30, 2014
Health Authority:	United States: Institutional Review Board

Keywords provided by Rush University Medical Center:


AIDS, HIV

Additional relevant MeSH terms:


Acquired Immunodeficiency Syndrome HIV Infections Immunologic Deficiency Syndromes Lentivirus Infections Retroviridae Infections RNA Virus Infections Virus Diseases Sexually Transmitted Diseases, Viral Sexually Transmitted Diseases Slow Virus Diseases Immune System Diseases Ritonavir Lopinavir Tenofovir Emtricitabine	Efavirenz 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 Cytochrome P-450 CYP2C9 Inhibitors Cytochrome P-450 CYP2C19 Inhibitors

Acquired Immunodeficiency Syndrome
HIV Infections
Immunologic Deficiency Syndromes
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Slow Virus Diseases
Immune System Diseases
Ritonavir
Lopinavir
Tenofovir
Emtricitabine

Efavirenz
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
Cytochrome P-450 CYP2C9 Inhibitors
Cytochrome P-450 CYP2C19 Inhibitors

ClinicalTrials.gov processed this record on September 29, 2016