CD4 Cell Recovery in HIV-1 Patients Comparing 2 Treatment Regimes
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ClinicalTrials.gov Identifier: NCT00966160 |
Recruitment Status
:
Completed
First Posted
: August 26, 2009
Last Update Posted
: September 29, 2009
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Therapy guidelines recommend the use of either the non-nucleoside reverse transcriptase inhibitor (NNRTI) efavirenz or a ritonavir-boostered protease inhibitor (PI) plus 2 nucleoside reverse transcriptase inhibitors (NRTI) as first-line treatment regimes of HIV-1 infection. Recent clinical studies suggest potential advantages of NNRTI- over PI-based regimes in therapy initiation due to lower rates of virologic failure and less metabolic side-effects. In contrast, PI regimes were claimed to cause greater increases in CD4 cell count than NNRTI regimes, which has been attributed to intrinsic antiapoptotic effects of the PI. However, it is still unclear whether the immunological response to a PI-containing regime is greater than to an NNRTI-containing regime, whether there is a difference in the extent of reduction of apoptosis between PI and NNRTI regimes and whether a difference in apoptosis is associated with a difference in CD4 cell recovery.
We conducted a controlled, long-term, random matched pair design study in HIV-1 infected individuals under sustained virologic suppression to evaluate in head-to-head comparison the clinical effects of a constant PI-based or NNRTI-based regime on CD4 cell recovery and the underlying molecular, biochemical and functional mechanisms.
Condition or disease | Intervention/treatment | Phase |
---|---|---|
Acquired Immunodeficiency Syndrome HIV Infections | Drug: Lopinavir/Ritonavir plus Lamivudine/Zidovudine Drug: Efavirenz plus Lamivudine/Zidovudine | Phase 3 |
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 215 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | Single (Investigator) |
Primary Purpose: | Treatment |
Official Title: | Phase 3, Single Center, Controlled, Investigator-blinded, Randomized Matched Pair Design Study of CD4 Cell Recovery in HIV-1 Patients With Sustained Virologic Response Comparing Protease Inhibitor and Non-nucleoside Reverse Transcriptase Inhibitor Based Treatment Regimes |
Study Start Date : | January 1999 |
Actual Primary Completion Date : | December 2008 |
Actual Study Completion Date : | December 2008 |

Arm | Intervention/treatment |
---|---|
Active Comparator: PI
400 mg lopinavir and 100 mg ritonavir (Kaletra capsules, Abbott Laboratories) twice daily plus 150 mg lamivudine (Epivir tablets, GlaxoSmithKline) and 300 mg zidovudine (Retrovir tablets, GlaxoSmithKline) twice daily over a 56-week run-in and a 420-week follow-up
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Drug: Lopinavir/Ritonavir plus Lamivudine/Zidovudine
400 mg lopinavir and 100 mg ritonavir (Kaletra capsules, Abbott Laboratories) twice daily plus 150 mg lamivudine (Epivir tablets, GlaxoSmithKline) and 300 mg zidovudine (Retrovir tablets, GlaxoSmithKline) twice daily over 476 weeks
|
Active Comparator: NNRTI
600 mg efavirenz (Sustiva tablets, Bristol-Myers Squibb) once daily plus 150 mg lamivudine (Epivir tablets, GlaxoSmithKline) and 300 mg zidovudine (Retrovir tablets, GlaxoSmithKline) twice daily over a 56-week run-in and a 420-week follow-up
|
Drug: Efavirenz plus Lamivudine/Zidovudine
600 mg efavirenz (Sustiva tablets, Bristol-Myers Squibb) once daily plus 150 mg lamivudine (Epivir tablets, GlaxoSmithKline) and 300 mg zidovudine (Retrovir tablets, GlaxoSmithKline) twice daily over 476 weeks
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- Difference in changes of CD4 cell count between PI and NNRTI groups [ Time Frame: 420 weeks ]
- Evolution of CD4 cell counts [ Time Frame: 420 weeks ]
- Molecular, biochemical and functional markers of CD4 cell apoptosis [ Time Frame: 420 weeks ]

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Ages Eligible for Study: | 20 Years to 60 Years (Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Recent, non-acute HIV-1 infection
- Caucasians
- BMI between 17.5 and 30 kg/m2
- CD4 count <200 cells/µl
- Plasma viral load >100,000 HIV-1 RNA copies/ml
Exclusion Criteria:
- Actual or previous antiretroviral therapy
- Acute illness
- Coinfection with HBV or HCV
- Opportunistic infection (Pneumocystis jiroveci pneumonia, Toxoplasma gondii encephalitis, Mycobacterium ssp. infection, syphilis, cryptosporidiosis, cryptococcosis, aspergillosis, cytomegalovirus infection or progressive multifocal leukoencephalopathy)
- Hepatic or renal disorder
- Severe cardiovascular disease
- Hematologic disorder
- Autoimmune disorder
- Diabetes mellitus or other severe endocrine disorder
- Malignancy
- Neurocognitive disorder
- Psychiatric disorder
- Drug or alcohol addiction
- Chronic drug use (except of blood pressure-lowering or lipid-lowering drugs or proton-pump inhibitors)
- Any acute medication within 7 days or vaccination within 30 days prior to entry
- Pregnancy or lactation

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00966160
Germany | |
Medical Clinic I and Department of Pharmacology, University of Cologne | |
Cologne, Germany |
Study Director: | Dirk Taubert, MD PhD | Department of Pharmacology, University of Cologne, Germany |
Publications:
Responsible Party: | Dirk Taubert, University of Cologne |
ClinicalTrials.gov Identifier: | NCT00966160 History of Changes |
Other Study ID Numbers: |
HIV-1999-LRE |
First Posted: | August 26, 2009 Key Record Dates |
Last Update Posted: | September 29, 2009 |
Last Verified: | August 2009 |
Keywords provided by University of Cologne:
treatment naive |
Additional relevant MeSH terms:
HIV Infections Immunologic Deficiency Syndromes Acquired Immunodeficiency Syndrome Lentivirus Infections Retroviridae Infections RNA Virus Infections Virus Diseases Sexually Transmitted Diseases, Viral Sexually Transmitted Diseases Immune System Diseases Slow Virus Diseases Ritonavir Lopinavir Lamivudine Zidovudine |
Lamivudine, zidovudine drug combination Efavirenz Reverse Transcriptase Inhibitors 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 Nucleic Acid Synthesis Inhibitors Antimetabolites |