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Protease Inhibitor Monotherapy Versus Ongoing Triple-therapy in the Long Term Management of HIV Infection (PIVOT) (PIVOT)

The recruitment status of this study is unknown. The completion date has passed and the status has not been verified in more than two years.
Verified October 2010 by Medical Research Council.
Recruitment status was:  Active, not recruiting
NHS Health Technology Assessment Programme
Information provided by:
Medical Research Council Identifier:
First received: October 27, 2010
Last updated: October 9, 2012
Last verified: October 2010
The PIVOT trial aims to determine whether a strategy of switching to PI monotherapy is non-inferior to continuing triple-therapy, in terms of the proportion of patients who maintain all the drug treatment options that were available to them at baseline after at least 3 years of follow-up, and to compare clinical events, safety, toxicity and health economic parameters between the two strategies.

Condition Intervention Phase
HIV Infection
Acquired Immunodeficiency Syndrome
Drug: Protease Inhibitor
Drug: Standard-of-care Antiretroviral therapy
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Randomised Controlled Trial of a Strategy of Switching to Boosted PI Monotherapy Versus Continuing Combination ART for the Long-term Management of HIV-1 Infected Patients Who Have Achieved Sustained Virological Suppression on HAART

Resource links provided by NLM:

Further study details as provided by Medical Research Council:

Primary Outcome Measures:
  • Loss of future drug options [ Time Frame: Up to 5 years ]
    The first occurrence of intermediate to high level resistance to any one or more of the standard antiretroviral drugs (limited to licensed drugs in contemporary use) to which the patient's virus was considered to be sensitive at trial entry (i.e. excluding drug resistance that was known to be present on previous resistance testing).

Secondary Outcome Measures:
  • Death from any cause [ Time Frame: Up to 5 years ]
  • Serious AIDS-defining illness [ Time Frame: Up to 5 years ]
  • Serious non-AIDS defining illness [ Time Frame: Up to 5 years ]
  • Adverse events [ Time Frame: Up to 5 years ]
  • Confirmed Virological rebound [ Time Frame: Up to 5 years ]
  • CD4+ count change [ Time Frame: Up to 5 years ]
  • Health-related Quality of Life change [ Time Frame: Up to 5 years ]
  • Neurocognitive function change [ Time Frame: Up to 5 years ]
  • Cardiovascular risk change [ Time Frame: Up to 5 years ]
  • Health care costs [ Time Frame: Up to 5 years ]
  • HIV VL in Genital Secretions [ Time Frame: Week 96 ]

    In a sub-set of participants (n=73):-

    • Compare prevalence of detectable VL and magnitude of viral replication in genital secretions in patients taking PI monotherapy and triple therapy; to test if PI monotherapy is non-inferior to triple therapy.
    • Compare drug levels in genital secretions and plasma.
    • Describe the profile of drug resistance (if any) in patients with detectable VL in genital secretions and to compare this with any previous or subsequent resistance profile in plasma.

    (Genital Secretions substudy REC # 09/H0305/58)

  • HIV VL in CSF [ Time Frame: Week 96 ]

    In a subset of participants on PI monotherapy (n=40).

    • Estimate the proportion of patients who have detectable HIV viral load in CSF after 48 weeks on PI monotherapy, and to refute the hypothesis that this proportion is greater than 20%.
    • Assess whether CSF markers of CNS immune activation, inflammation and neuronal degeneration are elevated after 48 weeks on PI monotherapy.
    • Assess whether CSF HIV viral load and markers of immune activation, inflammation and neuronal degeneration are elevated in patients with symptomatic CNS disease.

    (CNS substudy REC # 09/H0305/58).

Enrollment: 587
Study Start Date: November 2008
Estimated Study Completion Date: November 2013
Estimated Primary Completion Date: November 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Protease Inhibitor Monotherapy
Ritonavir-boosted protease inhibitor
Drug: Protease Inhibitor
Switch to a regimen comprising a single ritonavir-boosted Protease Inhibitor
Active Comparator: Control
Standard-of-care triple-therapy regimen
Drug: Standard-of-care Antiretroviral therapy
Regimen should consist of 3 drugs: 2 nucleoside reverse transcriptase inhibitors with either a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor


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

Inclusion Criteria:

Vl < 50 for 24 weeks prior to screening CD4 > 100 at screening

Exclusion Criteria:

  1. Known major protease resistance mutation(s) documented on prior resistance testing if performed (prior resistance testing is not mandatory for trial participation).
  2. Previous change in ART drug regimen for reasons of unsatisfactory virological response (patients who have changed regimen for prevention or management of toxicity or to improve regimen convenience are permitted to enter the trial).
  3. Previous allergic reaction to a PI.
  4. Patient currently using or likely to require use of concomitant medication with known interaction with PIs.
  5. Patient requiring treatment with radiotherapy, cytotoxic chemotherapy, or is anticipated to need these during the trial period.
  6. Treatment for acute opportunistic infection within 3 months prior to trial screening.
  7. Pregnant or trying to become pregnant at the time of trial entry.
  8. History of active substance abuse or psychiatric illness that, in the opinion of the investigator, would preclude compliance with the protocol, dosing schedule or assessments.
  9. History of HIV encephalopathy with current deficit >1 in any domain of the Neuropsychiatric AIDS Rating Scale (see Appendix 7).
  10. Past or current history of cardiovascular disease, or 10 year absolute coronary heart disease risk of >30%, or risk of >20% if the patient has diabetes or a family history of premature ischaemic heart disease or stroke.
  11. History of insulin-dependent diabetes mellitus.
  12. Patient currently receiving interferon therapy for Hepatitis C virus infection or planning to start treatment for Hepatitis C at the time of trial entry.
  13. Co-infection with hepatitis B, defined as Hepatitis BsAg positive at screening or at any time since HIV diagnosis, unless the patient has had a documented Hepatitis B DNA measurement of less than 1000 copies/ml taken whilst off Hepatitis B active drugs.
  14. Any other active clinically significant condition, or findings during screening medical history or examination, or abnormality on screening laboratory blood tests that would, in the opinion of the investigator, compromise the patient's safety or outcome in the trial.
  15. Fasting plasma glucose >7.0mmol/L at trial screening.
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Please refer to this study by its identifier: NCT01230580

Sponsors and Collaborators
Medical Research Council
NHS Health Technology Assessment Programme
Principal Investigator: Nick Paton, MD Medical Research Council
  More Information

Additional Information:
Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Medical Research Council (Dr Nick Paton Chief Investigator MRC Clinical Trials Unit), Medical Research Council Identifier: NCT01230580     History of Changes
Other Study ID Numbers: PIVOT
2007-006448-23 ( EudraCT Number )
Study First Received: October 27, 2010
Last Updated: October 9, 2012

Keywords provided by Medical Research Council:
Protease Inhibitors
RNA virus infections
Virus diseases
Sexually Transmitted Diseases viral
Immune system diseases
Anti-infective Agents
Drug resistance

Additional relevant MeSH terms:
Communicable Diseases
HIV Infections
Acquired Immunodeficiency Syndrome
Immunologic Deficiency Syndromes
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immune System Diseases
Slow Virus Diseases
Protease Inhibitors
HIV Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Anti-HIV Agents
Anti-Retroviral Agents
Antiviral Agents
Anti-Infective Agents processed this record on April 24, 2017