HIV Viremia and Persistence in Acutely HIV-Infected Patients Treated With Darunavir/Ritonavir and Etravirine
Primary Purpose
Acute HIV Infection, HIV Infections
Status
Terminated
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Darunavir
Ritonavir
Etravirine
Sponsored by
About this trial
This is an interventional treatment trial for Acute HIV Infection focused on measuring Acute HIV, HIV, Treatment Naive, Acute Infections
Eligibility Criteria
Inclusion Criteria:
- Documentation of Acute HIV Infection as defined above.
- Men and women age ≥18 years.
- Participants will be ART naïve, defined as ≤14 days of antiretroviral treatment at any time prior to entry. The only exceptions are: Post-exposure prophylaxis (PEP) provided the patient was documented as HIV-1 negative at least 3-6 months after completion of the PEP treatment.
- Screening HIV-1 RNA >1,000 copies/mL obtained within 30 days at study entry.
- Lab values obtained within 30 days prior to study entry:
- Absolute neutrophil count >500/mm3
- Hemoglobin > 8.5 g/dL for men and > 8.0 g/dL for women
- Platelet count >50,000/mm3
- AST (SGOT) ≤2.5 x ULN
- ALT (SGPT) ≤2.5 x ULN
- Total bilirubin <2.5 x ULN
Calculated creatinine clearance (Cockcroft-Gault formula) > 30mL/min:
- CrCl = (140-age) x body weight (kg) (x 0.85 if female)
- Serum creatinine [mg/dL] x (72)
- For women of reproductive potential, a negative serum or urine pregnancy test within 7 days prior to initiating antiretroviral study medications. Reproductive potential is defined as females who have reached menarche and have not been post-menopausal for at least 24 consecutive months, or have not undergone surgical sterilization (e.g., hysterectomy, bilateral oophorectomy, or salpingotomy). Acceptable documentation of surgical sterilization includes patient-reported history.
- If participating in sexual activity that could lead to pregnancy, female study patients must use at least one form of contraception, which could consist only of a barrier method. All patients must continue to use contraception for 6 weeks after stopping the study medications. Acceptable methods of contraception include: condoms (male or female) with or without spermicidal agent, diaphragm or cervical cap with spermicide, or IUD. Female volunteers not of reproductive potential are not required to use contraception.
- Ability and willingness of patient to give written informed consent.
Exclusion Criteria:
- Women who are pregnant or breast-feeding.
- Women with a positive pregnancy test on enrollment or prior to study drug administration.
- Women of reproductive potential who are unwilling or unable to use acceptable methods to avoid pregnancy for the entire study period
Use of immunomodulators (e.g., interleukins, interferons, cyclosporine), HIV vaccine, systemic cytotoxic chemotherapy, or investigational therapy within 30 days prior to study entry.
- Prednisone at a daily dose of 10 mg or less (physiologic replacement dose) is permitted.
- Known allergy/sensitivity to study drugs or their formulations.
- Difficulty swallowing capsules/tablets.
- Inability to communicate effectively with study personnel.
- Incarceration; prisoner recruitment and participation are not permitted.
- Active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements or confound the analysis of study endpoints.
- Any active psychiatric illness including schizophrenia, severe depression, or severe bipolar affective disorder that, in the opinion of the investigator, could confound the analysis of the neurological examination or neuropsychological test results.
- Active brain infection (except for HIV-1), brain neoplasm, space-occupying brain lesion requiring acute or chronic therapy. Participants with any fungal meningitis, parasitic infection, or CNS lymphoma are excluded from participation.
- Serious illness requiring systemic treatment and/or hospitalization until patient either completes therapy or is clinically stable on therapy, in the opinion of the site investigator, for at least 7 days prior to study entry. NOTE: Oral candidiasis, vaginal candidiasis, mucocutaneous herpes simplex, and other minor illnesses (as judged by the site investigator) have no restriction.
- Known cardiac conduction disease.
- Prior treatment with any other experimental drug for any indication (within 30 days of initiating study treatment).
- Unable to discontinue any current medications that are excluded during study treatment.
- A life expectancy less than twelve months.
- Acute Viral Hepatitis, including, but not limited to, Hepatitis A, B, or C
- Chronic Hepatitis B Infection documented by a detectable serum Hepatitis B surface antigen (HBsAg) or plasma HBV DNA
Sites / Locations
- The University of North Carolina - Chapel Hill
- Duke University
Arms of the Study
Arm 1
Arm Type
Other
Arm Label
Darunavir/Ritonavir and Etravirine
Arm Description
Darunavir/Ritonavir 800 mg/100 mg orally once daily. ETR will be given 200 mg orally twice daily, although patients may choose to take ETR 400 mg QD to have a simpler all QD regimen.
Outcomes
Primary Outcome Measures
Number of Participants With Virologic Response
Virologic response defined as plasma HIV RNA measurement <200 copies/mL at week 24
Secondary Outcome Measures
Number of Participants With Virologic Response
Virologic response to study treatment defined as plasma HIV RNA measurement <50 copies/mL at week 48
Median Change in CD4 Cell Count From Week 0 to Week 24.
Median Change in CD4 Cell Count From Week 0 to Week 48.
HIV RNA Levels Immediately Prior to Initiating Study Treatment.
Median Time to HIV RNA Suppression to <200 Copies/mL
HIV RNA Detection in Semen
Total cumulative levels of HIV RNA detected in the semen of participants from enrollment through week 48.
Number of Participants Who Stopped Study Treatment Due to Adverse Event or Intolerance
Adverse Events Possibly or Definitely Related to Study Treatment Through Week 48
Total number of adverse events observed that were possibly or definitely related to study treatment through week 48
Maximum Etravirine Exposure in Cerebrospinal Fluid Among Participants Who Consented to an Optional Lumbar Puncture
Minimum Etravirine Exposure in Cerebrospinal Fluid Among Participants Who Consented to an Optional Lumbar Puncture
Maximum Darunavir Exposure in Cerebrospinal Fluid Among Participants Who Consented to an Optional Lumbar Puncture
Minimum Darunavir Exposure in Cerebrospinal Fluid Among Participants Who Consented to an Optional Lumbar Puncture
Maximum Ritonavir Exposure in Cerebrospinal Fluid Among Participants Who Consented to an Optional Lumbar Puncture
Minimum Ritonavir Exposure Range in Cerebrospinal Fluid Among Participants Who Consented to an Optional Lumbar Puncture
Maximum Etravirine Exposure in Semen Among Participants Who Consented to an Optional Collection of Semen
Minimum Etravirine Exposure in Semen Among Participants Who Consented to an Optional Collection of Semen
Maximum Darunavir Exposure in Semen Among Participants Who Consented to an Optional Collection of Semen
Minimum Darunavir Exposure Range in Semen Among Participants Who Consented to an Optional Collection of Semen
Maximum Ritonavir Exposure in Semen Among Participants Who Consented to an Optional Collection of Semen
Minimum Ritonavir Exposure in Semen Among Participants Who Consented to an Optional Collection of Semen
Maximum Etravirine Exposure in Ileal Tissue Among Participants Who Consented to an Optional Gut Biopsy Procedure
Minimum Etravirine Exposure Range in Ileal Tissue Among Participants Who Consented to an Optional Gut Biopsy Procedure
Maximum Darunavir Exposure Range in Ileal Tissue Among Participants Who Consented to an Optional Gut Biopsy Procedure
Minimum Darunavir Exposure Range in Ileal Tissue Among Participants Who Consented to an Optional Gut Biopsy Procedure
Maximum Ritonavir Exposure Range in Ileal Tissue Among Participants Who Consented to an Optional Gut Biopsy Procedure
Minimum Ritonavir Exposure Range in Ileal Tissue Among Participants Who Consented to an Optional Gut Biopsy Procedure
Number of Participants With HIV RNA Measurement Above the Limits of Detection in Cerebrospinal Fluid
Number of Participants With Neurocognitive Impairment at Baseline
Number of Participants With Neurocognitive Impairment at Week 24
Number of Participants With Neurocognitive Impairment at Week 48
Overall Neurocognitive Impairment Score at Week 2 or 4
Neuropsychological performance was assessed at Week 2 or 4, Week 24 and Week 48 in the following measures: Premorbid/language (Wide Range Achievement Test 4 -Reading Subtest), Learning (HVLT-R, Hopkins Verbal Learning Test-Revised), Memory (HVLT-R), Speed of Processing (Trailmaking A (Army Individual Test Battery, 1944), 1974, Stroop color, Attention (WAIS-III Symbol Search; Stroop word, Fine motor, Executive (Trailmaking B, Stroop interference, Letter, Category Fluency. An overall summary score was created by averaging all tests. Participants also completed the self-reported functional status Patient's Assessment of Own Functioning Inventory (PAOFI) and the Activities of Daily Living Scale (ADLS). Best available demographically corrected normative data were utilized to create z scores. A negative z score denotes below-average performance relative to a US normative comparison population. A higher z score is a better outcome.
Overall Neurocognitive Impairment at Week 24
Neuropsychological performance was assessed at week 2 or 4, week 24 and week 48 in the following measures: Premorbid/language (Wide Range Achievement Test 4 -Reading Subtest), Learning (Hopkins Verbal Learning Test - Revised), Memory (HVLT-R), Speed of Processing (Trailmaking A (Army Individual Test Battery, 1944), 1974, Stroop color, Attention (WAIS-III Symbol Search; Stroop word, Fine motor, Executive (Trailmaking B, Stroop interference, Letter, Category Fluency. An overall summary score of neurocognitive functioning was created by averaging all tests. Participants also completed Patient's Assessment of Own Functioning Inventory (PAOFI) and the Activities of Daily Living Scale (ADLS). Best available demographically corrected normative data were utilized to create z scores. A negative z score denotes below-average performance relative to a US normative comparison population. A higher z score is a better outcome.
Overall Neurocognitive Impairment at Week 48
Neuropsychological performance was assessed at baseline (week 2 or 4), week 24 and week 48 in the following domain (measures): Premorbid/language (Wide Range Achievement Test (WRAT) 4 - Reading Subtest), Learning (HVLT-R, Hopkins Verbal Learning Test - Revised), Memory (HVLT-R), Speed of Processing (Trailmaking A (Army Individual Test Battery, 1944), 1974, Stroop color, Attention (WAIS-III Symbol Search; Stroop word, Fine motor, Executive (Trailmaking B, Stroop interference, Letter, Category Fluency. An overall summary score of neurocognitive functioning was created by averaging all tests. Participants also completed the self-reported functional status Patient's Assessment of Own Functioning Inventory (PAOFI) and the Activities of Daily Living Scale (ADLS). Best available demographically corrected normative data were utilized to create z scores. A negative z score denotes below-average performance relative to a US normative comparison population. A higher z score is a better outcome.
Change in Overall Neurocognitive Impairment From Baseline to Week 24 or 48
Change in overall z score from baseline to week 24 or 48. A negative z score denotes below-average performance relative to a US normative comparison population. A higher z score is a better outcome.
Correlation of HIV RNA Levels in CSF and Drug Levels With Neurocognitive Functioning
Correlation of Time to HIV RNA Levels <200 Copies/mL With Improvement in Neurocognitive Functioning From Baseline to Week 24 and 48
HIV RNA Detection in Ileal Biopsy Specimens
Average HIV RNA detected in the ileal biopsy specimens per participant over weeks 4 and 48.
Full Information
NCT ID
NCT00855413
First Posted
March 2, 2009
Last Updated
September 12, 2017
Sponsor
University of North Carolina, Chapel Hill
Collaborators
Janssen Pharmaceuticals
1. Study Identification
Unique Protocol Identification Number
NCT00855413
Brief Title
HIV Viremia and Persistence in Acutely HIV-Infected Patients Treated With Darunavir/Ritonavir and Etravirine
Official Title
CID 0821 - Pilot Study to Evaluate HIV Viremia and Persistence in Acutely HIV-Infected Antiretroviral Naïve Patients Treated With Darunavir/Ritonavir and Etravirine
Study Type
Interventional
2. Study Status
Record Verification Date
September 2017
Overall Recruitment Status
Terminated
Why Stopped
Study halted by sponsor due to slow enrollment.
Study Start Date
March 2009 (undefined)
Primary Completion Date
November 2013 (Actual)
Study Completion Date
November 2013 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of North Carolina, Chapel Hill
Collaborators
Janssen Pharmaceuticals
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Purpose: This is a pilot study to evaluate HIV viremia and persistence in acutely HIV infected antiretroviral naïve patients treated with Darunavir/ritonavir and Etravirine
Participants: 20 participants, age 18 and older, HIV infected, antiretroviral naïve patients
Procedures (methods): ARV treatment with Darunavir/ritonavir and Etravirine,
Optional studies:
Genital secretion samples, Cerebrospinal fluid samples, Leukapheresis, Endoscopy/colonoscopy
Detailed Description
Study Design
This is a multicenter, single arm, 48-week open-label pilot study of DRV/R & ETR in acute HIV infection. Study sites will be members of the Duke-UNC Acute HIV Infection Study Consortium. If baseline resistance is detected after treatment begins (e.g. evidence of pre-existing baseline resistance (genotypic or phenotypic) that may adversely affect the efficacy of the study regimen), the patient may elect to alter treatment as per best clinical practice. The new regimen will not be provided by the study, but will be obtained for the participant through available clinical resources.
After patients are identified with acute HIV infection, they will be offered the opportunity to participate in the study. Patients will also be offered the opportunity to co-enroll in CHAVI 001 and 012, studies that follow the virological and immunological response of patients with AHI, regardless of the initiation of ART. An overall consent form will be signed for study participation, and separate informed consents with signatures will be obtained for optional studies. Patients will be eligible for participation after signing the overall consent - agreeing to participate in studies of other compartment specimens is not required for enrollment. At the initial visit, patient eligibility will be confirmed with appropriate laboratory testing (see "STUDY POPULATION"). When eligibility is verified, entry laboratory studies will be obtained, and the participants will be started on DRV/r, and ETR. All participants will be followed at regular intervals thereafter as specified in the schedule of evaluations. Participants meeting criteria for virologic failure will be offered the opportunity to switch to the best available regimen as selected by their HIV provider.
Hypothesis
Combination therapy with DRV/R & ETR will suppress plasma viremia and improve immunologic function in antiretroviral (ART)-naïve, acutely HIV-infected (AHI) patients, and will limit replication in HIV-1 cellular compartments.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute HIV Infection, HIV Infections
Keywords
Acute HIV, HIV, Treatment Naive, Acute Infections
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
15 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Darunavir/Ritonavir and Etravirine
Arm Type
Other
Arm Description
Darunavir/Ritonavir 800 mg/100 mg orally once daily.
ETR will be given 200 mg orally twice daily, although patients may choose to take ETR 400 mg QD to have a simpler all QD regimen.
Intervention Type
Drug
Intervention Name(s)
Darunavir
Other Intervention Name(s)
Prezista
Intervention Description
800 mg orally once daily
Intervention Type
Drug
Intervention Name(s)
Ritonavir
Other Intervention Name(s)
Norvir
Intervention Description
100 mg orally once daily
Intervention Type
Drug
Intervention Name(s)
Etravirine
Other Intervention Name(s)
Intelence
Intervention Description
200 mg orally twice daily, although patients may choose to take ETR 400 mg QD to have a simpler all QD regimen
Primary Outcome Measure Information:
Title
Number of Participants With Virologic Response
Description
Virologic response defined as plasma HIV RNA measurement <200 copies/mL at week 24
Time Frame
24 weeks
Secondary Outcome Measure Information:
Title
Number of Participants With Virologic Response
Description
Virologic response to study treatment defined as plasma HIV RNA measurement <50 copies/mL at week 48
Time Frame
48 weeks from enrollment
Title
Median Change in CD4 Cell Count From Week 0 to Week 24.
Time Frame
week 0, week 24
Title
Median Change in CD4 Cell Count From Week 0 to Week 48.
Time Frame
48 weeks from enrollment
Title
HIV RNA Levels Immediately Prior to Initiating Study Treatment.
Time Frame
HIV RNA level at enrollment
Title
Median Time to HIV RNA Suppression to <200 Copies/mL
Time Frame
From enrollment to the date of HIV RNA suppression, assessed up to Week 48
Title
HIV RNA Detection in Semen
Description
Total cumulative levels of HIV RNA detected in the semen of participants from enrollment through week 48.
Time Frame
From enrollment through 48 weeks
Title
Number of Participants Who Stopped Study Treatment Due to Adverse Event or Intolerance
Time Frame
Enrollment to Week 48
Title
Adverse Events Possibly or Definitely Related to Study Treatment Through Week 48
Description
Total number of adverse events observed that were possibly or definitely related to study treatment through week 48
Time Frame
Enrollment to week 48
Title
Maximum Etravirine Exposure in Cerebrospinal Fluid Among Participants Who Consented to an Optional Lumbar Puncture
Time Frame
Week 4 and week 48
Title
Minimum Etravirine Exposure in Cerebrospinal Fluid Among Participants Who Consented to an Optional Lumbar Puncture
Time Frame
Week 4 and week 48
Title
Maximum Darunavir Exposure in Cerebrospinal Fluid Among Participants Who Consented to an Optional Lumbar Puncture
Time Frame
Week 4 and week 48
Title
Minimum Darunavir Exposure in Cerebrospinal Fluid Among Participants Who Consented to an Optional Lumbar Puncture
Time Frame
Week 4 and week 48
Title
Maximum Ritonavir Exposure in Cerebrospinal Fluid Among Participants Who Consented to an Optional Lumbar Puncture
Time Frame
Week 4 and Week 48
Title
Minimum Ritonavir Exposure Range in Cerebrospinal Fluid Among Participants Who Consented to an Optional Lumbar Puncture
Time Frame
Week 4 and week 48
Title
Maximum Etravirine Exposure in Semen Among Participants Who Consented to an Optional Collection of Semen
Time Frame
Weeks 0-4 and weeks 12, 48
Title
Minimum Etravirine Exposure in Semen Among Participants Who Consented to an Optional Collection of Semen
Time Frame
Weeks 0-4 and weeks 12, 48
Title
Maximum Darunavir Exposure in Semen Among Participants Who Consented to an Optional Collection of Semen
Time Frame
Weeks 0-4 and weeks 12, 48
Title
Minimum Darunavir Exposure Range in Semen Among Participants Who Consented to an Optional Collection of Semen
Time Frame
Weeks 0-4 and weeks 12, 48
Title
Maximum Ritonavir Exposure in Semen Among Participants Who Consented to an Optional Collection of Semen
Time Frame
Weeks 0-4 and Weeks 12, 48
Title
Minimum Ritonavir Exposure in Semen Among Participants Who Consented to an Optional Collection of Semen
Time Frame
Weeks 0-4 and Weeks 12, 48
Title
Maximum Etravirine Exposure in Ileal Tissue Among Participants Who Consented to an Optional Gut Biopsy Procedure
Time Frame
between Week 4-12 and between Weeks 36-48
Title
Minimum Etravirine Exposure Range in Ileal Tissue Among Participants Who Consented to an Optional Gut Biopsy Procedure
Time Frame
between Week 4-12 and between Weeks 36-48
Title
Maximum Darunavir Exposure Range in Ileal Tissue Among Participants Who Consented to an Optional Gut Biopsy Procedure
Time Frame
between Week 4-12 and between Weeks 36-48
Title
Minimum Darunavir Exposure Range in Ileal Tissue Among Participants Who Consented to an Optional Gut Biopsy Procedure
Time Frame
between week 4-12 and between weeks 36-48
Title
Maximum Ritonavir Exposure Range in Ileal Tissue Among Participants Who Consented to an Optional Gut Biopsy Procedure
Time Frame
between week 4-12 and between Weeks 36-48
Title
Minimum Ritonavir Exposure Range in Ileal Tissue Among Participants Who Consented to an Optional Gut Biopsy Procedure
Time Frame
between week 4-12 and between weeks 36-48
Title
Number of Participants With HIV RNA Measurement Above the Limits of Detection in Cerebrospinal Fluid
Time Frame
Week 4 and Week 48
Title
Number of Participants With Neurocognitive Impairment at Baseline
Time Frame
Week 2 or 4
Title
Number of Participants With Neurocognitive Impairment at Week 24
Time Frame
Week 24
Title
Number of Participants With Neurocognitive Impairment at Week 48
Time Frame
Week 48
Title
Overall Neurocognitive Impairment Score at Week 2 or 4
Description
Neuropsychological performance was assessed at Week 2 or 4, Week 24 and Week 48 in the following measures: Premorbid/language (Wide Range Achievement Test 4 -Reading Subtest), Learning (HVLT-R, Hopkins Verbal Learning Test-Revised), Memory (HVLT-R), Speed of Processing (Trailmaking A (Army Individual Test Battery, 1944), 1974, Stroop color, Attention (WAIS-III Symbol Search; Stroop word, Fine motor, Executive (Trailmaking B, Stroop interference, Letter, Category Fluency. An overall summary score was created by averaging all tests. Participants also completed the self-reported functional status Patient's Assessment of Own Functioning Inventory (PAOFI) and the Activities of Daily Living Scale (ADLS). Best available demographically corrected normative data were utilized to create z scores. A negative z score denotes below-average performance relative to a US normative comparison population. A higher z score is a better outcome.
Time Frame
Week 2 or 4
Title
Overall Neurocognitive Impairment at Week 24
Description
Neuropsychological performance was assessed at week 2 or 4, week 24 and week 48 in the following measures: Premorbid/language (Wide Range Achievement Test 4 -Reading Subtest), Learning (Hopkins Verbal Learning Test - Revised), Memory (HVLT-R), Speed of Processing (Trailmaking A (Army Individual Test Battery, 1944), 1974, Stroop color, Attention (WAIS-III Symbol Search; Stroop word, Fine motor, Executive (Trailmaking B, Stroop interference, Letter, Category Fluency. An overall summary score of neurocognitive functioning was created by averaging all tests. Participants also completed Patient's Assessment of Own Functioning Inventory (PAOFI) and the Activities of Daily Living Scale (ADLS). Best available demographically corrected normative data were utilized to create z scores. A negative z score denotes below-average performance relative to a US normative comparison population. A higher z score is a better outcome.
Time Frame
Week 24
Title
Overall Neurocognitive Impairment at Week 48
Description
Neuropsychological performance was assessed at baseline (week 2 or 4), week 24 and week 48 in the following domain (measures): Premorbid/language (Wide Range Achievement Test (WRAT) 4 - Reading Subtest), Learning (HVLT-R, Hopkins Verbal Learning Test - Revised), Memory (HVLT-R), Speed of Processing (Trailmaking A (Army Individual Test Battery, 1944), 1974, Stroop color, Attention (WAIS-III Symbol Search; Stroop word, Fine motor, Executive (Trailmaking B, Stroop interference, Letter, Category Fluency. An overall summary score of neurocognitive functioning was created by averaging all tests. Participants also completed the self-reported functional status Patient's Assessment of Own Functioning Inventory (PAOFI) and the Activities of Daily Living Scale (ADLS). Best available demographically corrected normative data were utilized to create z scores. A negative z score denotes below-average performance relative to a US normative comparison population. A higher z score is a better outcome.
Time Frame
Week 48
Title
Change in Overall Neurocognitive Impairment From Baseline to Week 24 or 48
Description
Change in overall z score from baseline to week 24 or 48. A negative z score denotes below-average performance relative to a US normative comparison population. A higher z score is a better outcome.
Time Frame
Baseline to Week 24 or 48
Title
Correlation of HIV RNA Levels in CSF and Drug Levels With Neurocognitive Functioning
Time Frame
From enrollment through Week 48
Title
Correlation of Time to HIV RNA Levels <200 Copies/mL With Improvement in Neurocognitive Functioning From Baseline to Week 24 and 48
Time Frame
Baseline to Week 24 and 48
Title
HIV RNA Detection in Ileal Biopsy Specimens
Description
Average HIV RNA detected in the ileal biopsy specimens per participant over weeks 4 and 48.
Time Frame
Weeks 4 and 48
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Documentation of Acute HIV Infection as defined above.
Men and women age ≥18 years.
Participants will be ART naïve, defined as ≤14 days of antiretroviral treatment at any time prior to entry. The only exceptions are: Post-exposure prophylaxis (PEP) provided the patient was documented as HIV-1 negative at least 3-6 months after completion of the PEP treatment.
Screening HIV-1 RNA >1,000 copies/mL obtained within 30 days at study entry.
Lab values obtained within 30 days prior to study entry:
Absolute neutrophil count >500/mm3
Hemoglobin > 8.5 g/dL for men and > 8.0 g/dL for women
Platelet count >50,000/mm3
AST (SGOT) ≤2.5 x ULN
ALT (SGPT) ≤2.5 x ULN
Total bilirubin <2.5 x ULN
Calculated creatinine clearance (Cockcroft-Gault formula) > 30mL/min:
CrCl = (140-age) x body weight (kg) (x 0.85 if female)
Serum creatinine [mg/dL] x (72)
For women of reproductive potential, a negative serum or urine pregnancy test within 7 days prior to initiating antiretroviral study medications. Reproductive potential is defined as females who have reached menarche and have not been post-menopausal for at least 24 consecutive months, or have not undergone surgical sterilization (e.g., hysterectomy, bilateral oophorectomy, or salpingotomy). Acceptable documentation of surgical sterilization includes patient-reported history.
If participating in sexual activity that could lead to pregnancy, female study patients must use at least one form of contraception, which could consist only of a barrier method. All patients must continue to use contraception for 6 weeks after stopping the study medications. Acceptable methods of contraception include: condoms (male or female) with or without spermicidal agent, diaphragm or cervical cap with spermicide, or IUD. Female volunteers not of reproductive potential are not required to use contraception.
Ability and willingness of patient to give written informed consent.
Exclusion Criteria:
Women who are pregnant or breast-feeding.
Women with a positive pregnancy test on enrollment or prior to study drug administration.
Women of reproductive potential who are unwilling or unable to use acceptable methods to avoid pregnancy for the entire study period
Use of immunomodulators (e.g., interleukins, interferons, cyclosporine), HIV vaccine, systemic cytotoxic chemotherapy, or investigational therapy within 30 days prior to study entry.
Prednisone at a daily dose of 10 mg or less (physiologic replacement dose) is permitted.
Known allergy/sensitivity to study drugs or their formulations.
Difficulty swallowing capsules/tablets.
Inability to communicate effectively with study personnel.
Incarceration; prisoner recruitment and participation are not permitted.
Active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements or confound the analysis of study endpoints.
Any active psychiatric illness including schizophrenia, severe depression, or severe bipolar affective disorder that, in the opinion of the investigator, could confound the analysis of the neurological examination or neuropsychological test results.
Active brain infection (except for HIV-1), brain neoplasm, space-occupying brain lesion requiring acute or chronic therapy. Participants with any fungal meningitis, parasitic infection, or CNS lymphoma are excluded from participation.
Serious illness requiring systemic treatment and/or hospitalization until patient either completes therapy or is clinically stable on therapy, in the opinion of the site investigator, for at least 7 days prior to study entry. NOTE: Oral candidiasis, vaginal candidiasis, mucocutaneous herpes simplex, and other minor illnesses (as judged by the site investigator) have no restriction.
Known cardiac conduction disease.
Prior treatment with any other experimental drug for any indication (within 30 days of initiating study treatment).
Unable to discontinue any current medications that are excluded during study treatment.
A life expectancy less than twelve months.
Acute Viral Hepatitis, including, but not limited to, Hepatitis A, B, or C
Chronic Hepatitis B Infection documented by a detectable serum Hepatitis B surface antigen (HBsAg) or plasma HBV DNA
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Cynthia Gay, MD, MPH
Organizational Affiliation
University of North Carolina, Chapel Hill
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
David M Margolis, MD
Organizational Affiliation
University of North Carolina, Chapel Hill
Official's Role
Principal Investigator
Facility Information:
Facility Name
The University of North Carolina - Chapel Hill
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27599
Country
United States
Facility Name
Duke University
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27707
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
21487250
Citation
Gay CL, Mayo AJ, Mfalila CK, Chu H, Barry AC, Kuruc JD, McGee KS, Kerkau M, Sebastian J, Fiscus SA, Margolis DM, Hicks CB, Ferrari G, Eron JJ; Duke-UNC Acute HIV Infection Consortium. Efficacy of NNRTI-based antiretroviral therapy initiated during acute HIV infection. AIDS. 2011 Apr 24;25(7):941-9. doi: 10.1097/QAD.0b013e3283463c07.
Results Reference
background
Citation
C Gay, O Dibben, A Stacey, N Gasper-Smith, M Liu, N Goonetilleke, G Ferrari, J Eron, C Hicks, A McMichael, B Haynes, P Borrow, M Cohen, the Duke-UNC CHAVI 001 Clinical Working Group. "Effect(s) of antiretroviral treatment on acute HIV infection." XVII International AIDS Conference, 2008 Abstract no. THPE0086.
Results Reference
background
PubMed Identifier
32773474
Citation
Gay CL, Neo DT, Devanathan AS, Kuruc JD, McGee KS, Schmitz JL, Sebastian J, Shaheen NJ, Ferrari G, McKellar M, Fiscus SA, Hicks CB, Robertson K, Kashuba ADM, Eron JJ, Margolis DM. Efficacy, pharmacokinetics and neurocognitive performance of dual, NRTI-sparing antiretroviral therapy in acute HIV-infection. AIDS. 2020 Nov 1;34(13):1923-1931. doi: 10.1097/QAD.0000000000002652.
Results Reference
derived
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HIV Viremia and Persistence in Acutely HIV-Infected Patients Treated With Darunavir/Ritonavir and Etravirine
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