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Atazanavir/Ritonavir and Zinc Pharmacokinetic Study (SSAT043)

Primary Purpose

HIV Infection

Status
Completed
Phase
Phase 4
Locations
United Kingdom
Study Type
Interventional
Intervention
1 Solvazinc tablet, day 2 to day 15
1 Solvazinc tablet, day 15 to day 28
Sponsored by
St Stephens Aids Trust
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infection focused on measuring HIV, Bilirubin

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. The ability to understand and sign a written informed consent form, prior to participation in any screening procedure and must be willing to comply with all study requirements
  2. Male or non-pregnant, non-lactating females.
  3. Aged between 18 to 65 years, inclusive.
  4. Documented HIV-1 infection
  5. Plasma HIV RNA less than 40 copies/mL (note retesting of screening viral load is allowed).
  6. CD4 count > 100 at screening (note retesting of screening CD4 count is allowed).
  7. Receiving an antiretroviral regimen of Truvada and atazanavir/ritonavir for more than 3 months.
  8. Serum total bilirubin concentration greater than 25 micromol/L
  9. Agrees not to change regimen, outside the study recommendations, from baseline until end of the treatment period unless this is medically indicated as decided by their treating physician.

Exclusion Criteria:

  1. Any serious or active medical or psychiatric illness, which, in the opinion of the investigator, would interfere with subject treatment, assessment, or compliance with the protocol. This would include any active clinically significant renal, cardiac, hepatic, pulmonary, vascular, metabolic disorders or malignancy.
  2. Body mass index (BMI) >35 kg/m2
  3. Presence of any current active AIDS defining illness (Category C conditions according to the CDC Classification System for HIV Infection 1993) with the following exceptions:

    • Stable cutaneous Kaposi's Sarcoma

  4. Clinically relevant alcohol or drug use (positive urine drug screen, with the exception of cannabinoids) or history of alcohol or drug use considered by the Investigator to be sufficient to hinder compliance with treatment, follow-up procedures or evaluation of adverse events.
  5. The use of zinc supplements for 1 month before screening and disallowed concomitant therapy (See Concomitant Medication and treatment, section 5.2) or medication that may interfere with the study results (as determined by the principal investigator).
  6. Females of childbearing potential who are not using effective non-hormonal birth control methods or not willing to continue using these birth control methods for at least 14 days after the end of the treatment period.
  7. Previous allergy to any of the constituents of the zinc sulphate tablets administered in this trial.
  8. Subjects with laboratory evidence of significantly decreased hepatic or renal function (as determined by the principal investigator).
  9. Exposure to any investigational drug or placebo within 4 weeks of first dose of study drug

Sites / Locations

  • St Stephen's AIDS Trust

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Arm A- early Solvazinc group

Arm B- late Solvazinc group

Arm Description

Zinc sulphate 125mg (1 Solvazinc tablet) once daily orally after dissolution in water, day 2 to day 15

Zinc sulphate 125mg (1 Solvazinc tablet) once daily orally after dissolution in water, day 15 to day 28

Outcomes

Primary Outcome Measures

To assess the change in unconjugated hyperbilirubinaemia following acute and chronic administration of zinc sulphate during atazanavir/ritonavir therapy.
Change in serum unconjugated bilirubin concentrations when atazanavir/ritonavir is added to zinc sulphate, adjusted for period effect

Secondary Outcome Measures

safety and tolerability of zinc sulphate supplement when given concomitantly with atazanavir/ritonavir
Assessment of the impact of adding zinc sulphate to atazanavir/ritonavir-based HAART on grade 2-4 laboratory abnormalities and adverse events.
To assess atazanavir plasma exposure in the presence of zinc and relationship between the latter and hyperbilirubin during zinc intake.
Atazanavir plasma exposure in the presence of zinc and relationship between the latter and hyperbilirubin during zinc intake.

Full Information

First Posted
October 31, 2011
Last Updated
March 21, 2012
Sponsor
St Stephens Aids Trust
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1. Study Identification

Unique Protocol Identification Number
NCT01475227
Brief Title
Atazanavir/Ritonavir and Zinc Pharmacokinetic Study
Acronym
SSAT043
Official Title
A Randomized Crossover Study of the Effects of Zinc Sulphate Supplementation on Atazanavir/Ritonavir-associated Hyperbilirubinemia
Study Type
Interventional

2. Study Status

Record Verification Date
March 2012
Overall Recruitment Status
Completed
Study Start Date
December 2011 (undefined)
Primary Completion Date
March 2012 (Actual)
Study Completion Date
March 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
St Stephens Aids Trust

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The study is being conducted as the most common side effect of the HIV drug atazanavir (taken with ritonavir) is hyperbilirubinaemia. Bilirubin is a normal waste product from the body and gets broken down in the liver so it can leave the body through the gut. Atazanavir slows the breakdown of this chemical, which can cause jaundice (yellowing of the skin) and/or scleral icterus (yellowing of the eyes). This is completely harmless; in fact up to 1 in 10 of the UK population have an inherited condition that causes the same yellowing. However, some patients don't like this side effect and it is the commonest reason for switching off the drug. A study in people with Gilberts syndrome (the inherited condition that causes the same changes in the chemical bilirubin) showed that a mineral supplement (zinc sulphate) reduced the levels of bilirubin in the blood. The aim of this study is to see if using zinc supplements can achieve the same effect in patients with high bilirubin due to atazanavir use.
Detailed Description
Atazanavir is a protease inhibitor (PI) and, like other agents in this class, requires pharmacological 'boosting' with the cytochrome p450 inhibitor ritonavir. Ritonavir slows the hepatic clearance of PIs, increasing plasma concentration and allowing the us eof lower, and less frequent doses. Atazanavir, boosted with ritonavir, is approved for once-daily use, is an internationally preferred first-line agent (in combination with a backbone of two nucleosides [NRTI]) and the most commonly prescribed PI in the UK. Once-daily atazanavir/ritonavir with two NRTI is an effective and well-tolerated therapeutic option for people living with HIV infection. The most common adverse event associated with atazanavir use is unconjugated hyperbilirubinaemia. This is observed in over 40% of patients and up to 5% of patients discontinue the drug due jaundice and/or scleral icterus. Truvada is a fixed dose combination of two NRTI, tenofovir (245mg) and emtricitabine (200mg), administered as one tablet once daily. Truvada is a preferred NRTI backbone in national and international guidelines and the first line, therefore most commonly used, NRTI backbone in our unit. Benefits of atazanavir/ritonavir compared with alternative agents include once daily dosing, low pill burden, low rates of gastro-intestinal toxicity and, importantly in a patient population already at an elevated risk of cardiovascular disease, a favourable lipid profile. If a simple intervention could reduce the incidence of hyperbilirubinaemia this could reduce the risk of treatment discontinuation/switch. The aim of this study is to explore the benefit, and safety, of adding zinc sulphate in patients on a stable regimen of Truvada, atazanavir and ritonavir.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infection
Keywords
HIV, Bilirubin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
16 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm A- early Solvazinc group
Arm Type
Experimental
Arm Description
Zinc sulphate 125mg (1 Solvazinc tablet) once daily orally after dissolution in water, day 2 to day 15
Arm Title
Arm B- late Solvazinc group
Arm Type
Experimental
Arm Description
Zinc sulphate 125mg (1 Solvazinc tablet) once daily orally after dissolution in water, day 15 to day 28
Intervention Type
Drug
Intervention Name(s)
1 Solvazinc tablet, day 2 to day 15
Other Intervention Name(s)
Zinc sulphate
Intervention Description
Zinc sulphate 125mg, day 2 to day 15
Intervention Type
Drug
Intervention Name(s)
1 Solvazinc tablet, day 15 to day 28
Other Intervention Name(s)
Zinc sulphate
Intervention Description
Zinc sulphate 125mg, day 15 to day 28
Primary Outcome Measure Information:
Title
To assess the change in unconjugated hyperbilirubinaemia following acute and chronic administration of zinc sulphate during atazanavir/ritonavir therapy.
Description
Change in serum unconjugated bilirubin concentrations when atazanavir/ritonavir is added to zinc sulphate, adjusted for period effect
Time Frame
baseline and day 29
Secondary Outcome Measure Information:
Title
safety and tolerability of zinc sulphate supplement when given concomitantly with atazanavir/ritonavir
Description
Assessment of the impact of adding zinc sulphate to atazanavir/ritonavir-based HAART on grade 2-4 laboratory abnormalities and adverse events.
Time Frame
baseline and day 14
Title
To assess atazanavir plasma exposure in the presence of zinc and relationship between the latter and hyperbilirubin during zinc intake.
Description
Atazanavir plasma exposure in the presence of zinc and relationship between the latter and hyperbilirubin during zinc intake.
Time Frame
baseline and day 14

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: The ability to understand and sign a written informed consent form, prior to participation in any screening procedure and must be willing to comply with all study requirements Male or non-pregnant, non-lactating females. Aged between 18 to 65 years, inclusive. Documented HIV-1 infection Plasma HIV RNA less than 40 copies/mL (note retesting of screening viral load is allowed). CD4 count > 100 at screening (note retesting of screening CD4 count is allowed). Receiving an antiretroviral regimen of Truvada and atazanavir/ritonavir for more than 3 months. Serum total bilirubin concentration greater than 25 micromol/L Agrees not to change regimen, outside the study recommendations, from baseline until end of the treatment period unless this is medically indicated as decided by their treating physician. Exclusion Criteria: Any serious or active medical or psychiatric illness, which, in the opinion of the investigator, would interfere with subject treatment, assessment, or compliance with the protocol. This would include any active clinically significant renal, cardiac, hepatic, pulmonary, vascular, metabolic disorders or malignancy. Body mass index (BMI) >35 kg/m2 Presence of any current active AIDS defining illness (Category C conditions according to the CDC Classification System for HIV Infection 1993) with the following exceptions: • Stable cutaneous Kaposi's Sarcoma Clinically relevant alcohol or drug use (positive urine drug screen, with the exception of cannabinoids) or history of alcohol or drug use considered by the Investigator to be sufficient to hinder compliance with treatment, follow-up procedures or evaluation of adverse events. The use of zinc supplements for 1 month before screening and disallowed concomitant therapy (See Concomitant Medication and treatment, section 5.2) or medication that may interfere with the study results (as determined by the principal investigator). Females of childbearing potential who are not using effective non-hormonal birth control methods or not willing to continue using these birth control methods for at least 14 days after the end of the treatment period. Previous allergy to any of the constituents of the zinc sulphate tablets administered in this trial. Subjects with laboratory evidence of significantly decreased hepatic or renal function (as determined by the principal investigator). Exposure to any investigational drug or placebo within 4 weeks of first dose of study drug
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marta Boffito, Dr
Organizational Affiliation
St Stephen's AIDS Trust
Official's Role
Principal Investigator
Facility Information:
Facility Name
St Stephen's AIDS Trust
City
London
ZIP/Postal Code
SW10 9NH
Country
United Kingdom

12. IPD Sharing Statement

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Atazanavir/Ritonavir and Zinc Pharmacokinetic Study

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