Raltegravir + Lopinavir/Ritonavir Versus Efavirenz + Tenofovir + Emtricitabine in Treatment Naive Patients
Primary Purpose
HIV Infections
Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Kaletra + Isentress
Atripla
Sponsored by
About this trial
This is an interventional treatment trial for HIV Infections focused on measuring HIV treatment, Treatment-naive, Adult
Eligibility Criteria
Inclusion Criteria:
- Documented HIV-1 infection.
- Treatment naïve (defined as having never received any HIV antiretroviral agents in past).
- CD4+ T-cell count greater than or equal to 50 cells/mm3
- HIV viral load greater than or equal to 5,000 copies/mL
Laboratory values obtained by screening laboratories within 30 days of entry:
- Absolute neutrophil count (ANC) greater than 750/mm3.
- Hemoglobin greater than 8.0 g/dL.
- Platelet count greater than 50,000/mm3.
Calculated creatinine clearance (CrCl) > 60 mL/min as estimated by the Cockcroft-Gault equation:
- For men, (140 - age in years) x (body weight in kg) ÷ (serum creatinine in mg/dL x 72) = CrCl (mL/min)
- For women, multiply the result by 0.85 = CrCl (mL/min)
- AST (SGOT), ALT (SGPT), and alkaline phosphatase less than 5 x ULN.
- Total bilirubin less than 2.5 x ULN.
- Females of childbearing potential must have a negative serum pregnancy test at screening and agree to use a double-barrier method of contraception throughout the study period.
- Men and women age greater than or equal to 18 years.
- Ability to obtain prescription for HIV antiretroviral medications and to have required prescriptions filled prior to entry.
- Ability and willingness of subject to give written informed consent
Exclusion Criteria:
- Pregnancy or breast-feeding
- Serious illness requiring systemic treatment and/or hospitalization until subject either completes therapy or is clinically stable on therapy, in the opinion of the investigator, for at least 30 days prior to study entry (day 0).
- Acute therapy for serious infection or other serious medical illnesses (in the judgment of the site investigator) requiring systemic treatment and/or hospitalization within 14 days prior to study entry (day 0).
- Evidence of HIV seroconversion within 6 months prior to study entry.
- Evidence of any major HIV drug resistance-associated mutation on any genotype performed prior to study entry or at the time of screening.
- History of chronic hepatitis C (defined as HCV antibody positive and HCV RNA detectable).
- History of chronic active hepatitis B (defined as surface antigen positive and/or HBV DNA detectable).
- Active drug or alcohol use or dependence that, in the opinion of the investigator, would interfere with adherence to study requirements.
- Use of any immunomodulator, HIV vaccine, or investigational therapy within 30 days of study entry.
- Use of human growth hormone within 30 days prior to study entry.
- Initiation of testosterone or anabolic steroids within 30 days prior to study entry. (Exception: Chronic replacement dosages in patient's with diagnosed hypogonadism is allowed).
Sites / Locations
- Living Hope Clinical Foundation
- University Southern California
- Univerisity California Irvine
- Desert AIDS Project
- University California San Diego
- Harbor-UCLA
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
1 - Kaletra + Isentress taken twice daily
2 - Atripla taken once daily
Arm Description
Kaletra (lopinavir/ritonavir 400/100 mg) + Isentress (Raltegravir 400 mg) twice-daily
Sustiva (EFV 600 mg), Viread (TDF 300 mg) and Emtriva (FTC 200 mg) taken as Atripla® once-daily
Outcomes
Primary Outcome Measures
To Compare the Phase 1 Viral Decay Rates Between LPV/r + RAL vs. EFV/TDF/FTC Treatment Combinations.
Repeated HIV RNA measured at different time points (baseline, days 2, 7, 10, 14) will be treated as the outcome variable in a linear mixed-effects model. The primary fixed effects will include time, treatment group, treatment group-by-time interaction; random effects will include both intercept and slope allowing each subject to have individual baseline viral load and viral decay (rate of decrease in viral load following initiation of antiretroviral therapy). The treatment group-by- time interaction term in the model will indicate the difference in viral decay rates between the two treatment groups. Baseline covariate adjustment will be included if necessary.
Secondary Outcome Measures
Viral Suppression Efficacy at 48 Weeks
To determine the antiviral efficacy of LPV/r + RAL compared to EFV/TDF/FTC after 48 weeks of treatment by achieving undetectable viral load
Compare Early Activated CD4+ T-cell Recovery Rates From Baseline to Week 4.
To compare early (baseline to Week 4) activated CD4+ T-cell recovery rates between treatment regimens.
Compare Late Activated CD4+ T-cell Recovery Rates Between Treatment Regimens From Baseline to Week 48
To compare late (baseline to Week 48) activated CD4+ T-cell recovery rates between treatment regimens.
Full Information
NCT ID
NCT00752856
First Posted
September 13, 2008
Last Updated
July 13, 2020
Sponsor
University of California, San Diego
Collaborators
California HIV/AIDS Research Program, Merck Sharp & Dohme LLC, Abbott
1. Study Identification
Unique Protocol Identification Number
NCT00752856
Brief Title
Raltegravir + Lopinavir/Ritonavir Versus Efavirenz + Tenofovir + Emtricitabine in Treatment Naive Patients
Official Title
Nucleoside-Sparing Combination Therapy With Lopinavir/Ritonavir (LPV/r) + Raltegravir (RAL) vs. Efavirenz (EFV) + Tenofovir Disoproxil Fumarate + Emtricitabine (TDF/FTC) in Antiretroviral-Naïve Patients
Study Type
Interventional
2. Study Status
Record Verification Date
July 2020
Overall Recruitment Status
Completed
Study Start Date
August 26, 2008 (Actual)
Primary Completion Date
May 5, 2011 (Actual)
Study Completion Date
February 11, 2014 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of California, San Diego
Collaborators
California HIV/AIDS Research Program, Merck Sharp & Dohme LLC, Abbott
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
CCTG 589 is a randomized, open-label, pilot study comparing the efficacy, safety and tolerability of RAL plus LPV/r to EFV plus TDF/FTC in HIV-infected, treatment-naïve subjects. Subjects will be ineligible if they have any evidence of drug resistant virus in the past or at the time of screening (if never previously tested). Those who are found to be eligible will be randomized 1:1 to initiate either LPV/r (400/100 mg) plus RAL (400mg), both given twice-daily, or fixed dose combination of EFV (600 mg), TDF (300 mg) and FTC (200 mg) given as once-daily Atripla® for 48 weeks.
Hypotheses
The novel nucleoside-sparing combination of LPV/r + RAL will have a faster phase 1 viral decay rate compared to standard-of-care therapy with EFV/TDF/FTC in antiretroviral-naïve patients.
Faster phase 1 viral decay dynamics will be associated with improved longer-term (week 48) viral suppression.
Faster phase 1 viral decay dynamics will be associated with accelerated early (Day 0-14) clearance of cell-associated HIV DNA.
Faster phase 1 viral decay dynamics will be associated with greater early (baseline to week 12) CD4+ T-cell recovery.
The LPV/r + RAL arm will have greater decreases in early (baseline to week 4) CD4/CD8 T-cell immune activation and apoptosis which will be associated with greater late (week 12 to week 48) CD4+ T-cell recovery.
Subjects treated with LPV/r + RAL arm will have smaller changes in total cholesterol and triglycerides from baseline than those receiving EFV/TDF/FTC.
Detailed Description
The purpose of this study is to determine how well a new anti-HIV drug combination (RAL plus LPV/r) taken twice a day decreases the amount of HIV found in participants' blood (viral load) compared to taking the once-a-day combination pill Atripla®. This study will also try to determine if the new combination has fewer side effects and is tolerated better than Atripla®. Another reason this study is being done is to see if this new drug combination helps participants' body's CD4 cells recover differently and will also look at how well participants' bodies absorbs these drugs and how safe these drugs are when given together.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections
Keywords
HIV treatment, Treatment-naive, Adult
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
51 (Actual)
8. Arms, Groups, and Interventions
Arm Title
1 - Kaletra + Isentress taken twice daily
Arm Type
Experimental
Arm Description
Kaletra (lopinavir/ritonavir 400/100 mg) + Isentress (Raltegravir 400 mg) twice-daily
Arm Title
2 - Atripla taken once daily
Arm Type
Active Comparator
Arm Description
Sustiva (EFV 600 mg), Viread (TDF 300 mg) and Emtriva (FTC 200 mg) taken as Atripla® once-daily
Intervention Type
Drug
Intervention Name(s)
Kaletra + Isentress
Other Intervention Name(s)
Lopinavir/ritonavir (LPV/r) + Raltegravir (RAL)
Intervention Description
kaletra 2 tabs twice a day + Raltegravir 1 tab twice a day
Intervention Type
Drug
Intervention Name(s)
Atripla
Other Intervention Name(s)
Efavirenz (EFV) + Tenofovir Disoproxil Fumarate + Emtricitabine (TDF/FTC)
Intervention Description
Atripla 1 tab once a day
Primary Outcome Measure Information:
Title
To Compare the Phase 1 Viral Decay Rates Between LPV/r + RAL vs. EFV/TDF/FTC Treatment Combinations.
Description
Repeated HIV RNA measured at different time points (baseline, days 2, 7, 10, 14) will be treated as the outcome variable in a linear mixed-effects model. The primary fixed effects will include time, treatment group, treatment group-by-time interaction; random effects will include both intercept and slope allowing each subject to have individual baseline viral load and viral decay (rate of decrease in viral load following initiation of antiretroviral therapy). The treatment group-by- time interaction term in the model will indicate the difference in viral decay rates between the two treatment groups. Baseline covariate adjustment will be included if necessary.
Time Frame
Baseline, days 2, 7, 10, 14
Secondary Outcome Measure Information:
Title
Viral Suppression Efficacy at 48 Weeks
Description
To determine the antiviral efficacy of LPV/r + RAL compared to EFV/TDF/FTC after 48 weeks of treatment by achieving undetectable viral load
Time Frame
48 weeks
Title
Compare Early Activated CD4+ T-cell Recovery Rates From Baseline to Week 4.
Description
To compare early (baseline to Week 4) activated CD4+ T-cell recovery rates between treatment regimens.
Time Frame
Baseline to Week 4
Title
Compare Late Activated CD4+ T-cell Recovery Rates Between Treatment Regimens From Baseline to Week 48
Description
To compare late (baseline to Week 48) activated CD4+ T-cell recovery rates between treatment regimens.
Time Frame
48 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Documented HIV-1 infection.
Treatment naïve (defined as having never received any HIV antiretroviral agents in past).
CD4+ T-cell count greater than or equal to 50 cells/mm3
HIV viral load greater than or equal to 5,000 copies/mL
Laboratory values obtained by screening laboratories within 30 days of entry:
Absolute neutrophil count (ANC) greater than 750/mm3.
Hemoglobin greater than 8.0 g/dL.
Platelet count greater than 50,000/mm3.
Calculated creatinine clearance (CrCl) > 60 mL/min as estimated by the Cockcroft-Gault equation:
For men, (140 - age in years) x (body weight in kg) ÷ (serum creatinine in mg/dL x 72) = CrCl (mL/min)
For women, multiply the result by 0.85 = CrCl (mL/min)
AST (SGOT), ALT (SGPT), and alkaline phosphatase less than 5 x ULN.
Total bilirubin less than 2.5 x ULN.
Females of childbearing potential must have a negative serum pregnancy test at screening and agree to use a double-barrier method of contraception throughout the study period.
Men and women age greater than or equal to 18 years.
Ability to obtain prescription for HIV antiretroviral medications and to have required prescriptions filled prior to entry.
Ability and willingness of subject to give written informed consent
Exclusion Criteria:
Pregnancy or breast-feeding
Serious illness requiring systemic treatment and/or hospitalization until subject either completes therapy or is clinically stable on therapy, in the opinion of the investigator, for at least 30 days prior to study entry (day 0).
Acute therapy for serious infection or other serious medical illnesses (in the judgment of the site investigator) requiring systemic treatment and/or hospitalization within 14 days prior to study entry (day 0).
Evidence of HIV seroconversion within 6 months prior to study entry.
Evidence of any major HIV drug resistance-associated mutation on any genotype performed prior to study entry or at the time of screening.
History of chronic hepatitis C (defined as HCV antibody positive and HCV RNA detectable).
History of chronic active hepatitis B (defined as surface antigen positive and/or HBV DNA detectable).
Active drug or alcohol use or dependence that, in the opinion of the investigator, would interfere with adherence to study requirements.
Use of any immunomodulator, HIV vaccine, or investigational therapy within 30 days of study entry.
Use of human growth hormone within 30 days prior to study entry.
Initiation of testosterone or anabolic steroids within 30 days prior to study entry. (Exception: Chronic replacement dosages in patient's with diagnosed hypogonadism is allowed).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Richard Haubrich, MD
Organizational Affiliation
California Collaborative Treatment Group (CCTG)
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Sheldon Morris, MD
Organizational Affiliation
UC San Diego AntiViral Research Center (AVRC)
Official's Role
Study Chair
Facility Information:
Facility Name
Living Hope Clinical Foundation
City
Long Beach
State/Province
California
ZIP/Postal Code
90813
Country
United States
Facility Name
University Southern California
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033
Country
United States
Facility Name
Univerisity California Irvine
City
Orange
State/Province
California
ZIP/Postal Code
92868
Country
United States
Facility Name
Desert AIDS Project
City
Palm Springs
State/Province
California
ZIP/Postal Code
92262
Country
United States
Facility Name
University California San Diego
City
San Diego
State/Province
California
ZIP/Postal Code
92103
Country
United States
Facility Name
Harbor-UCLA
City
Torrance
State/Province
California
ZIP/Postal Code
90502
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
26977746
Citation
Karris MY, Jain S, Bowman VQ, Rieg G, Goicoechea M, Dube MP, Kerkar S, Kemper C, Diamond C, Sun X, Daar ES, Haubrich RH, Morris S; California Collaborative Treatment Group (CCTG) 589 Study Team. Nucleoside-Sparing Regimens With Raltegravir and a Boosted Protease Inhibitor: An Unsettled Issue. J Acquir Immune Defic Syndr. 2016 Jun 1;72(2):e48-50. doi: 10.1097/QAI.0000000000000990. No abstract available.
Results Reference
derived
Learn more about this trial
Raltegravir + Lopinavir/Ritonavir Versus Efavirenz + Tenofovir + Emtricitabine in Treatment Naive Patients
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