A Comparison of Two Anti-HIV Treatment Plans

NCT ID: NCT00005915

Last Updated: 2013-10-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

480 participants

Study Classification

OBSERVATIONAL

Study Completion Date

2004-06-30

Brief Summary

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The purpose of this study is to compare 2 treatment plans to try to increase the effects of anti-HIV drugs in patients who are resistant to the drug effects.

Sometimes the increase in a patient's viral load (the level of HIV in the blood) can be slowed or stopped by taking anti-HIV drugs. This does not always happen. Sometimes anti-HIV drugs work at first but then stop working. When most of the usual anti-HIV drugs no longer seem to work, the virus is called multidrug-resistant (MDR). This study will compare 2 treatment plans to try to increase the effects of anti-HIV drugs in patients with MDR virus.

Detailed Description

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An increasing number of patients are developing multidrug-resistant (MDR) virus, as determined by genotypic antiretroviral resistance testing (GART), due to treatment failure to suppress viral replication after several rounds of combination antiretroviral therapy. The best therapeutic strategy for these patients is uncertain. Two strategies currently being used are (1) STI followed by a new antiretroviral regimen and (2) immediate initiation of a new antiretroviral regimen.

Patients are screened for the presence of MDR virus and a plasma HIV RNA level greater than 10,000 \[AS PER AMENDMENT 07/03/01: greater than 5,000\] copies/ml. Eligible patients attend a baseline visit \[AS PER AMENDMENT 07/03/01: and a subsequent randomization visit\] where the qualifying GART results are provided. Patients who consent to participate have phenotypic antiretroviral resistance testing (PART) done on a specimen from the same blood draw that was used for the GART evaluation. After PART results are available, patients are randomized \[AS PER AMENDMENT 07/03/01: If the predicted sensitivities are not available for some or all drugs included in the PART, the patient may still be randomized.\] to either a 4-month STI followed by a new antiretroviral regimen or an immediate new antiretroviral regimen. The antiretroviral regimens chosen are based on the patients' history and both GART and PART results. \[AS PER AMENDMENT 07/03/01: Additional GART and PART may be requested after at least 4 months of antiretroviral treatment.\] Patients have the follow-up data collection done at Months 1-8 and every 4 months thereafter. Changes in antiretroviral therapy, Grade 4 adverse experiences, progression of disease, and deaths are reported as they occur. Patients are seen for clinical management as often as deemed necessary. All patients are followed to a common closing date estimated to be 24 months after the last patient is randomized. Some patients may participate in a Point Mutation Substudy \[AS PER AMENDMENT 07/03/01: Plasma Point Mutation Substudy and PBMC Point Mutation Substudy\].

Conditions

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HIV Infections

Keywords

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HIV-1 Drug Administration Schedule Drug Resistance, Microbial Disease Progression Genotype Phenotype Drug Resistance, Multiple Anti-HIV Agents Treatment Experienced

Eligibility Criteria

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Inclusion Criteria

Patients may be eligible if they:

* Have proof of MDR virus from a blood test.
* Have a viral load above 5,000 copies/ml from the same blood sample showing MDR virus.
* Intend to start a new anti-HIV treatment around the time of the study.
* Have been on a stable anti-HIV treatment between 14 days prior to the blood test mentioned above and when they are randomly assigned to a treatment.
* Are at least 13 years old (consent of parent or guardian required if under 18).
* (This protocol has been changed to reflect new criteria.)

Exclusion Criteria

Patients will not be eligible if they:

* Have received a vaccine or had an illness that might affect viral load within 14 days before the blood test showing MDR virus.
* Have received IL-2 within 4 months of the above-mentioned blood test or plan to take IL-2 during the study.
* Have an opportunistic (AIDS-related) infection requiring treatment.
* Are pregnant or breast-feeding.
* Are currently participating in CPCRA 057 (PIP study).
Minimum Eligible Age

13 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Allergy and Infectious Diseases (NIAID)

NIH

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jody Lawrence

Role: STUDY_CHAIR

Locations

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Community Consortium / UCSF

San Francisco, California, United States

Site Status

Lawrence Goldyn, MD

San Francisco, California, United States

Site Status

Denver CPCRA / Denver Public Hlth

Denver, Colorado, United States

Site Status

Univ Hosp Infectious Disease

Denver, Colorado, United States

Site Status

Yale U / New Haven Med Ctr / AIDS Clinical Trials Unit

New Haven, Connecticut, United States

Site Status

Washington Reg AIDS Prog / Dept of Infect Dis

Washington D.C., District of Columbia, United States

Site Status

AIDS Research Alliance - Chicago

Chicago, Illinois, United States

Site Status

Louisiana Comm AIDS Rsch Prog / Tulane Univ Med

New Orleans, Louisiana, United States

Site Status

Our Lady of the Lake Regional Med Ctr

New Orleans, Louisiana, United States

Site Status

Wayne State Univ - WSU/DMC / Univ Hlth Ctr

Detroit, Michigan, United States

Site Status

Henry Ford Hosp

Detroit, Michigan, United States

Site Status

Southern New Jersey AIDS Clinical Trials

Camden, New Jersey, United States

Site Status

North Jersey Community Research Initiative

Newark, New Jersey, United States

Site Status

Harlem AIDS Treatment Grp / Harlem Hosp Ctr

New York, New York, United States

Site Status

Bronx-Lebanon Hosp Ctr

The Bronx, New York, United States

Site Status

The Research and Education Group

Portland, Oregon, United States

Site Status

Philadelphia FIGHT

Philadelphia, Pennsylvania, United States

Site Status

Montrose Clinic

Houston, Texas, United States

Site Status

Houston Veterans Administration Med Ctr

Houston, Texas, United States

Site Status

Univ TX Health Science Ctr

Houston, Texas, United States

Site Status

Richmond AIDS Consortium / Div of Infect Diseases

Richmond, Virginia, United States

Site Status

Countries

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United States

References

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Lawrence J, Mayers DL, Hullsiek KH, Collins G, Abrams DI, Reisler RB, Crane LR, Schmetter BS, Dionne TJ, Saldanha JM, Jones MC, Baxter JD; 064 Study Team of the Terry Beirn Community Programs for Clinical Research on AIDS. Structured treatment interruption in patients with multidrug-resistant human immunodeficiency virus. N Engl J Med. 2003 Aug 28;349(9):837-46. doi: 10.1056/NEJMoa035103.

Reference Type BACKGROUND
PMID: 12944569 (View on PubMed)

Anti-HIV agents. An attempt at treatment interruption--trial CPCRA 064. TreatmentUpdate. 2003 Aug-Sep;15(5):4-5. No abstract available.

Reference Type RESULT
PMID: 17216857 (View on PubMed)

Lawrence J, Hullsiek KH, Thackeray LM, Abrams DI, Crane LR, Mayers DL, Jones MC, Saldanha JM, Schmetter BS, Baxter JD. Disadvantages of structured treatment interruption persist in patients with multidrug-resistant HIV-1: final results of the CPCRA 064 study. J Acquir Immune Defic Syndr. 2006 Oct 1;43(2):169-78. doi: 10.1097/01.qai.0000242450.74779.ee.

Reference Type RESULT
PMID: 16951642 (View on PubMed)

Paquet AC, Baxter J, Weidler J, Lie Y, Lawrence J, Kim R, Bates M, Coakley E, Chappey C. Differences in reversion of resistance mutations to wild-type under structured treatment interruption and related increase in replication capacity. PLoS One. 2011 Jan 31;6(1):e14638. doi: 10.1371/journal.pone.0014638.

Reference Type RESULT
PMID: 21297946 (View on PubMed)

Other Identifiers

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11619

Identifier Type: REGISTRY

Identifier Source: secondary_id

CPCRA 064

Identifier Type: -

Identifier Source: org_study_id