A Comparison of Two Ways to Manage Anti-HIV Treatment (The SMART Study)

NCT ID: NCT00027352

Last Updated: 2009-11-25

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

6000 participants

Study Classification

OBSERVATIONAL

Brief Summary

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The purpose of this study is to compare two ways of using anti-HIV drugs to help health care providers and patients decide how to best use anti-HIV treatments over many years. Many health care providers now treat patients with daily drugs to keep the viral load as low as possible. This approach helps patients with CD4 counts less than 200-250 cells/mm3 live longer without serious diseases. But it is not known if this is the best way to treat patients with higher CD4 counts. There is information suggesting that these patients may be able to wait to use anti-HIV drugs while CD4 counts are above 250 cells/mm3. Because this study will be carried out over several years, it will provide information on the long-term advantages and disadvantages of these two treatment strategies.

Detailed Description

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Implementation of antiretroviral treatment (ART) guidelines, which emphasize maximal and durable suppression of viral load for the majority of individuals infected with HIV, has resulted in a substantial decline in morbidity and mortality. However, many asymptomatic patients are not at immediate risk of serious opportunistic diseases, the effectiveness of ART wanes over time due to HIV drug resistance, and there are short- and long-term toxicities of treatment. This motivates a comparison of two strategies: one which conserves treatments by deferring their use while the risk of opportunistic disease is low and one which aims for sustained virologic suppression, irrespective of disease risk.

In this large, long-term trial, patients will be randomly assigned to either the drug conservation (DC) or viral suppression (VS) group. Patients will be enrolled over a 3-year period and followed for an average of 7.5 years. The DC group will stop or defer ART until CD4 cell count declines to below 250 cells/mm3; they will then receive treatment to increase CD4 count to greater than 350 cells/mm3 followed by episodic ART based on CD4 cell count. The VS group will use ART to maintain viral load as low as possible, irrespective of CD4 cell count. Patients will be seen Months 1, 2, 4, 6, 8, 10, and 12, then every 4 months for data collection visits. All available ARTs, including immunomodulators, and resistance testing may be used by patients in both treatment groups. Selected subsamples of patients enrolled in the study will be followed with more intensive data collection for secondary outcomes relating to cost and health care utilization, quality of life, HIV transmission risk behaviors, and metabolic complications of treatment.

Conditions

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HIV Infections

Keywords

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Physician's Practice Patterns Anti-HIV Agents

Study Design

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Study Time Perspective

PROSPECTIVE

Eligibility Criteria

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Inclusion Criteria

* HIV infection
* CD4 cell count greater than 350 cells/mm3 within 45 days of study entry
* Willing to start, change, or stop antiretroviral therapy
* Acceptable methods of contraception
* Good health at the time of study entry
* Available for the study for at least 6 months
* Able, in the clinician's opinion, to comply with the protocol

Exclusion Criteria

* Currently participating in the MDR-HIV, NvR study, or another study which is not consistent with one of the treatment groups in this study. CPCRA FIRST participants may be screened for SMART after August 8, 2005 and can be randomized into SMART on or after September 19, 2005.
* Pregnant or breast-feeding
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

Principal Investigators

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Wafaa El-Sadr, MD, MPH

Role: STUDY_CHAIR

Harlem AIDS Treatment Group, Harlem Hospital Center

James Neaton, PhD

Role: STUDY_CHAIR

CPCRA Statistcal and Data Management Center / CCBR

Locations

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Kaiser Permanente-Fremont/Hayward Medical Centers

Fremont, California, United States

Site Status

AIDS Healthcare Foundation

Los Angeles, California, United States

Site Status

Los Angeles Gay and Lesbian Community Service Ctr

Los Angeles, California, United States

Site Status

Community Consortium / UCSF

San Francisco, California, United States

Site Status

Dr. Shawn Hassler

San Francisco, California, United States

Site Status

East Bay AIDS Ctr

San Francisco, California, United States

Site Status

Lawrence Goldyn, MD

San Francisco, California, United States

Site Status

Drs. Lichtenstein & Greenberg

Denver, Colorado, United States

Site Status

Western Infectious Disease Consultants

Denver, Colorado, United States

Site Status

Denver CPCRA / Denver Public Hlth

Denver, Colorado, United States

Site Status

McDowell Healthcare Center

Denver, Colorado, United States

Site Status

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

New Haven, Connecticut, United States

Site Status

Veterans Administration Medical Center

New Haven, Connecticut, United States

Site Status

Christiana Care Health Services HIV Program George

Wilmington, Delaware, United States

Site Status

Timothy A Price

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

Site Status

George Washington Univ

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

Site Status

Washington Reg AIDS Prog / Dept of Infect Dis

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

Site Status

Miami Veterans Affairs Med Ctr

Miami, Florida, United States

Site Status

Center for Prevention and Treatment of Infections

Pensacola, Florida, United States

Site Status

Treasure Coast Infectious Disease Consultants

Vero Beach, Florida, United States

Site Status

Absolute Care Clinic

Atlanta, Georgia, United States

Site Status

AID Atlanta/Morehouse Med School Ryan White Cl

Atlanta, Georgia, United States

Site Status

AIDS Research Consortium of Atlanta (ARCA) Central

Atlanta, Georgia, United States

Site Status

Cobb-Douglas County Infectious Disease Clinic

Atlanta, Georgia, United States

Site Status

Dekalb County Health Dept Infectious Disease

Atlanta, Georgia, United States

Site Status

Dr. Dennis Melton (Private Practice)

Atlanta, Georgia, United States

Site Status

Dr. Melanie Thompson and Dr. Annette Bernard (Private Practice)

Atlanta, Georgia, United States

Site Status

Dr. Richard Hudson (Private Practice)

Atlanta, Georgia, United States

Site Status

HIV Services Clinic/Family Practice Medical Center

Boise, Idaho, United States

Site Status

Cook County Hosp

Chicago, Illinois, United States

Site Status

Klein and Slotten Associates / AIDS Research Alliance

Chicago, Illinois, United States

Site Status

Lakeshore Infectious Disease Associates

Chicago, Illinois, United States

Site Status

University of Illinois at Chicago

Chicago, Illinois, United States

Site Status

AIDS Research Alliance - Chicago

Chicago, Illinois, United States

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Northside Family Medicine

Chicago, Illinois, United States

Site Status

Northwestern Memorial Physicians

Chicago, Illinois, United States

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University of Chicago

Chicago, Illinois, United States

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Southern Illinois University (SIU) School of Medicine

Springfield, Illinois, United States

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KU Medical School-Wichita, Midtown Clinic

Wichita, Kansas, United States

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KU Medical School-Wichita, MPA

Wichita, Kansas, United States

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University of Mississippi Medical Center

New Orleans, Louisiana, United States

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Our Lady of the Lake Regional Med Ctr

New Orleans, Louisiana, United States

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Louisiana Comm AIDS Rsch Prog / Tulane Univ Med

New Orleans, Louisiana, United States

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Community Research Initiatives of New England

Boston, Massachusetts, United States

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Community Research Initiatives/ProACT

Boston, Massachusetts, United States

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Community Research Initiative/ProACT

Springfield, Massachusetts, United States

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University of Michigan Health System

Ann Arbor, Michigan, United States

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Detroit Community Health Connection

Detroit, Michigan, United States

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Detroit Receiving

Detroit, Michigan, United States

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Wayne State Univ / Medical College of Ohio at Toledo

Detroit, Michigan, United States

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Henry Ford Hosp

Detroit, Michigan, United States

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Mt. Clemens General Hospital

Detroit, Michigan, United States

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Providence Hosp- Newland Med Assoc. Inc.

Detroit, Michigan, United States

Site Status

McAuley Health Center

Grand Rapids, Michigan, United States

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Michigan State University Infectious Diseases Clinic

Lansing, Michigan, United States

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William Beaumont Hospital/CORNET

Royal Oak, Michigan, United States

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Mayo Clinic/CORNET

Rochester, Minnesota, United States

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Cooper Hospital Early Intervention Program

Camden, New Jersey, United States

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Jersey Shore Med Ctr

Neptune City, New Jersey, United States

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Raritan Bay Med Ctr

Newark, New Jersey, United States

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Saint Michael's Med Ctr

Newark, New Jersey, United States

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Jeffrey Bomser Clinic / NJCR

Newark, New Jersey, United States

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New Jersey Community Research Initiative

Newark, New Jersey, United States

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NJCRI

Newark, New Jersey, United States

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South Jersey Infectious Disease

Somers Poinnt, New Jersey, United States

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SUNY Downstate Med Ctr

Brooklyn, New York, United States

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Grant Houses Health Ctr

New York, New York, United States

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HHC MMC Unit #1

New York, New York, United States

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HHC Outpatient Clinics

New York, New York, United States

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Jacobi Medical Center

New York, New York, United States

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Lenox Avenue Health Ctr

New York, New York, United States

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Lincoln Medical & Mental Health Center

New York, New York, United States

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Polo Grounds Health Care Ctr

New York, New York, United States

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Syndenham Neighborhood Family Care Ctr

New York, New York, United States

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Metropolitan Hospital Center

New York, New York, United States

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Bronx-Lebanon Hosp Ctr

The Bronx, New York, United States

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Bronx Veterans Affairs Medical Center

The Bronx, New York, United States

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Wake Forest Univ Health Sciences

Winston-Salem, North Carolina, United States

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Univ of Oklahoma Health Sciences

Oklahoma City, Oklahoma, United States

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Legacy Clinic NE

Portland, Oregon, United States

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Salem Hospital

Portland, Oregon, United States

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The Research & Education Group / Multomah Cnty Hlth Dept

Portland, Oregon, United States

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The Research & Education Group / The R & E Grp Office

Portland, Oregon, United States

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The Research & Education Grp / Oregon Hlth Sci Univ

Portland, Oregon, United States

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The Rsch & Ed Grp / Legacy Cln at Good Samaritan

Portland, Oregon, United States

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The Rsch & Ed Grp / Providence Portland Med Ctr

Portland, Oregon, United States

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The Research and Education Group

Portland, Oregon, United States

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Penn Community Infectious Diseases

Philadelphia, Pennsylvania, United States

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Philadelphia FIGHT

Philadelphia, Pennsylvania, United States

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Einstein Medical Center

Philadelphia, Pennsylvania, United States

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Temple Univ School of Medicine

Philadelphia, Pennsylvania, United States

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Montrose Clinic

Houston, Texas, United States

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Houston Veterans Administration Med Ctr

Houston, Texas, United States

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Univ TX Health Science Ctr

Houston, Texas, United States

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University Clinical Research Center

Houston, Texas, United States

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South Texas Veterans Health Care System

San Antonio, Texas, United States

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Infectious Disease Associates of Virginia

Lynchburg, Virginia, United States

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Cross Over Clinic / Div of Infectious Diseases

Richmond, Virginia, United States

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McGuire VA / Division of Infectious Diseases

Richmond, Virginia, United States

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MCV ID Clinic

Richmond, Virginia, United States

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MediCorp, Infectious Disease Associates

Richmond, Virginia, United States

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Petersburg Health Care Alliance

Richmond, Virginia, United States

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South Richmond Health Ctr

Richmond, Virginia, United States

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Vernon J. Harris East End Community Health Care Ct

Richmond, Virginia, United States

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University Of Wisconsin Hospital and Clinics/CORNET, HIV Care Program

Madison, Wisconsin, United States

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Hospital de Clinicas Jose de San Martin

Buenos Aires, , Argentina

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Hospital de Infecciosas F.J. Muniz

Buenos Aires, , Argentina

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Hospital Gn'l de Agudos JM Ramos Mejia

Buenos Aires, , Argentina

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Hospital Gn'l de Agudos T. Alvarez

Buenos Aires, , Argentina

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Hospital Italiano de Buenos Aires

Buenos Aires, , Argentina

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Hospital Rawson

Córdoba, , Argentina

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Hospital Interzonall de San Juan de Dios

La Plata, , Argentina

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Hospital Central

Mendoza, , Argentina

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CAICI

Rosario, , Argentina

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Royal Adelaide Hospital

Adelaide, South Australia, Australia

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Prahran Market Clinic

South Yarra, Victoria, Australia

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The Centre Clinic

South Yarra, Victoria, Australia

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Burwood Street General Pratice

Burwood Nsw, , Australia

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Royal Perth Hosp

Perth, , Australia

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Alfred Hosp

Prahan, , Australia

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Royal Prince Alfred Hospital

Prahan, , Australia

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National Centre in HIV Epidemiology and Clinical Research

Sydney, , Australia

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University of Vienna Medical School, AKH

Vienna, , Austria

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Institute of Tropical Medicine

Antwerp, , Belgium

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Centre Hospitalier Universitaire Sart-Tilman

Liège, , Belgium

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Hospital Escola Sao Francisco de Asis

Rio de Janeiro, Rio de Janeiro, Brazil

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Hospital Nossa Senhora da Conceicao

Porto Alegre, Rio Grande do Sul, Brazil

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Instituto de Infectologia Emilio Ribas

São Paulo, S.P. CEP, Brazil

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Cassiano Antonio de Moraes University Hospital

Boqueirao-Santos, , Brazil

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Centro de Pesquisa Clinical do Hospital Guilherme

Boqueirao-Santos, , Brazil

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Hospital de Clinicas de Porto Alegre

Porto Alegre-RS Cep, , Brazil

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Hospital dos Servidores do Estado

Rio de Janeiro, , Brazil

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Hospital Universitario Professor Edgard Santos

Salvador-BA, , Brazil

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Ambulatorio de Imunodeficiencias Secundarias/Der30

São Paulo, , Brazil

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Universidade Federal De Sao Paulo-Hospital Sao Paulo

São Paulo, , Brazil

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Centro de Referencia e Treinamento DST/AIDS

São Paulo, , Brazil

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Unidade de Pesquisa Clinica

São Paulo, , Brazil

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Downtown Infectious Disease Clinic

Vancouver, British Columbia, Canada

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Queen Elizabeth II Health Sciences Centre

Halifax, Nova Scotia, Canada

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The HAVEN Program, HRSRH

Greater Sudbury, Ontario, Canada

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Hamilton Health Science Centre-McMaster

Hamilton, Ontario, Canada

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St. Joseph's Health Care Centre of London

London, Ontario, Canada

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St. Josephs Hospital

London, Ontario, Canada

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Tronto General Hospital

Toronto, Ontario, Canada

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HIV Care Program, Windsor Regional Hospital

Windsor, Ontario, Canada

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University de Sherbrooke

Fleurimont, Quebec, Canada

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Clinique Medicale L'actuel

Montreal, Quebec, Canada

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Montreal Chest Institute/Royal Victoria Hospital

Montreal, Quebec, Canada

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Centre hospitalier de l'universite Laval (CHUL)

Sainte-Foy, Quebec, Canada

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Recherche Clinique Centre Medical Halles de Saint-

Ste-Foy, Quebec, Canada

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West-Tallinn Central Hospital

Tallinn, , Estonia

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CHU de la Region Annecienne

Annecy, , France

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Hopital Pellegrin

Bordeaux, , France

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Centre Hospitalier Universitaire

Chu-grenoble, , France

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Hopital Louis Mourier

Colombes, , France

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Hopital Sainte-Marguerite

Marseille, , France

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Hopital Saint-Louis

Paris, , France

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Hopital Pitie Salpetriere

Paris, , France

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Klinik fur Dermatologie, Venerologie, Allergologie

Essen, , Germany

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Johann Wolfgang Goethe University Hospital

Frankfurt am Main, , Germany

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Klinikum der Ruprecht-Karis-Universitat (U. Hospital)

Heidelberg, , Germany

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University Hospital Zurich

Zurich Ch-, , Germany

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St. James Hospital

Dublin, , Ireland

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Ramathibodi Hospital

Tel Aviv, , Israel

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U.O. Malattie Infettive, H.S.Maria Annunziata

Antella-Firenze, , Italy

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SOCDU Malattie Infettive Ospedale Civile Asti

Asti, , Italy

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Instituto de Malattie Infettive e Tropicali

Brescia, , Italy

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Malattie Infettive Busto

Busto Arsizio (va), , Italy

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Universita degli Studi di Modena e Reggio Emilia

Modena, , Italy

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Clinica Malattie Infettive

Pavia, , Italy

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I.R.C.C.S."L.Spallanzani"

Rome, , Italy

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University of Turin

Torino, , Italy

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Servizio Regionale di Immunologia Clinica e Tipizz

Torrette Di Ancona, , Italy

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S.S. Giovanni e Paolo Hospital

Venice, , Italy

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AIDS Medical Center, International Medical Center

Tokyo, , Japan

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International Medical Center of Japan

Tokyo, , Japan

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Lithuanian AIDS center

Vilnius, , Lithuania

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Centre Hospitalier de Luxembourg

Barble, , Luxembourg

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C.H.U. Fort-de-France

Fort-de-France, , Martinique

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Christchurch Hosp

Christchurch, , New Zealand

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Wellington Hosp

Wellington, , New Zealand

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Ulleval Hospital

Oslo, , Norway

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Hospital Nacional Edgardo Rebagliati Martins

Lima, , Peru

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Hospital Nacional Guillermo Almenara Irigoyen

Lima, , Peru

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Wroclaw University School of Medicine

Koszarowa Str. 5, , Poland

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Instituto A. Z. de Pesquisa e Ensino

Curitiba, , Puerto Rico

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Hospital de la Santa Creu i Sant Pau

Barcelona, , Spain

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Hospital Universitario de La Princesa

Madrid, , Spain

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Hospital Universitario Principe de Asturias

Madrid, , Spain

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Hospital U. Virgen del Rocio

Seville, , Spain

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Hospital Mutua de Terrassa

Terrassa, , Spain

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Consorcio Hospital General Universitario de Valencia

Valencia, , Spain

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University Hospital Basel

Basel Ch, , Switzerland

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Poliklinik fur Infektiologie

Bern, , Switzerland

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Hopital de la Ville

La Chaux-de-Fonds, , Switzerland

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Centre Hospitalier Universitaire Vaudois (CHUV)

Lausanne, , Switzerland

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Ospedale Regionale di Lugano

Lugano, , Switzerland

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Sanpatong Hospital

Chiang Mai, , Thailand

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Bamrasnaradura Institute

Nonthaburi, , Thailand

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John Radcliffe Hospital

Oxford, England, United Kingdom

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Royal Victoria Hospital

Belfast, , United Kingdom

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Hawthorn House, Birmingham Heartlands NHS Trust

Birmingham, , United Kingdom

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Southmead Hospital

Bristol, , United Kingdom

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St. Helier Hospital

Carshalton, , United Kingdom

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St. Helier Hospital

Carshalton, Surrey, , United Kingdom

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Essex County Hospital

Essex, , United Kingdom

Site Status

Victoria General Hospital, Q.E. II Health Sciences

Halifax, , United Kingdom

Site Status

Homerton University Hospital NHS Foundation Trust

London, , United Kingdom

Site Status

Barts and The London, NHS Trust

London, , United Kingdom

Site Status

Central Middlesex Hospital

London, , United Kingdom

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Royal Free Hospital

London, , United Kingdom

Site Status

St. Thomas' Hospital

London, , United Kingdom

Site Status

T1 Coleridge Unit, North Middlesex Hospital

London, , United Kingdom

Site Status

The Caldecot Centre, Kings College Hospital NHS Tr

London, , United Kingdom

Site Status

Chelsea and Westminster Hospital

London, , United Kingdom

Site Status

St. George's Hospital

London, , United Kingdom

Site Status

St. Mary's Hospital

London, , United Kingdom

Site Status

The Mortimer Market Center

London, , United Kingdom

Site Status

The James Cook University Hospital

Middlesbrough, , United Kingdom

Site Status

Pasteur Suite, Ealing Hospital

Middlesex, , United Kingdom

Site Status

Newcastle General Hospital

Newcastle, , United Kingdom

Site Status

Dept. of Infection and Tropical Medicine - Royal Hallamshire Hospital

Sheffield, , United Kingdom

Site Status

Watford Sexual Health Center;Watford General Hosp

Watford Wd, , United Kingdom

Site Status

Countries

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United States Argentina Australia Austria Belgium Brazil Canada Estonia France Germany Ireland Israel Italy Japan Lithuania Luxembourg Martinique New Zealand Norway Peru Poland Puerto Rico Spain Switzerland Thailand United Kingdom

References

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Lederman MM, Valdez H. Immune restoration with antiretroviral therapies: implications for clinical management. JAMA. 2000 Jul 12;284(2):223-8. doi: 10.1001/jama.284.2.223.

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PMID: 10889597 (View on PubMed)

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Mocroft A, Katlama C, Johnson AM, Pradier C, Antunes F, Mulcahy F, Chiesi A, Phillips AN, Kirk O, Lundgren JD. AIDS across Europe, 1994-98: the EuroSIDA study. Lancet. 2000 Jul 22;356(9226):291-6. doi: 10.1016/s0140-6736(00)02504-6.

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Tebas P, Henry K, Mondy K, Deeks S, Valdez H, Cohen C, Powderly WG. Effect of prolonged discontinuation of successful antiretroviral therapy on CD4+ T cell decline in human immunodeficiency virus-infected patients: implications for intermittent therapeutic strategies. J Infect Dis. 2002 Sep 15;186(6):851-4. doi: 10.1086/342603. Epub 2002 Aug 28.

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Borges AH, Neuhaus J, Sharma S, Neaton JD, Henry K, Anagnostou O, Staub T, Emery S, Lundgren JD; INSIGHT SMART; START Study Groups. The Effect of Interrupted/Deferred Antiretroviral Therapy on Disease Risk: A SMART and START Combined Analysis. J Infect Dis. 2019 Jan 7;219(2):254-263. doi: 10.1093/infdis/jiy442.

Reference Type DERIVED
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Castillo-Mancilla JR, Phillips AN, Neaton JD, Neuhaus J, Collins S, Mannheimer S, Pett S, Touzeau-Romer V, Polizzotto MN, Lundgren JD, Gardner EM; INSIGHT SMART Study Group. Association of Suboptimal Antiretroviral Therapy Adherence With Inflammation in Virologically Suppressed Individuals Enrolled in the SMART Study. Open Forum Infect Dis. 2017 Dec 22;5(1):ofx275. doi: 10.1093/ofid/ofx275. eCollection 2018 Jan.

Reference Type DERIVED
PMID: 29362724 (View on PubMed)

Larson GS, Carey C, Grarup J, Hudson F, Sachi K, Vjecha MJ, Gordin F; INSIGHT Group. Lessons learned: Infrastructure development and financial management for large, publicly funded, international trials. Clin Trials. 2016 Apr;13(2):127-36. doi: 10.1177/1740774515625974. Epub 2016 Feb 8.

Reference Type DERIVED
PMID: 26908541 (View on PubMed)

Nordell AD, McKenna M, Borges AH, Duprez D, Neuhaus J, Neaton JD; INSIGHT SMART, ESPRIT Study Groups; SILCAAT Scientific Committee. Severity of cardiovascular disease outcomes among patients with HIV is related to markers of inflammation and coagulation. J Am Heart Assoc. 2014 May 28;3(3):e000844. doi: 10.1161/JAHA.114.000844.

Reference Type DERIVED
PMID: 24870935 (View on PubMed)

Lucas GM, Cozzi-Lepri A, Wyatt CM, Post FA, Bormann AM, Crum-Cianflone NF, Ross MJ; INSIGHT SMART Study Group. Glomerular filtration rate estimated using creatinine, cystatin C or both markers and the risk of clinical events in HIV-infected individuals. HIV Med. 2014 Feb;15(2):116-23. doi: 10.1111/hiv.12087. Epub 2013 Sep 11.

Reference Type DERIVED
PMID: 24024499 (View on PubMed)

Baker JV, Brummel-Ziedins K, Neuhaus J, Duprez D, Cummins N, Dalmau D, DeHovitz J, Lehmann C, Sullivan A, Woolley I, Kuller L, Neaton JD, Tracy RP; INSIGHT SMART Study Team. HIV replication alters the composition of extrinsic pathway coagulation factors and increases thrombin generation. J Am Heart Assoc. 2013 Jul 29;2(4):e000264. doi: 10.1161/JAHA.113.000264.

Reference Type DERIVED
PMID: 23896681 (View on PubMed)

Hoy J, Grund B, Roediger M, Ensrud KE, Brar I, Colebunders R, Castro ND, Johnson M, Sharma A, Carr A; INSIGHT SMART Body Composition Substudy Group. Interruption or deferral of antiretroviral therapy reduces markers of bone turnover compared with continuous therapy: The SMART body composition substudy. J Bone Miner Res. 2013 Jun;28(6):1264-74. doi: 10.1002/jbmr.1861.

Reference Type DERIVED
PMID: 23299909 (View on PubMed)

Zetterberg E, Neuhaus J, Baker JV, Somboonwit C, Llibre JM, Palfreeman A, Chini M, Lundgren JD; INSIGHT SMART Study Group. Platelet count kinetics following interruption of antiretroviral treatment. AIDS. 2013 Jan 2;27(1):59-68. doi: 10.1097/QAD.0b013e32835a104d.

Reference Type DERIVED
PMID: 23018440 (View on PubMed)

Mocroft A, Neuhaus J, Peters L, Ryom L, Bickel M, Grint D, Koirala J, Szymczak A, Lundgren J, Ross MJ, Wyatt CM; INSIGHT SMART Study Group; ESPRIT Study Group. Hepatitis B and C co-infection are independent predictors of progressive kidney disease in HIV-positive, antiretroviral-treated adults. PLoS One. 2012;7(7):e40245. doi: 10.1371/journal.pone.0040245. Epub 2012 Jul 20.

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Baker JV, Neuhaus J, Duprez D, Cooper DA, Hoy J, Kuller L, Lampe FC, Liappis A, Friis-Moller N, Otvos J, Paton NI, Tracy R, Neaton JD; INSIGHT SMART Study Group. Inflammation predicts changes in high-density lipoprotein particles and apolipoprotein A1 following initiation of antiretroviral therapy. AIDS. 2011 Nov 13;25(17):2133-42. doi: 10.1097/QAD.0b013e32834be088.

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PMID: 21857489 (View on PubMed)

Mocroft A, Lifson AR, Touloumi G, Neuhaus J, Fox Z, Palfreeman A, Vjecha MJ, Hodder S, De Wit S, Lundgren JD, Phillips AN; INSIGHT SMART Study Group. Haemoglobin and anaemia in the SMART study. Antivir Ther. 2011;16(3):329-37. doi: 10.3851/IMP1746.

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PMID: 21555815 (View on PubMed)

Duprez DA, Neuhaus J, Tracy R, Kuller LH, Deeks SG, Orkin C, Stoehr A, Woolley IJ, Neaton JD; INSIGHT SMART Group. N-terminal-proB-type natriuretic peptide predicts cardiovascular disease events in HIV-infected patients. AIDS. 2011 Mar 13;25(5):651-7. doi: 10.1097/QAD.0b013e32834404a1.

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PMID: 21245726 (View on PubMed)

Lampe FC, Duprez DA, Kuller LH, Tracy R, Otvos J, Stroes E, Cooper DA, Hoy J, Paton NI, Friis-Moller N, Neuhaus J, Liappis AP, Phillips AN; INSIGHT SMART Study Group. Changes in lipids and lipoprotein particle concentrations after interruption of antiretroviral therapy. J Acquir Immune Defic Syndr. 2010 Jul;54(3):275-84. doi: 10.1097/qai.0b013e3181d32158.

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PMID: 20658749 (View on PubMed)

Dore GJ, Soriano V, Rockstroh J, Kupfer B, Tedaldi E, Peters L, Neuhaus J, Puoti M, Klein MB, Mocroft A, Clotet B, Lundgren JD; SMART INSIGHT study group. Frequent hepatitis B virus rebound among HIV-hepatitis B virus-coinfected patients following antiretroviral therapy interruption. AIDS. 2010 Mar 27;24(6):857-65. doi: 10.1097/QAD.0b013e328334bddb.

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PMID: 20216301 (View on PubMed)

Rodger AJ, Fox Z, Lundgren JD, Kuller LH, Boesecke C, Gey D, Skoutelis A, Goetz MB, Phillips AN; INSIGHT Strategies for Management of Antiretroviral Therapy (SMART) Study Group. Activation and coagulation biomarkers are independent predictors of the development of opportunistic disease in patients with HIV infection. J Infect Dis. 2009 Sep 15;200(6):973-83. doi: 10.1086/605447.

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PMID: 19678756 (View on PubMed)

Grund B, Peng G, Gibert CL, Hoy JF, Isaksson RL, Shlay JC, Martinez E, Reiss P, Visnegarwala F, Carr AD; INSIGHT SMART Body Composition Substudy Group. Continuous antiretroviral therapy decreases bone mineral density. AIDS. 2009 Jul 31;23(12):1519-29. doi: 10.1097/QAD.0b013e32832c1792.

Reference Type DERIVED
PMID: 19531929 (View on PubMed)

Duprez DA, Kuller LH, Tracy R, Otvos J, Cooper DA, Hoy J, Neuhaus J, Paton NI, Friis-Moller N, Lampe F, Liappis AP, Neaton JD; INSIGHT SMART Study Group. Lipoprotein particle subclasses, cardiovascular disease and HIV infection. Atherosclerosis. 2009 Dec;207(2):524-9. doi: 10.1016/j.atherosclerosis.2009.05.001. Epub 2009 May 13.

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PMID: 19515371 (View on PubMed)

Mocroft A, Wyatt C, Szczech L, Neuhaus J, El-Sadr W, Tracy R, Kuller L, Shlipak M, Angus B, Klinker H, Ross M; INSIGHT SMART Study Group. Interruption of antiretroviral therapy is associated with increased plasma cystatin C. AIDS. 2009 Jan 2;23(1):71-82. doi: 10.1097/QAD.0b013e32831cc129.

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PMID: 19050388 (View on PubMed)

Fox Z, Phillips A, Cohen C, Neuhaus J, Baxter J, Emery S, Hirschel B, Hullsiek KH, Stephan C, Lundgren J; SMART Study Group. Viral resuppression and detection of drug resistance following interruption of a suppressive non-nucleoside reverse transcriptase inhibitor-based regimen. AIDS. 2008 Nov 12;22(17):2279-89. doi: 10.1097/QAD.0b013e328311d16f.

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PMID: 18981767 (View on PubMed)

Tedaldi E, Peters L, Neuhaus J, Puoti M, Rockstroh J, Klein MB, Dore GJ, Mocroft A, Soriano V, Clotet B, Lundgren JD; SMART Study Group and International Network for Strategic Initiatives in Global HIV Trials (INSIGHT). Opportunistic disease and mortality in patients coinfected with hepatitis B or C virus in the strategic management of antiretroviral therapy (SMART) study. Clin Infect Dis. 2008 Dec 1;47(11):1468-75. doi: 10.1086/593102.

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PMID: 18959492 (View on PubMed)

Kuller LH, Tracy R, Belloso W, De Wit S, Drummond F, Lane HC, Ledergerber B, Lundgren J, Neuhaus J, Nixon D, Paton NI, Neaton JD; INSIGHT SMART Study Group. Inflammatory and coagulation biomarkers and mortality in patients with HIV infection. PLoS Med. 2008 Oct 21;5(10):e203. doi: 10.1371/journal.pmed.0050203.

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PMID: 18942885 (View on PubMed)

SMART Study Group; El-Sadr WM, Grund B, Neuhaus J, Babiker A, Cohen CJ, Darbyshire J, Emery S, Lundgren JD, Phillips A, Neaton JD. Risk for opportunistic disease and death after reinitiating continuous antiretroviral therapy in patients with HIV previously receiving episodic therapy: a randomized trial. Ann Intern Med. 2008 Sep 2;149(5):289-99. doi: 10.7326/0003-4819-149-5-200809020-00003.

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PMID: 18765698 (View on PubMed)

Strategies for Management of Anti-Retroviral Therapy/INSIGHT; DAD Study Groups. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients. AIDS. 2008 Sep 12;22(14):F17-24. doi: 10.1097/QAD.0b013e32830fe35e.

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PMID: 18753925 (View on PubMed)

Gordin FM, Roediger MP, Girard PM, Lundgren JD, Miro JM, Palfreeman A, Rodriguez-Barradas MC, Wolff MJ, Easterbrook PJ, Clezy K, Slater LN. Pneumonia in HIV-infected persons: increased risk with cigarette smoking and treatment interruption. Am J Respir Crit Care Med. 2008 Sep 15;178(6):630-6. doi: 10.1164/rccm.200804-617OC. Epub 2008 Jul 10.

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PMID: 18617640 (View on PubMed)

Phillips AN, Carr A, Neuhaus J, Visnegarwala F, Prineas R, Burman WJ, Williams I, Drummond F, Duprez D, Belloso WH, Goebel FD, Grund B, Hatzakis A, Vera J, Lundgren JD. Interruption of antiretroviral therapy and risk of cardiovascular disease in persons with HIV-1 infection: exploratory analyses from the SMART trial. Antivir Ther. 2008;13(2):177-87. doi: 10.1177/135965350801300215.

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PMID: 18505169 (View on PubMed)

Strategies for Management of Antiretroviral Therapy (SMART) Study Group; Lundgren JD, Babiker A, El-Sadr W, Emery S, Grund B, Neaton JD, Neuhaus J, Phillips AN. Inferior clinical outcome of the CD4+ cell count-guided antiretroviral treatment interruption strategy in the SMART study: role of CD4+ Cell counts and HIV RNA levels during follow-up. J Infect Dis. 2008 Apr 15;197(8):1145-55. doi: 10.1086/529523.

Reference Type DERIVED
PMID: 18476293 (View on PubMed)

Strategies for Management of Antiretroviral Therapy (SMART) Study Group; Emery S, Neuhaus JA, Phillips AN, Babiker A, Cohen CJ, Gatell JM, Girard PM, Grund B, Law M, Losso MH, Palfreeman A, Wood R. Major clinical outcomes in antiretroviral therapy (ART)-naive participants and in those not receiving ART at baseline in the SMART study. J Infect Dis. 2008 Apr 15;197(8):1133-44. doi: 10.1086/586713.

Reference Type DERIVED
PMID: 18476292 (View on PubMed)

Carr A, Grund B, Neuhaus J, El-Sadr WM, Grandits G, Gibert C, Prineas RJ; SMART Study Investigators. Asymptomatic myocardial ischaemia in HIV-infected adults. AIDS. 2008 Jan 11;22(2):257-67. doi: 10.1097/QAD.0b013e3282f20a77.

Reference Type DERIVED
PMID: 18097228 (View on PubMed)

Burman WJ, Grund B, Roediger MP, Friedland G, Darbyshire J, Wu AW; SMART Study Group. The impact of episodic CD4 cell count-guided antiretroviral therapy on quality of life. J Acquir Immune Defic Syndr. 2008 Feb 1;47(2):185-93. doi: 10.1097/QAI.0b013e31815acaa4.

Reference Type DERIVED
PMID: 17971716 (View on PubMed)

Strategies for Management of Antiretroviral Therapy (SMART) Study Group; El-Sadr WM, Lundgren J, Neaton JD, Gordin F, Abrams D, Arduino RC, Babiker A, Burman W, Clumeck N, Cohen CJ, Cohn D, Cooper D, Darbyshire J, Emery S, Fatkenheuer G, Gazzard B, Grund B, Hoy J, Klingman K, Losso M, Markowitz N, Neuhaus J, Phillips A, Rappoport C. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med. 2006 Nov 30;355(22):2283-96. doi: 10.1056/NEJMoa062360.

Reference Type DERIVED
PMID: 17135583 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

SMART

Identifier Type: -

Identifier Source: secondary_id

CPCRA 065

Identifier Type: -

Identifier Source: org_study_id