Discontinuation of Antiretroviral Therapy in Patients With Asymptomatic HIV Infection

NCT ID: NCT00050284

Last Updated: 2010-11-09

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

158 participants

Study Classification

OBSERVATIONAL

Brief Summary

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The purpose of this study is to determine whether patients who have asymptomatic HIV infection can discontinue antiretroviral therapy (ART) without adverse clinical, virologic, or immunologic consequences. This study will also assess the virologic, immunologic, and clinical outcomes in any patients who restart ART.

Detailed Description

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Patients who can discontinue ART without a significant loss of virologic or immunologic control and without an increase in clinical events may be spared the expense and adverse effects of treatment. However, the consequences of treatment discontinuation in patients with asymptomatic HIV infections are not well understood. This study will follow the clinical and immunologic progression of HIV infection in patients who have low HIV viral load and preserved CD4+ cell counts at the time ART is stopped.

Patients will fast for at least 8 hours prior to the first study visit. At this visit, blood will be drawn and body measurements will be taken. Patients will then discontinue their ART. Patients taking nonnucleoside reverse transcriptase inhibitors (NNRTIs) will stop taking NNRTIs 48 hours before withdrawing their other ART drugs. Study visits will occur every 4 to 8 weeks for the first year, then every 12 weeks for the second year. Blood will be taken at most visits, and patients will be asked to fast for at least 8 hours prior to Week 12 and 24 visits and again every 6 months. Patients who reinitiate ART for any reason will be registered to Step 2 and followed for 24 weeks.

Conditions

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HIV Infections

Keywords

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Treatment Experienced Disease Progression Anti-HIV Agents Treatment Interruption

Study Design

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Study Time Perspective

PROSPECTIVE

Eligibility Criteria

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Inclusion Criteria

* HIV infection
* ART with 2 or more drugs for 6 or more months
* CD4+ cell count(s) \> 350 cells/mm3 immediately prior to initiation of first ART
* CD4+ cell count \> 350 cells/mm3 within 45 days prior to study entry
* Plasma viral load \< 55,000 copies/ml within 45 days prior to study entry
* Willingness to discontinue ART at study entry
* Negative serum or urine pregnancy test within 14 days prior to study entry

Exclusion Criteria

* Pregnancy or breast-feeding
* Systemic cancer chemotherapy, systemic investigational agents, or immunomodulators within 30 days prior to study entry
* Drug or alcohol use or dependence that would interfere with adherence to study requirements
* Illness requiring systemic treatment and/or hospitalization until the patient either completes therapy or has been clinically stable on therapy for at least 30 days prior to study entry
* Chronic medical condition that would have a negative impact on the participation of the patient or would be expected to result in significant use of the medical care system
* History of an HIV-related illness or complication in CDC categories B and C
* Nonadherence to ART
* Active infection with hepatitis B and currently taking adefovir at doses \> 10 mg or 3TC and/or TDF
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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Daniel J. Skiest, M. D.

Role: STUDY_CHAIR

University of Texas Southwestern Medical Center

Locations

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Univ of Southern California

Los Angeles, California, United States

Site Status

Univ of California, San Diego Antiviral Research Ctr

San Diego, California, United States

Site Status

Univ of California San Francisco

San Francisco, California, United States

Site Status

San Mateo County AIDS Program

Stanford, California, United States

Site Status

Santa Clara Valley Med Ctr

Stanford, California, United States

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Stanford Univ

Stanford, California, United States

Site Status

Willow Clinic

Stanford, California, United States

Site Status

Harbor General/UCLA

Torrance, California, United States

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Georgetown Univ Med Ctr

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

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Univ of Hawaii

Honolulu, Hawaii, United States

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Northwestern Univ

Chicago, Illinois, United States

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Cook County Hosp Core Ctr

Chicago, Illinois, United States

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Rush-Presbyterian / St.Lukes (Chicago)

Chicago, Illinois, United States

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Indiana Univ Hosp

Indianapolis, Indiana, United States

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Methodist Hosp of Indiana

Indianapolis, Indiana, United States

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Wishard Hosp

Indianapolis, Indiana, United States

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Univ of Minnesota

Minneapolis, Minnesota, United States

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St. Louis Connect Care

St Louis, Missouri, United States

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Washington Univ (St. Louis)

St Louis, Missouri, United States

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Beth Israel Med Ctr

New York, New York, United States

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NYU/Bellevue

New York, New York, United States

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Chelsea Clinic

New York, New York, United States

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The Cornell Clinical Trials Unit

New York, New York, United States

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Univ of North Carolina

Chapel Hill, North Carolina, United States

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Duke Univ Med Ctr

Durham, North Carolina, United States

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Univ of Cincinnati

Cincinnati, Ohio, United States

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Presbyterian Med Ctr- Univ of PA

Norristown, Pennsylvania, United States

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Univ of Pennsylvania, Philadelphia

Philadelphia, Pennsylvania, United States

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Univ of Pittsburgh

Pittsburgh, Pennsylvania, United States

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Rhode Island Hosp

Providence, Rhode Island, United States

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Stanley Street Treatment and Resource

Providence, Rhode Island, United States

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The Miriam Hospital

Providence, Rhode Island, United States

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Comprehensive Care Clinic

Nashville, Tennessee, United States

Site Status

Univ of Texas, Southwestern Medical Ctr

Dallas, Texas, United States

Site Status

Countries

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United States

References

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Le Moing V, Chene G, Leport C, Lewden C, Duran S, Garre M, Masquelier B, Dupon M, Raffi F; Antiproteases Cohorte (APROCO) Study Group. Impact of discontinuation of initial protease inhibitor therapy on further virological response in a cohort of human immunodeficiency virus-infected patients. Clin Infect Dis. 2002 Jan 15;34(2):239-47. doi: 10.1086/324354. Epub 2001 Dec 4.

Reference Type BACKGROUND
PMID: 11740714 (View on PubMed)

Mocroft A, Youle M, Moore A, Sabin CA, Madge S, Lepri AC, Tyrer M, Chaloner C, Wilson D, Loveday C, Johnson MA, Phillips AN. Reasons for modification and discontinuation of antiretrovirals: results from a single treatment centre. AIDS. 2001 Jan 26;15(2):185-94. doi: 10.1097/00002030-200101260-00007.

Reference Type BACKGROUND
PMID: 11216926 (View on PubMed)

Deeks SG, Wrin T, Liegler T, Hoh R, Hayden M, Barbour JD, Hellmann NS, Petropoulos CJ, McCune JM, Hellerstein MK, Grant RM. Virologic and immunologic consequences of discontinuing combination antiretroviral-drug therapy in HIV-infected patients with detectable viremia. N Engl J Med. 2001 Feb 15;344(7):472-80. doi: 10.1056/NEJM200102153440702.

Reference Type BACKGROUND
PMID: 11172188 (View on PubMed)

Daar ES, Bai J, Hausner MA, Majchrowicz M, Tamaddon M, Giorgi JV. Acute HIV syndrome after discontinuation of antiretroviral therapy in a patient treated before seroconversion. Ann Intern Med. 1998 May 15;128(10):827-9. doi: 10.7326/0003-4819-128-10-199805150-00005. No abstract available.

Reference Type BACKGROUND
PMID: 9599194 (View on PubMed)

Robertson KR, Su Z, Margolis DM, Krambrink A, Havlir DV, Evans S, Skiest DJ; A5170 Study Team. Neurocognitive effects of treatment interruption in stable HIV-positive patients in an observational cohort. Neurology. 2010 Apr 20;74(16):1260-6. doi: 10.1212/WNL.0b013e3181d9ed09. Epub 2010 Mar 17.

Reference Type RESULT
PMID: 20237308 (View on PubMed)

Other Identifiers

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ACTG A5170

Identifier Type: -

Identifier Source: org_study_id