Effect of Addition of Raltegravir (MK-0518) to PI- or NNRTI-Based ART Regimens in HIV Infected Subjects With Undetectable Viral Load

NCT ID: NCT00515827

Last Updated: 2021-11-04

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

53 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-11-30

Study Completion Date

2008-11-30

Brief Summary

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Raltegravir (MK-0518) is an HIV-1 integrase inhibitor with potent in vitro activity against HIV-1 strains including those resistant to currently available antiretroviral drugs. The purpose of this study is to assess the effectiveness of raltegravir in further reducing viral load in HIV infected patients that have already achieved viral suppression below the level of detection of standard viral load assays when added to antiretroviral therapy (ART).

Detailed Description

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Although ART has reduced the morbidity and mortality from HIV-1 infection, most individuals who stop ART experience rapid viral rebound. Effective ART can suppress viral load to less than 50 copies/ml; however, current treatment regimens cannot completely eliminate the infection. The primary purpose of this study was to assess the ability of the HIV-1 integrase inhibitor, raltegravir, to reduce viral load when added to ART regimens of HIV-1 infected patients who have achieved viral suppression to less than 50 copies/ml.

The study lasted 24 weeks. Participants were randomly assigned to one of two arms. Participants in Arm A were administered raltegravir in addition to their usual ART regimen from study entry until Week 12. At Week 12, subjects halted raltegravir use and received a placebo until Week 24. Participants in Arm B were administered the placebo in addition to their usual ART regimen from study entry until Week 12. At Week 12, subjects halted the placebo and received raltegravir until Week 24. A real-time polymerase chain reaction (PCR) single copy assay (SCA) capable of detecting 1 copy of HIV RNA was used to assay viral load. The cross-over design allowed assessment of the effect of intensification with raltegravir between the two arms at Weeks 10/12 and every participant enrolled in the study receiving raltegravir for 12 weeks. Primary analysis focused on weeks 10/12 measurement and with no washout period, typical analysis of cross-over design was not intended.

All participants had scheduled visits at Weeks 0, 2, 4, 10, 12, 14, 16, 22, and 24. A targeted physical exam occurred at all visits. Blood and urine collection occurred at selected visits. A medical/medication assessment occurred at trial entry. Drug dispensing and an adherence questionnaire occurred at some visits. A pregnancy test occurred at select visits. Participants' background ART medications were not provided by the study.

Conditions

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HIV Infections

Keywords

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Treatment Experienced

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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Raltegravir then Placebo (Arm A)

400 mg raltegravir (MK-0518) administered twice daily in addition to optimized background regimen (OBR) from entry to Week 12; halt raltegravir at Week 12 and add placebo twice daily for 12 weeks

Group Type EXPERIMENTAL

Raltegravir (MK-0518)

Intervention Type DRUG

400 mg tablet taken orally twice daily

Placebo

Intervention Type DRUG

400 mg placebo tablet taken orally twice daily

Placebo then Raltegravir (Arm B)

Placebo administered twice daily in addition to OBR from entry until Week 12; halt placebo at Week 12 and add 400 mg raltegravir tablet twice daily for 12 weeks

Group Type EXPERIMENTAL

Raltegravir (MK-0518)

Intervention Type DRUG

400 mg tablet taken orally twice daily

Placebo

Intervention Type DRUG

400 mg placebo tablet taken orally twice daily

Interventions

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Raltegravir (MK-0518)

400 mg tablet taken orally twice daily

Intervention Type DRUG

Placebo

400 mg placebo tablet taken orally twice daily

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* HIV-1 Infection
* ART for at least 12 months prior to study entry that includes at least two NRTIs and either an NNRTI or a ritonavir-boosted PI
* No change in ART regimen for at least 3 months prior to study entry
* CD4 count of 200 or more at screening
* Viral load below the limit of quantification of an ultrasensitive assay for at least 6 months prior to study entry
* Viral load less than 50 copies/ml using Roche Amplicor HIV-1 RNA Ultrasensitive assay within 60 days of study entry
* All viral load assays obtained within 6 months prior to study entry lower than limits of quantification on all tests
* Pre-ART viral load level greater than 100,000 copies/ml
* Detectable viral load of 1 copy or more on the screening SCA
* Available pre-study entry plasma sample for SCA viral load determination
* Absolute neutrophil count of 750/mm3 or more
* Hemoglobin of 9 g/dL or more for female subjects and 10 g/dL or more for male subjects
* Platelet count of 50,000/mm3 or more
* Calculated creatinine clearance of 30 ml/min or more
* AST, ALT, and alkaline phosphate less than or equal to 5 x ULN
* Total bilirubin less than or equal to 2.5 x ULN. If subject is taking indinavir or atazanavir at screening, total bilirubin must be less than or equal to 5 x ULN.
* Negative serum or urine pregnancy test within 48 hours prior to study entry for females with reproductive potential
* Willing to use acceptable means of contraception

Exclusion Criteria

* Previous documented virologic failure on an antiretroviral regimen
* Unstable clinical condition that would preclude the subject from undergoing study procedures
* Use of immunosuppressive medications within 60 days prior to study entry. Participants using inhaled or nasal steroids are not excluded.
* Opportunistic infection within 60 days prior to study entry
* Allergy or sensitivity to components of study drug
* Active drug or alcohol abuse
* Serious illness requiring systemic treatment within 60 days prior to study entry
* Receipt of non-HIV vaccination within 30 days prior to study entry
* Receipt of any HIV vaccines
* Plan to change background ART within 24 weeks after study entry
* Pregnant or breastfeeding
Minimum Eligible Age

18 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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Rajesh T Gandhi, MD

Role: STUDY_CHAIR

Massachusetts General Hospital

Joseph J Eron Jr., MD

Role: STUDY_CHAIR

University of North Carolina, Chapel Hill

John W Mellors, MD

Role: STUDY_CHAIR

University of Pittsburgh Medical Center

Locations

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Alabama Therapeutics CRS

Birmingham, Alabama, United States

Site Status

Stanford CRS

Palo Alto, California, United States

Site Status

Ucsf Aids Crs

San Francisco, California, United States

Site Status

Harbor-UCLA Med. Ctr. CRS

Torrance, California, United States

Site Status

University of Colorado Hospital CRS

Aurora, Colorado, United States

Site Status

Northwestern University CRS

Chicago, Illinois, United States

Site Status

Massachusetts General Hospital ACTG CRS

Boston, Massachusetts, United States

Site Status

Beth Israel Deaconess Med. Ctr., ACTG CRS

Boston, Massachusetts, United States

Site Status

Washington U CRS

St Louis, Missouri, United States

Site Status

Cornell CRS

New York, New York, United States

Site Status

NY Univ. HIV/AIDS CRS

New York, New York, United States

Site Status

Columbia P&S CRS

New York, New York, United States

Site Status

Harlem ACTG CRS

New York, New York, United States

Site Status

Univ. of Rochester ACTG CRS

Rochester, New York, United States

Site Status

Unc Aids Crs

Chapel Hill, North Carolina, United States

Site Status

Duke Univ. Med. Ctr. Adult CRS

Durham, North Carolina, United States

Site Status

MetroHealth CRS

Cleveland, Ohio, United States

Site Status

Hosp. of the Univ. of Pennsylvania CRS

Philadelphia, Pennsylvania, United States

Site Status

Pitt CRS

Pittsburgh, Pennsylvania, United States

Site Status

University of Washington AIDS CRS

Seattle, Washington, United States

Site Status

Countries

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United States

References

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Grinsztejn B, Nguyen BY, Katlama C, Gatell JM, Lazzarin A, Vittecoq D, Gonzalez CJ, Chen J, Harvey CM, Isaacs RD; Protocol 005 Team. Safety and efficacy of the HIV-1 integrase inhibitor raltegravir (MK-0518) in treatment-experienced patients with multidrug-resistant virus: a phase II randomised controlled trial. Lancet. 2007 Apr 14;369(9569):1261-1269. doi: 10.1016/S0140-6736(07)60597-2.

Reference Type BACKGROUND
PMID: 17434401 (View on PubMed)

Kassahun K, McIntosh I, Cui D, Hreniuk D, Merschman S, Lasseter K, Azrolan N, Iwamoto M, Wagner JA, Wenning LA. Metabolism and disposition in humans of raltegravir (MK-0518), an anti-AIDS drug targeting the human immunodeficiency virus 1 integrase enzyme. Drug Metab Dispos. 2007 Sep;35(9):1657-63. doi: 10.1124/dmd.107.016196. Epub 2007 Jun 25.

Reference Type BACKGROUND
PMID: 17591678 (View on PubMed)

Markowitz M, Morales-Ramirez JO, Nguyen BY, Kovacs CM, Steigbigel RT, Cooper DA, Liporace R, Schwartz R, Isaacs R, Gilde LR, Wenning L, Zhao J, Teppler H. Antiretroviral activity, pharmacokinetics, and tolerability of MK-0518, a novel inhibitor of HIV-1 integrase, dosed as monotherapy for 10 days in treatment-naive HIV-1-infected individuals. J Acquir Immune Defic Syndr. 2006 Dec 15;43(5):509-15. doi: 10.1097/QAI.0b013e31802b4956.

Reference Type BACKGROUND
PMID: 17133211 (View on PubMed)

Gandhi RT, Zheng L, Bosch RJ, Chan ES, Margolis DM, Read S, Kallungal B, Palmer S, Medvik K, Lederman MM, Alatrakchi N, Jacobson JM, Wiegand A, Kearney M, Coffin JM, Mellors JW, Eron JJ; AIDS Clinical Trials Group A5244 team. The effect of raltegravir intensification on low-level residual viremia in HIV-infected patients on antiretroviral therapy: a randomized controlled trial. PLoS Med. 2010 Aug 10;7(8):e1000321. doi: 10.1371/journal.pmed.1000321.

Reference Type RESULT
PMID: 20711481 (View on PubMed)

Gandhi RT, Coombs RW, Chan ES, Bosch RJ, Zheng L, Margolis DM, Read S, Kallungal B, Chang M, Goecker EA, Wiegand A, Kearney M, Jacobson JM, D'Aquila R, Lederman MM, Mellors JW, Eron JJ; AIDS Clinical Trials Group (ACTG) A5244 Team. No effect of raltegravir intensification on viral replication markers in the blood of HIV-1-infected patients receiving antiretroviral therapy. J Acquir Immune Defic Syndr. 2012 Mar 1;59(3):229-35. doi: 10.1097/QAI.0b013e31823fd1f2.

Reference Type DERIVED
PMID: 22083073 (View on PubMed)

Other Identifiers

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10440

Identifier Type: REGISTRY

Identifier Source: secondary_id

ACTG A5244

Identifier Type: -

Identifier Source: secondary_id

A5244

Identifier Type: -

Identifier Source: org_study_id