Switching From Efavirenz to Atazanavir/ Ritonavir in HIV-infected Subjects With Good Virologic Suppression

NCT ID: NCT01194856

Last Updated: 2017-08-11

Basic Information

• Recruitment Status: TERMINATED
• Clinical Phase: PHASE4
• Total Enrollment: 1 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2010-10-31
• Study Completion Date: 2011-12-31

Brief Summary

The purposes of this study are to evaluate if switching an antiretroviral medication from efavirenz (EFV) to atazanavir/ ritonavir (ARV/r) will, in a 96-week period, change:

1. the amount of fat in HIV patients with lipoatrophy,

2. metabolic lab values such as your lipid (fat) profile, glucose (blood sugar), and insulin (a hormone that regulates glucose) in HIV patients with lipoatrophy.

Detailed Description

Our study will evaluate the effects on peripheral fat of switching from EFV to ATV/r over 96 weeks in HIV+ patients with clinical lipoatrophy. From a virologic standpoint, EFV and ATV/r are medications which are recommended equally as preferred components of antiretroviral regimens in the December 2009 version of the Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents.[20] The study subjects should be receiving a stable EFV-containing antiretroviral (ART) regimen for at least 48 weeks prior to study entry. Blood will be saved for further investigations if needed. Safety parameters will be regularly assessed throughout the study. In addition, a subcutaneous fat biopsy will be obtained to measure fat mtDNA, mtRNA, and fat apoptosis. These measurements would provide significant insight into the clinical changes which have been recently described.

Conditions

HIV Infection; Mitochondrial Dysfunction

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: CROSSOVER
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Efavirenz 600 mg

Serving as the Control Arm - patients will maintain EFV-containing antiretroviral regimen

Group Type: ACTIVE_COMPARATOR

Efavirenz

Intervention Type: DRUG

Maintain dosage - 600 mg orally QHS for 96 weeks

Arm B - Atazanavir/Ritonavir

Atazanavir 300 mg orally with Ritonavir 100 mg orally once daily for 96 wks

Group Type: EXPERIMENTAL

Atazanavir/ritonavir

Intervention Type: DRUG

300 mg orally once daily with Ritonavir 100mg orally once daily for 96 weeks

Interventions

Atazanavir/ritonavir

300 mg orally once daily with Ritonavir 100mg orally once daily for 96 weeks

Intervention Type: DRUG

Efavirenz

Maintain dosage - 600 mg orally QHS for 96 weeks

Intervention Type: DRUG

Other Intervention Names

Reyataz®: 100 mg, 150 mg, 200 mg, 300 mg; Norvir®: 100 mg; Sustiva®: 50 mg, 200 mg

Eligibility Criteria

Inclusion Criteria

1. HIV infection

2. Age > or = 18 years old.

3. Signed informed consent.

4. Clinical lipoatrophy of at least moderate severity and in at least two different areas of the following: face, arms, legs, or buttocks (as self reported by the patient and confirmed by the physician).

5. Women of childbearing potential must be using an adequate method of contraception to avoid pregnancy throughout the study in such a manner that the risk of pregnancy is minimized.

6. All subjects must not participate in a conception process (e.g. active attempt to become pregnant or to impregnate, sperm donation, in vitro fertilization), and if participating in sexual activity that could lead to pregnancy, the female subject/ male partner must use condoms (male or female) in addition to one of the following forms of contraception while on study: either a spermicidal agent, diaphragm, cervical cap, IUD, or hormonal-based contraception.

Prior to study enrollment, women of childbearing potential (WOCBP) must be advised of the importance of avoiding pregnancy during trial participation and the potential risk factors for an unintentional pregnancy. In addition, men enrolled on this study should understand the risks to any sexual partner of childbearing potential and should practice an effective method of birth control.

7. Receiving EFV-containing antiretroviral regimen for at least the last 48 weeks prior to study entry. Backbone NRTI regimens can include tenofovir, abacavir, emtricitabine, and/ or lamivudine. Backbone NRTI regimens cannot include zidovudine, stavudine, or didanosine. Breaks in therapy for a maximum of 5 consecutive days will be allowed during these 48 weeks, including the period immediately preceding study entry.

8. Patient willing and able to stop aspirin/ NSAIDS for 7 days before study entry and the scheduled skin biopsy procedures.

9. HIV-1 RNA < 400 copies/mL for at least 90 days prior to study entry.

10. Laboratory values obtained within 60 days prior to study entry:

1. Absolute neutrophil count (ANC) ≥ 500 / mm3

2. Hemoglobin ≥ 9.0 g/dL

3. Platelet count ≥ 75,000/ mm3

4. Creatinine clearance > 50 mL / min

5. PT/PTT < 1.2 ULN

Exclusion Criteria

1. Receipt of AZT, d4T, ddI, or ddC at study entry or within 24 weeks of entry

2. Life expectancy < 12 months

3. Women who are pregnant or breastfeeding

4. WOCBP unwilling to use contraception WOCBP who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period

5. Women with a positive pregnancy test.

6. Sexually active fertile men not using effective birth control if their partners are WOCBP.

1. Prisoners or subjects who are involuntarily incarcerated.

2. Subjects who are compulsorily detained for treatment of either a psychiatric or physical (eg, infectious disease) illness.

8. Clinically important illness within 14 days prior to study entry

9. Inability to communicate effectively with the study personnel.

10. Bleeding diathesis

11. Supplementation with recombinant growth hormone, growth hormone releasing factor, anabolic steroids, estrogen or testosterone, unless it is for replacement purposes.

12. Have no plans to alter any vitamin supplementation that subjects are receiving at study entry. This includes all vitamin supplementation, coenzyme Q, N acetyl cysteine, L-acetyl carnitine, and uridine.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Institute of Allergy and Infectious Diseases (NIAID)

NIH

Sponsor Role: collaborator

Case Western Reserve University

OTHER

Sponsor Role: collaborator

Bristol-Myers Squibb

INDUSTRY

Sponsor Role: collaborator

The Cleveland Clinic

OTHER

Sponsor Role: lead

Responsible Party

Marisa Tungsiripat

Staff Physician

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Marisa Tungsiripat, MD

Role: PRINCIPAL_INVESTIGATOR

The Cleveland Clinic

Locations

Cleveland Clinic

Cleveland, Ohio, United States

Countries

United States

Other Identifiers

5K23AI070078

Identifier Type: NIH

Identifier Source: secondary_id

View Link

BMS100MT

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

10-418

Identifier Type: -

Identifier Source: org_study_id