Atazanavir (BMS-232632) in Combination With Ritonavir or Saquinavir, and Lopinavir/Ritonavir, Each With Tenofovir and a Nucleoside in Subjects With HIV

Phase III Open Label Atazanavir (BMS-232632) in Combination With Ritonavir or Saquinavir, and Lopinavir/Ritonavir, Each With Tenofovir and a Nucleoside in Subjects With HIV

The purpose of this study is to learn how well atazanavir (ATV) works in combination with ritonavir (RTV) or saquinavir (SQV) with tenofovir (TDF) and a nucleoside to reduce the viral load of treatment experienced subjects with human immunodeficiency virus (HIV). There is a comparison arm with lopinavir (LPV)/RTV and TDF and a nucleoside.

Study Overview

• Status: Completed
• Conditions: HIV Infections
• Intervention / Treatment: Drug: Atazanavir + ritonavir + tenofovir + nucleoside; Drug: Atazanavir + saquinavir + tenofovir + nucleoside; Drug: Lopinavir/ritonavir + tenofovir + nucleoside

• Study Type: Interventional
• Enrollment (Actual): 571
• Phase: Phase 3

Contacts and Locations

Study Locations

• United States
  • California
    • San Francisco, California, United States, 94121
    • Torrance, California, United States, 90502
  • Colorado
    • Boulder, Colorado, United States, 80304
  • Florida
    • Altamonte Springs, Florida, United States
    • Ft Lauderdale, Florida, United States, 33308
    • Ft Lauderdale, Florida, United States, 33306
    • Miami Beach, Florida, United States, 33160
    • Orlando, Florida, United States, 32801
  • Georgia
    • Decatur, Georgia, United States
  • Hawaii
    • Honolulu, Hawaii, United States, 96816
  • Indiana
    • Boise, Indiana, United States
  • Kansas
    • Wichita, Kansas, United States, 67214
  • Kentucky
    • Louisville, Kentucky, United States, 40202
  • Louisiana
    • New Orleans, Louisiana, United States
  • Massachusetts
    • Brookline, Massachusetts, United States
    • Fall River, Massachusetts, United States, 02720
  • New Jersey
    • East Orange, New Jersey, United States
    • Newark, New Jersey, United States, 07103
  • New York
    • Buffalo, New York, United States, 14215
    • Manhasset, New York, United States, 11030
    • New York, New York, United States, 10019
    • Rochester, New York, United States, 14620
  • North Carolina
    • Huntersville, North Carolina, United States, 28078
    • Winston Salem, North Carolina, United States, 29203
    • Winston-Salem, North Carolina, United States, 27157
  • Ohio
    • Akron, Ohio, United States
  • Texas
    • Dallas, Texas, United States
    • Dallas, Texas, United States, 75246
    • Houston, Texas, United States, 77006

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Virologic failure to 2 or more highly active antiretroviral therapy (HAART) regimens that, in total, have included at least one drug from all approved classes protease inhibitors, non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors (PI, NNRTI, NRTI):

  1. Currently on a failing HAART regimen with 2 qualifying plasma viral load measurements (hospital/clinic value within 4 weeks of screening with viral load equivalent to =>1,000 c/mL on the Roche Amplicor[TM] and central lab measurements of =>1,000 c/mL (Roche Amplicor[TM]) within 4 weeks of randomization
  2. Cluster of Differentiation 4 (CD4) cell count =>50 cells/mm3 obtained within 4 weeks prior to randomization
• =>16 years of age (or minimum age as determined by local regulations or as legal requirements dictate);
• History of prior virologic response to at least one HAART regimen, defined as a 1.0 log10 decline or a decline in viral load to <400 c/mL by Roche Amplicor or <500 c/mL by Chiron Quantiplex branched DNA (bDNA) assay
• Both females of child bearing potential and males must utilize effective barrier contraception to reduce transmission of sexually transmitted disease, including human immunodeficiency virus (HIV). Other contraception in addition to barrier methods is permitted; interaction between atazanavir and oral contraceptives has not been studied.
• Subjects must be able to provide written informed consent;
• Subjects should be available for follow-up for a period of at least 48 weeks

• Baseline laboratory values measured within 2 weeks prior to initiating study drugs as follows:

  1. serum creatine <1.5 times the upper limit of normal (ULN)
  2. total serum lipase <1.4 times the ULN
  3. liver enzymes alanine aminotransferase (AST), aspartate aminotransferase (ALT) <3 times the ULN
  4. total serum bilirubin <1.5 times the ULN

Exclusion Criteria:

• Prior use (=>3 days) of atazanavir, TVF or LPV/RTV; if history of SQV, then must be phenotypically sensitive
• the current failing antiretroviral regimen must have been administered for at least eight weeks at he initiation of screening and must not include both a PI and NNRTI
• Presence of a newly diagnosed HIV-related opportunistic infection or any medical requiring acute therapy at the time of enrollment
• Proven or suspected acute hepatitis in the 30 days prior to study entry. Subjects with chronic hepatitis are eligible provided that their liver function enzymes (ALT/AST) are <3 x ULN
• Previous therapy with agents with significant systemic myelosuppressive, neurotoxic, pancreatoxic, hepatoxic or cytotoxic potential within 3 months of study start or the expected need for such therapy at the time of enrollment of therapy with methadone or ribavirin/interferons or treatment with neurotoxic drugs or drugs that affect Cytochrome P450 3A4 (CYP3A4).
• Active alcohol or substance use sufficient, in the Investigator's opinion, to prevent adequate compliance with study therapy or to increase the risk of developing pancreatitis or chemical hepatitis
• Intractable diarrhea (=> 6 loose stools/day for at least 7 days consecutive days) within 30 days prior to study entry
• Pregnancy or breast-feeding
• History of hemophilia
• Presence of cardiomyopathy

• Any one of the following:

  1. Heart rate-corrected QT (QTc) interval >450 msec on the screening electrocardiogram (EKG)
  2. Heart rate <40 beats per minute (bpm)
  3. Pause length >3 seconds seen on EKG
  4. Clinical symptoms potentially related to heart block
  5. Third degree heart block
• History of acute or chronic pancreatitis
• If choosing 2'-3' dideoxyinosine (ddI) or 2',3'-didehydro-3'-deoxythymidine (d4T) as the NRTI: History or signs and symptoms of bilateral peripheral neuropathy => Grade 2 at the time of screening
• Inability to tolerate oral medications
• Any other clinical conditions or prior therapy that, in the opinion of the Investigator, would make the subject unsuitable for study or unable to comply with the dosing requirements.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: I; ATV 300 mg + RTV 100 mg + TDF 300 mg + nucleoside of choice ATV , RTV, and TDF once daily, nucleoside per label 48 Weeks and then for as long as subject is in need of therapy through study	Drug: Atazanavir + ritonavir + tenofovir + nucleoside; Active Comparator, Capsules, tablets, Oral; Other Names: Reyataz; BMS-232632
Active Comparator: II; ATV 400 mg + SQV 1200 mg + TDF 300 mg + nucleoside of choice ATV, SQV, and TDF once daily, nucleoside per label 48 Weeks and then for as long as subject is in need of therapy through study	Drug: Atazanavir + saquinavir + tenofovir + nucleoside; Active Comparator, Capsules, tablets, Oral; Other Names: Reyataz; BMS-232632
Active Comparator: III; LPV/RTV 400/100 mg + TDF 300 mg + nucleoside of choice LPV/RTV twice daily, TDF once daily, nucleoside per label 48 Weeks and then for as long as subject is in need of therapy through study	Drug: Lopinavir/ritonavir + tenofovir + nucleoside; Active Comparator, Capsules, tablets, Oral

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Mean Change From Baseline in HIV Ribonucleic Acid (RNA) at Week 24	Baseline, Week 24
Mean Change From Baseline in HIV RNA at Week 48	Baseline, Week 48
Mean Change From Baseline in HIV RNA at Week 96	Baseline, Week 96

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in CD4 Cell Count at Week 24		Baseline, Week 24
Change From Baseline in CD4 Cell Count at Week 48		Baseline, Week 48
Change From Baseline in CD4 Cell Count at Week 96		Baseline, Week 96
Mean Change From Baseline in HIV RNA at Week 2		Baseline, Week 2
Participants Achieving Virologic Half Log Suppression (Limit of Quantification [LOQ] = 400 c/mL) at Week 24 (Overall and by Protease Inhibitor [PI] Sensitivity)	Number of participants with a >=0.5 log10 decrease in HIV RNA from baseline or HIV RNA < 400 c/mL at Week 24, by their baseline phenotypic sensitivity to their randomized PI.	Baseline, Week 24
Participants Achieving Virologic Half Log Suppression (LOQ = 400 c/mL) at Week 48, (Overall and by PI Sensitivity)	Number of participants with a >=0.5 log10 decrease in HIV RNA from baseline or HIV RNA < 400 c/mL at Week 48, by their baseline phenotypic sensitivity to their randomized PI.	Baseline, Week 48
Participants Achieving Virologic Half Log Suppression (LOQ = 400 c/mL) at Week 96	Number of participants with a >=0.5 log10 decrease in HIV RNA from baseline or HIV RNA < 400 c/mL at Week 96.	Baseline, Week 96
Participants Achieving Virologic Half Log Suppression (LOQ = 50 c/mL) at Week 24		Week 24
Participants Achieving Virologic Half Log Suppression (LOQ = 50 c/mL) at Week 24, by PI Sensitivity	Number of participants with a >=0.5 log10 decrease in HIV RNA from baseline or HIV RNA < 50 c/mL at Week 24, by their baseline phenotypic sensitivity to their randomized PI.	Baseline, Week 24
Participants Achieving Virologic Half Log Suppression (LOQ = 50 c/mL) at Week 48		Week 48
Participants Achieving Virologic Half Log Suppression (LOQ = 50 c/mL) at Week 48, by PI Sensitivity	Number of participants with a >=0.5 log10 decrease in HIV RNA from baseline or HIV RNA < 50 c/mL at Week 48, by their baseline phenotypic sensitivity to their randomized PI.	Baseline, Week 48
Participants Achieving Virologic Half Log Suppression (LOQ = 50 c/mL) at Week 96		Week 96
Participants Achieving Treatment Response (LOQ = 400 c/mL) Without Prior Failure at Week 24	Treatment Response = confirmed suppression to LOQ (400 c/mL). The Algorithm for Treatment Response Without Prior Failure (TRPWF) = participants staying in response at the analysis timepoint without having an intervening, confirmed rebound.	Week 24
Participants Achieving Treatment Response (LOQ = 400 c/mL) Without Prior Failure at Week 48	Treatment Response = confirmed suppression to LOQ (400 c/mL). The Algorithm for Treatment Response Without Prior Failure (TRPWF) = participants staying in response at the analysis timepoint without having an intervening, confirmed rebound.	Week 48
Participants Achieving Treatment Response (LOQ = 400 c/mL) Without Prior Failure at Week 96	Treatment Response = confirmed suppression to LOQ (400 c/mL). The Algorithm for Treatment Response Without Prior Failure (TRPWF) = participants staying in response at the analysis timepoint without having an intervening, confirmed rebound.	Week 96
Participants Achieving Treatment Response (LOQ = 50 c/mL) Without Prior Failure at Week 24	Treatment Response = confirmed suppression to LOQ (50 c/mL). The Algorithm for Treatment Response Without Prior Failure (TRPWF) = participants staying in response at the analysis timepoint without having an intervening, confirmed rebound.	Week 24
Participants Achieving Treatment Response (LOQ = 50 c/mL) Without Prior Failure at Week 48	Treatment Response = confirmed suppression to LOQ (50 c/mL). The Algorithm for Treatment Response Without Prior Failure (TRPWF) = participants staying in response at the analysis timepoint without having an intervening, confirmed rebound.	Week 48
Participants Achieving Treatment Response (LOQ = 50 c/mL) Without Prior Failure at Week 96	Treatment Response = confirmed suppression to LOQ (50 c/mL). The Algorithm for Treatment Response Without Prior Failure (TRPWF) = participants staying in response at the analysis timepoint without having an intervening, confirmed rebound.	Week 96
Correlation of ATV Minimum Plasma Concentration (Cmin), Inhibitory Quotient (IQ), and Number of Protease Inhibitor (PI) Mutations at Baseline With HIV RNA Change From Baseline at Week 24	Pearson correlations of the Cmin (trough plasma concentration), IQ (the ratio of Cmin of ATV to HIV IC50), and Number of baseline PI Mutations with HIV RNA change from baseline at Week 24 were explored.	Baseline, Week 24
Correlation of ATV Minimum Plasma Concentration (Cmin), Inhibitory Quotient (IQ), and Number of Protease Inhibitor (PI) Mutations at Baseline With HIV RNA Change From Baseline at Week 48	Pearson correlations of the Cmin (trough plasma concentration), IQ (the ratio of Cmin of ATV to HIV IC50), and Number of baseline PI Mutations with HIV RNA change from baseline at Week 48 were explored.	Baseline, Week 48
Correlation of ATV Minimum Plasma Concentration (Cmin) Inhibitory Quotient (IQ), and Number of PI Mutations at Baseline and CD4 Cell Count Change From Baseline at Week 24	Pearson correlations of the Cmin (trough plasma concentration), IQ (the ratio of Cmin of ATV to HIV IC50), and Number of baseline PI Mutations with CD4 cell count change from baseline at Week 24 were explored.	Baseline, Week 24
Correlation of ATV Minimum Plasma Concentration (Cmin) Inhibitory Quotient (IQ), and Number of PI Mutations at Baseline and CD4 Cell Count Change From Baseline at Week 48	Pearson correlations of the Cmin (trough plasma concentration), IQ (the ratio of Cmin of ATV to HIV IC50), and Number of baseline PI Mutations with CD4 cell count change from baseline at Week 48 were explored.	Baseline, Week 48
Lipid Mean Percent Change From Baseline at Week 24	Mean percent change in total cholesterol, high density lipoprotein (HDL) cholesterol, fasting low density lipoprotein (LDL) cholesterol, and fasting triglycerides.	Baseline, Week 24
Lipid Mean Percent Change From Baseline at Week 48	Mean percent change in total cholesterol, high density lipoprotein (HDL) cholesterol, fasting low density lipoprotein (LDL) cholesterol, and fasting triglycerides.	Week 48
Lipid Mean Percent Change From Baseline at Week 96, Observed Values	Mean percent change in total cholesterol, high density lipoprotein (HDL) cholesterol, fasting low density lipoprotein (LDL) cholesterol, and fasting triglycerides.	Week 96
Deaths, Serious Adverse Events (SAEs), and Adverse Events (AEs) Through Week 48	AE=any new untoward medical occurrence/worsening of a pre-existing medical condition regardless of causal relationship. SAE=any untoward medical occurrence at any dose that: results in death; is life-threatening; requires/prolongs inpatient hospitalization; results in persistent/significant disability; is cancer; is congenital anomaly/birth defect; results in drug dependency/abuse; is an important medical event.	From Enrollment through Week 48
Most Common AEs and AEs of Interest Through Week 48	Prespecified AEs of interest included jaundice, ocular icterus, and hyperbilirubinemia.	From Enrollment to Week 48
Fasting Glucose Mean Change From Baseline at Week 24		Baseline, Week 24
Fasting Glucose Mean Change From Baseline at Week 48		Week 48
Grade 3/4 Laboratory Abnormalities Through Week 48	Common Terminology Criteria for Adverse Events v3.0 (CTCAE) Grades:1=Mild, 2=Moderate, 3=Severe, 4=Life-threatening/disabling, 5=Death. Abnormal values: absolute neutrophil count: ≥500 to <750/mm3 (grade 3), <500/mm3 (grade 4); platelets: 20,000-49,999/mm3 (grade 3), <20,000/mm3 or diffuse petechiae (grade 4); alanine transaminase (ALT): 5.1-10 x upper limit of normal (ULN; grade 3), >10 x ULN (grade 4); aspartate transaminase (AST): 5.1-10 x ULN (grade 3), >10 x ULN (grade 4); bilirubin: 2.6-5 x ULN (grade 3), >5 x ULN (grade 4).	From Enrollment to Week 48
Fridericia-corrected QT (QTcF) Interval and Change From Baseline by Analysis Time Point	The QT interval is a measure of the time between the start of the Q wave and the end of the T wave in the heart's electrical cycle. The QT interval was corrected for heart rate using Fridericia's (QTcF) formula.	Baseline, Week 4 predose, 2-3 hours postdose, 6-12 hours postdose, Week 12, Week 24, Week 48
PR Interval and Change From Baseline by Analysis Time Point	The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex, and reflects the time the electrical impulse takes to travel from the sinus node through the atrioventricular (AV) node and entering the ventricles. The PR interval is therefore a good estimate of AV node function.	Baseline, Week 4 predose, 2-3 hours postdose, 6-12 hours postdose, Week 12, Week 24, Week 48
Adherence to Regimen Though Week 48 Based on MACS the Multicenter AIDS Cohort Study (MACS) Adherence Questionnaire	The MACS adherence questionnaire asks patients how many medication doses they missed during the previous day, 2 days, 3 days and 4 days. Drug-specific questions included adherence with dose and frequency. Adherence was defined as taking all doses and numbers of pills as prescribed for each medication. This strict adherence cut-off was based on the guidelines stating that anything less than excellent adherence may result in a virus breakthrough and development of resistance.	Baseline, Week 24, Week 48
Mean Score of European Quality of Life-5 Dimensions (EQ-5D) Health Index Score at Baseline, Mid-Study (Week 24), and Final (Week 48)	The EQ-5D is a 5-item questionnaire to assess health-related quality of life in 5 health dimensions (mobility, self-care, usual activity, pain/discomfort, anxiety/depression) are scored on a 3-level scale: no problems (1), some problems (2), extreme problems (3). Using a standard algorithm, responses are summarized into a single score, the EQ-5D Health Index Score (HIS), which ranges between 1 (representing perfect health) and 0 (representing the worst imaginable health state or death). The smallest coefficient of change is 0.03.	Baseline, Week 24, Week 48
Mean Score of European Quality of Life-5 Dimensions (EQ-5D) Visual Analog Scale (VAS) at Baseline, Mid-Study (Week 24), and Final (Week 48)	The EQ-5D has a Visual Analog Scale (VAS), which is a feeling thermometer-like scale with a range between 0 and 100. Patients are required to draw a line from a box on the VAS scale to an actual mark on the thermometer-like scale that corresponds with a number that reflects their self-assessed health status at the time they are completing the questionnaire. Higher VAS scores indicate better overall health. There is no minimum clinically important difference reported in the literature for VAS.	Baseline, Week 24, Week 48
Number of Participants Utilizing Resources for Managing Lipid Elevation	Participants' overall resource utilization for managing lipid elevation that includes the management of side effects of lipid lowering medications, such as those due to drug interactions.	Baseline, Week 24, Week 48
Mean ATV, RTV and SQV Minimum Concentration (Cmin) Values	The minimum or "trough" concentration (Cmin) of a drug observed after its administration and just prior to the administration of a subsequent dose.	collected at the pre-dose time point after receiving atazanavir for at least four weeks
HIV IC50 at Week 24	IC50: inhibitory concentration of drug required to reduce viral replication by 50%.	Week 24
Inhibitory Quotient at Week 24	Inhibitory quotient is a measure of drug exposure and susceptibility in an individual. The IQ is typically calculated as the ratio of Cmin to HIV IC50.	Baseline, Week 24
Inhibitory Quotient at Week 48	Inhibitory quotient is a measure of drug exposure and susceptibility in an individual. The IQ is typically calculated as the ratio of Cmin to HIV IC50.	Baseline, Week 48
HIV RNA Level - Treated Subjects With Evaluable Cmins at Week 24	Week 24 HIV RNA level and change from baseline were summarized for treated subjects with evaluable Cmins.	Baseline, Week 24
HIV RNA Level - Treated Subjects With Evaluable Cmins at Week 48	Week 24 HIV RNA level and change from baseline were summarized for treated subjects with evaluable Cmins.	Baseline, Week 48

Collaborators and Investigators

• Sponsor: Bristol-Myers Squibb

Study record dates

Study Major Dates

• Study Start: November 1, 2001
• Primary Completion (Actual): July 1, 2003
• Study Completion (Actual): March 1, 2009

Study Registration Dates

• First Submitted: May 6, 2002
• First Submitted That Met QC Criteria: May 7, 2002
• First Posted (Estimate): May 8, 2002

Study Record Updates

• Last Update Posted (Estimate): December 24, 2010
• Last Update Submitted That Met QC Criteria: November 29, 2010
• Last Verified: November 1, 2010

More Information

Terms related to this study

• Additional Relevant MeSH Terms: RNA Virus Infections; Virus Diseases; Infections; Blood-Borne Infections; Communicable Diseases; Sexually Transmitted Diseases, Viral; Sexually Transmitted Diseases; Lentivirus Infections; Retroviridae Infections; Immunologic Deficiency Syndromes; Immune System Diseases; HIV Infections; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Antiviral Agents; Reverse Transcriptase Inhibitors; Nucleic Acid Synthesis Inhibitors; Enzyme Inhibitors; Anti-HIV Agents; Anti-Retroviral Agents; Protease Inhibitors; Cytochrome P-450 CYP3A Inhibitors; Cytochrome P-450 Enzyme Inhibitors; HIV Protease Inhibitors; Viral Protease Inhibitors; Tenofovir; Ritonavir; Lopinavir; Atazanavir Sulfate; Saquinavir
• Other Study ID Numbers: AI424-045