A Multicentre Trial of Second-line Antiretroviral Treatment Strategies in African Adults Using Atazanavir or Lopinavir/Ritonavir (ALISA)
A Multicenter Phase III Trial of Second-line Antiretroviral Treatment Strategies in African Adults (Tanzania Ans South Africa) Using Atazanavir or Lopinavir/Ritonavir
In the well recognized context of HIV infection chronicity, it is now crucial to identify and evaluate effective, well tolerated and affordable second line regimen in resources limited countries where patients often change treatment after a long period of viral replication while on first line regimen.
This multicentre international, randomized, non-blinded phase III trial aim to demonstrate the non-inferiority of a generic lamivudine-tenofovir-atazanavir/ritonavir regimen (daily intake) as compared to a standard emtricitabine-tenofovir-lopinavir/ritonavir (twice daily intake)regimen for second line HIV-1 treatment. by stratifying on the viral load level (between 1000 and 5000 copies/mL versus > 5000 copies/mL) at inclusion, this trial will also allow to evaluate the optimum moment for instituting the second-line treatment.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Fase
Fase
- Fase 3
Kontakter og lokationer
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- age 18 and above
- out patient
- documented HIV-1 infection
first line treatment failure:
- after first-line antiretroviral treatment with a combination including a non-nucleoside reverse transcriptase inhibitor and two nucleoside reverse transcriptase inhibitors
- two measurements of plasma HIV RNA levels > 1000 copies/mL after at least 6 months of uninterrupted treatment or without any major modification
- satisfactory compliance (>80%) to 1st line antiretroviral treatment
- signed informed consent
- agreement for contraception for women of childbearing age
Exclusion Criteria:
- HIV-2 infection or HIV-1/HIV-2 coinfection
- uncontrolled, ongoing opportunistic infection or of any severe or progressive disease including active TB
- first line antiretroviral treatment with a protease inhibitor or tenofovir
- ongoing treatment with rifampicin
- severe hepatic insufficiency (PT < 50%)
- ALT < 3 times the upper limit of normal
- creatinine clearance calculated by Cockcroft's formula < 50 mL/min
- Hb <=8 g/dL; platelets < 50,000 cells/mm3; neutrophils < 500 cells/mm3
- pregnancy and lactation
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Aktiv komparator: Arm A : Lopinavir
Emtricitabine/tenofovir :
Lopinavir/ritonavir :
|
Evaluation of second line antiretroviral regimen including boosted lopinavir
|
|
Eksperimentel: Arm B : Atazanavir
Lamivudine/tenofovir :
Atazanavir/ritonavir :
|
Evaluation of second line antiretroviral regimen including boosted atazanavir
|
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Virological response
Tidsramme: 48 weeks
|
Proportion of patients with plasma HIV RNA < 50 copies/mL
|
48 weeks
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Virological response
Tidsramme: 12 and 24 weeks
|
Proportion of patients with plasma HIV RNA < 400 copies/mL
|
12 and 24 weeks
|
|
Viral resistance
Tidsramme: 12, 24 and 48 weeks
|
Incidence of resistance mutations after treatment failure (HIV RNA < 1000 copies/mL)
|
12, 24 and 48 weeks
|
|
Clinical course of HIV infection
Tidsramme: Up to 48 weeks
|
Mortality, occurence of clinical events stage 3 or 4 (WHO classification), immune reconstitution sundrome, non-AIDS clinical events including bacterial infections
|
Up to 48 weeks
|
|
Tolerance assessment
Tidsramme: 24 and 48 weeks
|
Proportion of adverse events related to antiretroviral treatment, proportion of treatement discontinuations due to antiretroviral side effect, variation of biological parameters and metabolic markers between second line antiretroviral initiation and 24/48 weeks.
|
24 and 48 weeks
|
|
Adherence assessment
Tidsramme: At each protocol visit : week 2, 4, 12, 24, 36 and 48
|
Measurement of pills consumption at each visit, face-to-face questionnaire with the pharmacist
|
At each protocol visit : week 2, 4, 12, 24, 36 and 48
|
|
Hepatitis B evaluation
Tidsramme: At entry
|
Prevalence of HBs AG, HBe Ag, HBV viremia, and HBV asociated drug resistance mutations at baseline
|
At entry
|
|
Immunologic response
Tidsramme: 24 and 48 weeks
|
Variation of circulating total and CD4+ lymphocyte count between second line treatment initiation and 24 weeks/48 weeks
|
24 and 48 weeks
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Efterforskere
Efterforskere
- Ledende efterforsker: Eric Delaporte, Institut de Recherche pour le Developpement, France
- Ledende efterforsker: Issakwisa Mwakyula, NIMR-Mbeya Medical Research Program-Mbeya Referral Hospital, Tanzania
- Ledende efterforsker: Mzileni O Mogiyana, University of Limpopo
- Ledende efterforsker: Alexandra Calmy, University of Geneva, Switzerland
Datoer for undersøgelser
Studer store datoer
Studiestart
Studiestart
Primær færdiggørelse (Forventet)
Primær færdiggørelse
Studieafslutning (Forventet)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Skøn)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Skøn)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- ANRS 12221 ALISA
- IP.07.33011.004 (Andet bevillings-/finansieringsnummer: EDCTP)
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
Studerer et amerikansk FDA-reguleret lægemiddelprodukt
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