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Long-Term Effects of HAART in Youth With Stronger Immune Systems Versus Youth With Weaker Immune Systems

23 de abril de 2010 actualizado por: National Institute of Allergy and Infectious Diseases (NIAID)

Establishment and Maintenance of Long-Term Undetectable Plasma HIV-1 RNA: Correlation With Immunologic Reconstitution and Viral Dynamics

The purpose of this study is to see if children and young adults with better immune systems before starting highly active antiretroviral therapy (HAART) do better than those who have weaker immune systems before starting HAART.

HIV infection weakens the immune system's ability to fight other infections and diseases. HAART is a type of anti-HIV therapy shown to improve the immune system of adults. However, not all patients show the same amount of improvement with HAART. Doctors believe that results may depend on how strong a patient's immune system is before starting HAART. Long-term effects of HAART in children and young adults have not yet been studied.

Descripción general del estudio

Estado

Terminado

Condiciones

Descripción detallada

Recent adult clinical trials involving combination HAART, including a protease inhibitor (PI), have demonstrated improvements in somatic immune system functioning. [AS PER AMENDMENT 2/27/01: More recently, similar success has been demonstrated with a PI-sparing regimen, zidovudine, lamivudine, and efavirenz.] Not all individuals, however, experience the same level of immune reconstitution, and oftentimes any improvement is short-lived. Adolescent patients may have a greater potential for immune restoration because of residual thymic tissue and therefore may experience greater long-term virus-free states as compared to adult patients. This study examines the duration of virologic efficacy HAART has on the adolescent HIV-positive population.

Patients begin study by initiating a HAART regimen of a minimum of 3 drugs, at least 1 of which must be a PI [AS PER AMENDMENT 2/27/01: or efavirenz (EFV)]. A variety of drug combinations are used; therefore, patients are grouped according to the classes of drugs in their respective regimen (e.g., 2 nucleoside reverse transcriptase inhibitors [NRTIs] plus 1 PI; 2 NRTIs plus 2 PIs; 1 or 2 NRTIs plus 1 PI plus 1 nonnucleoside reverse transcriptase inhibitor [NNRTI] [AS PER AMENDMENT 2/27/01: ; and 2 NRTIs plus EFV]). At the time of HAART initiation, patients undergo immunologic and virologic assessments in order to determine baseline values. Then, to determine the virologic success or failure of HAART, HIV-1 RNA measurements are taken and compared to initial baseline values. Virologic success equals undetectable HIV-1 RNA at Week 12 [AS PER AMENDMENT 2/27/01: and confirmed at Week 16] or a significant (greater than 1 log) decrease in HIV-1 RNA from baseline to Week 12 [AS PER AMENDMENT 2/27/01: and confirmed undetectable HIV-1 RNA before the next scheduled visit (Week 24)]. Patients are followed for a minimum of 3 years of maintained viral suppression or until they have demonstrated virologic failure. From these values, any correlation that may exist between HIV-1 RNA values and HAART can be deduced. Patients with virologic failure on the initial HAART regimen may be allowed to change to a second HAART regimen. [AS PER AMENDMENT 2/27/01: Patients with virologic success on the second HAART regimen are followed for a minimum of 3 years.] Patients with virologic failure on the second HAART regimen or who voluntarily discontinue HAART are followed using an abbreviated schedule for 3 years.

Tipo de estudio

De observación

Inscripción

120

Contactos y Ubicaciones

Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.

Ubicaciones de estudio

  • Estados Unidos
    • Alabama
      • Birmingham, Alabama, Estados Unidos, 35233
        • Univ of Alabama at Birmingham - Pediatric
      • Mobile, Alabama, Estados Unidos, 36604
        • Univ of South Alabama
    • Arizona
      • Phoenix, Arizona, Estados Unidos, 85006
        • Phoenix Childrens Hosp
    • California
      • La Jolla, California, Estados Unidos, 920930672
        • UCSD Med Ctr / Pediatrics / Clinical Sciences
      • Los Angeles, California, Estados Unidos, 900276016
        • Children's Hosp of Los Angeles/UCLA Med Ctr
      • Los Angeles, California, Estados Unidos, 90033
        • Los Angeles County - USC Med Ctr
      • Los Angeles, California, Estados Unidos, 905022004
        • Harbor - UCLA Med Ctr / UCLA School of Medicine
    • Colorado
      • Denver, Colorado, Estados Unidos, 802181088
        • Children's Hosp of Denver
    • Connecticut
      • Farmington, Connecticut, Estados Unidos, 060303805
        • Connecticut Children's Med Ctr
    • District of Columbia
      • Washington, District of Columbia, Estados Unidos, 20060
        • Howard Univ Hosp
    • Florida
      • Fort Lauderdale, Florida, Estados Unidos, 33311
        • North Broward Hosp District
      • Gainesville, Florida, Estados Unidos, 32610
        • Univ of Florida Gainesville
      • Jacksonville, Florida, Estados Unidos, 32209
        • Univ of Florida Health Science Ctr / Pediatrics
      • Miami, Florida, Estados Unidos, 33161
        • Univ of Miami (Pediatric)
      • Riviera Beach, Florida, Estados Unidos, 33404
        • Palm Beach County Health Dept
    • Georgia
      • Atlanta, Georgia, Estados Unidos, 30306
        • Emory Univ Hosp / Pediatrics
    • Illinois
      • Chicago, Illinois, Estados Unidos, 60612
        • Cook County Hosp
      • Chicago, Illinois, Estados Unidos, 606143394
        • Chicago Children's Memorial Hosp
      • Chicago, Illinois, Estados Unidos, 606371470
        • Univ of Chicago Children's Hosp
      • Chicago, Illinois, Estados Unidos, 60612
        • Univ of Illinois College of Medicine / Pediatrics
    • Louisiana
      • New Orleans, Louisiana, Estados Unidos, 70112
        • Earl K Long Early Intervention Clinic
    • Massachusetts
      • Boston, Massachusetts, Estados Unidos, 021155724
        • Children's Hosp of Boston
      • Boston, Massachusetts, Estados Unidos, 02118
        • Boston City Hosp / Pediatrics
      • Springfield, Massachusetts, Estados Unidos, 01199
        • Baystate Med Ctr of Springfield
    • Michigan
      • Detroit, Michigan, Estados Unidos, 48201
        • Children's Hosp of Michigan
    • Mississippi
      • Jackson, Mississippi, Estados Unidos, 39213
        • Univ of Mississippi Med Ctr
    • New York
      • Bronx, New York, Estados Unidos, 10467
        • Montefiore Med Ctr Adolescent AIDS Program
      • Bronx, New York, Estados Unidos, 10457
        • Bronx Lebanon Hosp Ctr
      • Brooklyn, New York, Estados Unidos, 11203
        • SUNY - Brooklyn
      • Great Neck, New York, Estados Unidos, 11021
        • North Shore Univ Hosp
      • New Hyde Park, New York, Estados Unidos, 11040
        • Schneider Children's Hosp
      • New York, New York, Estados Unidos, 10016
        • Bellevue Hosp / New York Univ Med Ctr
      • New York, New York, Estados Unidos, 10032
        • Columbia Presbyterian Med Ctr
      • New York, New York, Estados Unidos, 10032
        • Incarnation Children's Ctr / Columbia Presbyterian Med Ctr
      • New York, New York, Estados Unidos, 10037
        • Harlem Hosp Ctr
      • Syracuse, New York, Estados Unidos, 13210
        • SUNY Health Sciences Ctr at Syracuse / Pediatrics
    • North Carolina
      • Durham, North Carolina, Estados Unidos, 277103499
        • Duke Univ Med Ctr
    • Pennsylvania
      • Philadelphia, Pennsylvania, Estados Unidos, 191044318
        • Children's Hosp of Philadelphia
    • Tennessee
      • Memphis, Tennessee, Estados Unidos, 381052794
        • Saint Jude Children's Research Hosp of Memphis
    • Texas
      • Dallas, Texas, Estados Unidos, 75235
        • Children's Med Ctr of Dallas
      • Houston, Texas, Estados Unidos, 77030
        • Texas Children's Hosp / Baylor Univ
    • Virginia
      • Norfolk, Virginia, Estados Unidos, 23507
        • Children's Hosp of the King's Daughters
    • Washington
      • Seattle, Washington, Estados Unidos, 981050371
        • Children's Hospital & Medical Center / Seattle ACTU
  • Puerto Rico
      • Bayamon, Puerto Rico, 00956
        • Ramon Ruiz Arnau Univ Hosp / Pediatrics
      • San Juan, Puerto Rico, 009367344
        • San Juan City Hosp
      • San Juan, Puerto Rico, 009365067
        • Univ of Puerto Rico / Univ Children's Hosp AIDS

Criterios de participación

Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.

Criterio de elegibilidad

Edades elegibles para estudiar

8 años a 22 años (Niño, Adulto)

Acepta Voluntarios Saludables

No

Géneros elegibles para el estudio

Todos

Descripción

Inclusion Criteria

Children may be eligible for this study if they:

  • Are HIV-positive.
  • Are between 8 and 22 years old (consent of parent or guardian required if under 18).
  • Have detectable levels of HIV in the blood within 30 days prior to study entry.
  • Expect to be on the study for at least 1 year. (This study has been changed by adding this requirement.)
  • Are pregnant and are not taking didanosine/stavudine (ddI/d4T) or EFV as part of their HAART regimen. (This study has been changed so that pregnant patients may be eligible if they are not taking ddI/d4T or EFV.)

Exclusion Criteria

Children will not be eligible for this study if they:

  • Are taking HAART or more than 1 anti-HIV drug.
  • Were infected with HIV before birth, at the time of delivery, or by a blood transfusion during birth.
  • Have taken part in the study before.
  • Have not responded well to HAART in the past.
  • Have taken drugs to boost the immune system such as HIV vaccines, IVIG, or cytokine therapy.
  • Have AIDS-related (opportunistic) infection at the time of screening. (This study has been changed so that patients with an AIDS-related infection are ineligible.)
  • Are pregnant and are taking ddI/d4T or EFV as part of their HAART regimen. (This study has been changed so that pregnant patients are ineligible if they are taking ddI/d4T or EFV.)

Plan de estudios

Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.

¿Cómo está diseñado el estudio?

Colaboradores e Investigadores

Aquí es donde encontrará personas y organizaciones involucradas en este estudio.

Patrocinador

National Institute of Allergy and Infectious Diseases (NIAID)

Colaboradores

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Investigadores

  • Silla de estudio: Patricia Flynn

Publicaciones y enlaces útiles

La persona responsable de ingresar información sobre el estudio proporciona voluntariamente estas publicaciones. Estos pueden ser sobre cualquier cosa relacionada con el estudio.

Publicaciones Generales

Fechas de registro del estudio

Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados ​​por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.

Fechas importantes del estudio

Inicio del estudio

1 de diciembre de 1997

Fechas de registro del estudio

Enviado por primera vez

2 de noviembre de 1999

Primero enviado que cumplió con los criterios de control de calidad

30 de agosto de 2001

Publicado por primera vez (Estimar)

31 de agosto de 2001

Actualizaciones de registros de estudio

Última actualización publicada (Estimar)

26 de abril de 2010

Última actualización enviada que cumplió con los criterios de control de calidad

23 de abril de 2010

Última verificación

1 de noviembre de 2005

Más información

Términos relacionados con este estudio

Palabras clave

Términos MeSH relevantes adicionales

Otros números de identificación del estudio

  • ACTG 381
  • PACTG 381

Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .

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