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Effectiveness of the Early Addition of Abacavir to an Anti-HIV Drug Combination

8 septembre 2008 mis à jour par: National Institute of Allergy and Infectious Diseases (NIAID)

A Pilot Study of Early Treatment Intensification of Antiretroviral Therapy

The purpose of this study is to see if adding 1 drug to an anti-HIV drug combination early in treatment against HIV can lower the viral load (amount of HIV in the blood) to a level so low that it cannot be measured (undetectable). The drug that will be added to a treatment is abacavir (ABC).

Many patients who take 3 anti-HIV drugs together are able to achieve very low viral loads, for example, viral loads below 50 copies/ml. However, some patients taking only 3 drugs are not able to achieve a viral load this low. Doctors hope that, by adding the drug ABC to a current treatment, a viral load below 50 copies/ml can be achieved. Doctors would like to find out if it is effective to start patients on 3 drugs and then add another drug (treatment intensification) if the treatment is not working as well as hoped.

Aperçu de l'étude

Statut

Complété

Les conditions

Intervention / Traitement

Description détaillée

Combination antiretroviral therapy can offer patients potent suppression of HIV replication and improved immunologic functioning. However, despite aggressive antiretroviral regimens currently in use, only about 50 to 60 percent of patients attain plasma viral loads below 50 copies/ml after 24 weeks. Initiating treatment with a 4-drug regimen may increase this percentage, but this may also contribute to patient non-adherence, drug-related toxicities, potential cross-resistance to drugs used in future regimens, and high financial costs. Another strategy is early intensification (adding a single drug to an existing regimen) in patients who are at risk for attaining incomplete viral suppression after 24 weeks of therapy. ABC may produce a significant antiviral effect when used as an intensification agent in patients on a stable antiretroviral regimen. The results of this study will offer insight into the potential benefits of early treatment intensification.

Patients entering this study will have initiated potent antiretroviral therapy. Between 60 and 90 days [AS PER AMENDMENT 1/9/01: 60 and 104 days] after beginning their background regimen, patients are randomized to add either ABC (Arm A) or a matching placebo (Arm B) for 12 weeks. Patients completing 12 weeks of treatment continue on study for an additional 24 weeks to Week 36. Patients discontinue treatment if virologic failure occurs at any time. Patients still return to the clinic for HIV-1 RNA measurements at Weeks 12 and 36, depending on when discontinuation occurred. Patients who discontinue treatment at or after Week 12 due to virologic failure are offered open-label ABC for the remainder of the study (through Week 36). Blood samples are collected at Weeks 4, 8, 12, 20, 28, and 36. Plasma samples for population sequencing of HIV-1 PR and RT genes are collected on all patients at study entry and at the time of virologic failure. Baseline genotype (presence or absence of PR and RT resistance mutations and number of resistance mutations) is correlated to treatment outcome. Samples from the time of failure are analyzed for the accumulation of additional resistance mutations. [AS PER AMENDMENT 5/5/00: Patients and their primary care physicians will be unblinded to the patient's treatment after the study is completed at Week 36 or if virologic failure occurs at or after Week 12 [AS PER AMENDMENT 1/9/01: or if ABC hypersensitivity is suspected].]

Type d'étude

Interventionnel

Inscription

80

Phase

  • Phase 2

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Lieux d'étude

  • Porto Rico
      • San Juan, Porto Rico, 009365067
        • Univ of Puerto Rico
  • États-Unis
    • California
      • Los Angeles, California, États-Unis, 90095
        • UCLA CARE Ctr
      • Menlo Park, California, États-Unis, 94025
        • Willow Clinic
      • San Jose, California, États-Unis, 951282699
        • Santa Clara Valley Med Ctr / AIDS Community Rsch Consortium
      • Stanford, California, États-Unis, 943055107
        • San Mateo AIDS Program / Stanford Univ
      • Stanford, California, États-Unis, 943055107
        • Stanford Univ Med Ctr
      • Torrance, California, États-Unis, 90502
        • Harbor UCLA Med Ctr
    • Colorado
      • Denver, Colorado, États-Unis, 80262
        • Univ of Colorado Health Sciences Ctr
    • Florida
      • Miami, Florida, États-Unis, 331361013
        • Univ of Miami School of Medicine
    • Georgia
      • Atlanta, Georgia, États-Unis, 30308
        • Emory Univ
    • Illinois
      • Chicago, Illinois, États-Unis, 60611
        • Northwestern Univ Med School
      • Chicago, Illinois, États-Unis, 60612
        • Cook County Hosp
    • Maryland
      • Baltimore, Maryland, États-Unis, 21287
        • Johns Hopkins Hosp
      • Baltimore, Maryland, États-Unis, 212052196
        • State of MD Div of Corrections / Johns Hopkins Univ Hosp
    • Missouri
      • St Louis, Missouri, États-Unis, 63112
        • St Louis Regional Hosp / St Louis Regional Med Ctr
    • New York
      • Buffalo, New York, États-Unis, 14215
        • SUNY / Erie County Med Ctr at Buffalo
      • New York, New York, États-Unis, 10003
        • Beth Israel Med Ctr
      • New York, New York, États-Unis, 10016
        • Bellevue Hosp / New York Univ Med Ctr
      • New York, New York, États-Unis, 10032
        • Columbia Presbyterian Med Ctr
      • New York, New York, États-Unis, 10021
        • Aaron Diamond AIDS Rsch Ctr / Rockefeller Univ
      • Rochester, New York, États-Unis, 14642
        • Univ of Rochester Medical Center
    • North Carolina
      • Chapel Hill, North Carolina, États-Unis, 275997215
        • Univ of North Carolina
      • Durham, North Carolina, États-Unis, 27710
        • Duke Univ Med Ctr
    • Ohio
      • Cincinnati, Ohio, États-Unis, 452670405
        • Univ of Cincinnati
    • Pennsylvania
      • Philadelphia, Pennsylvania, États-Unis, 19104
        • Univ of Pennsylvania at Philadelphia
      • Philadelphia, Pennsylvania, États-Unis, 19104
        • Philadelphia Veterans Administration Med Ctr
    • South Carolina
      • West Columbia, South Carolina, États-Unis, 29169
        • Julio Arroyo
    • Tennessee
      • Nashville, Tennessee, États-Unis, 37203
        • Vanderbilt Univ Med Ctr
    • Texas
      • Dallas, Texas, États-Unis, 75390
        • Univ of Texas, Southwestern Med Ctr of Dallas
    • Washington
      • Seattle, Washington, États-Unis, 98104
        • Univ of Washington

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

13 ans et plus (Enfant, Adulte, Adulte plus âgé)

Accepte les volontaires sains

Non

Sexes éligibles pour l'étude

Tout

La description

Inclusion Criteria

Patients may be eligible for this study if they:

  • Are HIV-positive.
  • Have been taking anti-HIV therapy that includes at least 3 anti-HIV drugs and is an acceptable anti-HIV drug combination for 60 to 104 days before study treatment. Patients must not have changed any of the drugs in the 28 days before study entry. (This study has been changed by extending the number of days that anti-HIV therapy has been received.)
  • Have a viral load greater than 500 but less than or equal to 10,000 copies/ml and have had a significant decrease in viral load between 49 and 84 days after starting this anti-HIV therapy. (This study has been changed by extending the length of time of viral load decrease.)
  • Are at least 13 years old (consent of parent or guardian required if under 18).
  • Agree to practice abstinence or use barrier method of birth control (such as condoms) during the study and for 3 months after.

Exclusion Criteria

Patients will not be eligible for this study if they:

  • Have ever taken ABC.
  • Have received anti-HIV therapy for more than 104 days in the past. (This study has been changed by extending the number of days that anti-HIV therapy has been received.)
  • Have a fever for 7 days in the 30 days before study entry.
  • Have cancer, including Kaposi's sarcoma, that requires chemotherapy.
  • Have an active infection that requires treatment in the 21 days before study entry.
  • Have any opportunistic (AIDS-related) infection or disease that requires a change in medication in the 14 days before study entry.
  • Have any medical condition or history of an illness that the doctor feels would place them at risk or make them unable to complete the study.
  • Are taking drugs that affect the immune system or any experimental anti-HIV drugs, except for their current drug combination.
  • Are taking St. John's wort. (This study has been changed. Previously, patients taking St. John's wort were eligible.)
  • Have received a vaccine in the 21 days before study entry.
  • Are pregnant or breast-feeding.

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: Traitement
  • Masquage: Double

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Parrainer

National Institute of Allergy and Infectious Diseases (NIAID)

Les enquêteurs

  • Chaise d'étude: Pablo Tebas
  • Chaise d'étude: John Bartlett

Publications et liens utiles

La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.

Publications générales

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude

1 novembre 1999

Achèvement de l'étude

1 avril 2001

Dates d'inscription aux études

Première soumission

17 janvier 2000

Première soumission répondant aux critères de contrôle qualité

30 août 2001

Première publication (Estimation)

31 août 2001

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Estimation)

9 septembre 2008

Dernière mise à jour soumise répondant aux critères de contrôle qualité

8 septembre 2008

Dernière vérification

1 juin 2003

Plus d'information

Termes liés à cette étude

Mots clés

Termes MeSH pertinents supplémentaires

Autres numéros d'identification d'étude

  • ACTG A5064
  • AACTG A5064

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .

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Conditions

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Commanditaire / collaborateurs

Emplacements

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