CD4 Cell Recovery in HIV-1 Patients Comparing 2 Treatment Regimes
Phase 3, Single Center, Controlled, Investigator-blinded, Randomized Matched Pair Design Study of CD4 Cell Recovery in HIV-1 Patients With Sustained Virologic Response Comparing Protease Inhibitor and Non-nucleoside Reverse Transcriptase Inhibitor Based Treatment Regimes
Therapy guidelines recommend the use of either the non-nucleoside reverse transcriptase inhibitor (NNRTI) efavirenz or a ritonavir-boostered protease inhibitor (PI) plus 2 nucleoside reverse transcriptase inhibitors (NRTI) as first-line treatment regimes of HIV-1 infection. Recent clinical studies suggest potential advantages of NNRTI- over PI-based regimes in therapy initiation due to lower rates of virologic failure and less metabolic side-effects. In contrast, PI regimes were claimed to cause greater increases in CD4 cell count than NNRTI regimes, which has been attributed to intrinsic antiapoptotic effects of the PI. However, it is still unclear whether the immunological response to a PI-containing regime is greater than to an NNRTI-containing regime, whether there is a difference in the extent of reduction of apoptosis between PI and NNRTI regimes and whether a difference in apoptosis is associated with a difference in CD4 cell recovery.
We conducted a controlled, long-term, random matched pair design study in HIV-1 infected individuals under sustained virologic suppression to evaluate in head-to-head comparison the clinical effects of a constant PI-based or NNRTI-based regime on CD4 cell recovery and the underlying molecular, biochemical and functional mechanisms.
研究概览
地位
条件
研究类型
注册 (实际的)
阶段
- 第三阶段
联系人和位置
学习地点
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Cologne、德国
- Medical Clinic I and Department of Pharmacology, University of Cologne
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Recent, non-acute HIV-1 infection
- Caucasians
- BMI between 17.5 and 30 kg/m2
- CD4 count <200 cells/µl
- Plasma viral load >100,000 HIV-1 RNA copies/ml
Exclusion Criteria:
- Actual or previous antiretroviral therapy
- Acute illness
- Coinfection with HBV or HCV
- Opportunistic infection (Pneumocystis jiroveci pneumonia, Toxoplasma gondii encephalitis, Mycobacterium ssp. infection, syphilis, cryptosporidiosis, cryptococcosis, aspergillosis, cytomegalovirus infection or progressive multifocal leukoencephalopathy)
- Hepatic or renal disorder
- Severe cardiovascular disease
- Hematologic disorder
- Autoimmune disorder
- Diabetes mellitus or other severe endocrine disorder
- Malignancy
- Neurocognitive disorder
- Psychiatric disorder
- Drug or alcohol addiction
- Chronic drug use (except of blood pressure-lowering or lipid-lowering drugs or proton-pump inhibitors)
- Any acute medication within 7 days or vaccination within 30 days prior to entry
- Pregnancy or lactation
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:单身的
武器和干预
参与者组/臂 |
干预/治疗 |
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有源比较器:PI
400 mg lopinavir and 100 mg ritonavir (Kaletra capsules, Abbott Laboratories) twice daily plus 150 mg lamivudine (Epivir tablets, GlaxoSmithKline) and 300 mg zidovudine (Retrovir tablets, GlaxoSmithKline) twice daily over a 56-week run-in and a 420-week follow-up
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400 mg lopinavir and 100 mg ritonavir (Kaletra capsules, Abbott Laboratories) twice daily plus 150 mg lamivudine (Epivir tablets, GlaxoSmithKline) and 300 mg zidovudine (Retrovir tablets, GlaxoSmithKline) twice daily over 476 weeks
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有源比较器:NNRTI
600 mg efavirenz (Sustiva tablets, Bristol-Myers Squibb) once daily plus 150 mg lamivudine (Epivir tablets, GlaxoSmithKline) and 300 mg zidovudine (Retrovir tablets, GlaxoSmithKline) twice daily over a 56-week run-in and a 420-week follow-up
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600 mg efavirenz (Sustiva tablets, Bristol-Myers Squibb) once daily plus 150 mg lamivudine (Epivir tablets, GlaxoSmithKline) and 300 mg zidovudine (Retrovir tablets, GlaxoSmithKline) twice daily over 476 weeks
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研究衡量的是什么?
主要结果指标
结果测量 |
大体时间 |
---|---|
Difference in changes of CD4 cell count between PI and NNRTI groups
大体时间:420 weeks
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420 weeks
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次要结果测量
结果测量 |
大体时间 |
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Evolution of CD4 cell counts
大体时间:420 weeks
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420 weeks
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Molecular, biochemical and functional markers of CD4 cell apoptosis
大体时间:420 weeks
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420 weeks
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合作者和调查者
调查人员
- 研究主任:Dirk Taubert, MD PhD、Department of Pharmacology, University of Cologne, Germany
出版物和有用的链接
一般刊物
- Staszewski S, Morales-Ramirez J, Tashima KT, Rachlis A, Skiest D, Stanford J, Stryker R, Johnson P, Labriola DF, Farina D, Manion DJ, Ruiz NM. Efavirenz plus zidovudine and lamivudine, efavirenz plus indinavir, and indinavir plus zidovudine and lamivudine in the treatment of HIV-1 infection in adults. Study 006 Team. N Engl J Med. 1999 Dec 16;341(25):1865-73. doi: 10.1056/NEJM199912163412501.
- Riddler SA, Haubrich R, DiRienzo AG, Peeples L, Powderly WG, Klingman KL, Garren KW, George T, Rooney JF, Brizz B, Lalloo UG, Murphy RL, Swindells S, Havlir D, Mellors JW; AIDS Clinical Trials Group Study A5142 Team. Class-sparing regimens for initial treatment of HIV-1 infection. N Engl J Med. 2008 May 15;358(20):2095-106. doi: 10.1056/NEJMoa074609.
- Badley AD, Pilon AA, Landay A, Lynch DH. Mechanisms of HIV-associated lymphocyte apoptosis. Blood. 2000 Nov 1;96(9):2951-64.
研究记录日期
研究主要日期
学习开始
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (估计)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
关键字
其他相关的 MeSH 术语
- RNA 病毒感染
- 病毒病
- 感染
- 血源性感染
- 传染病
- 性传播疾病,病毒
- 性病
- 慢病毒感染
- 逆转录病毒科感染
- 免疫系统疾病
- 慢病毒病
- 艾滋病毒感染
- 获得性免疫缺陷综合症
- 免疫缺陷综合症
- 药理作用的分子机制
- 抗感染药
- 抗病毒药物
- 逆转录酶抑制剂
- 核酸合成抑制剂
- 酶抑制剂
- 抗艾滋病药物
- 抗逆转录病毒药物
- 抗代谢物
- 蛋白酶抑制剂
- 细胞色素 P-450 CYP3A 抑制剂
- 细胞色素 P-450 酶抑制剂
- 细胞色素 P-450 酶诱导剂
- 细胞色素 P-450 CYP3A 诱导剂
- HIV 蛋白酶抑制剂
- 病毒蛋白酶抑制剂
- 细胞色素 P-450 CYP2B6 诱导剂
- 细胞色素 P-450 CYP2C9 抑制剂
- 细胞色素 P-450 CYP2C19 抑制剂
- 利托那韦
- 洛匹那韦
- 拉米夫定
- 齐多夫定
- 依法韦仑
- 拉米夫定、齐多夫定药物组合
其他研究编号
- HIV-1999-LRE
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