CClinicalTrials.gg
CompletedNCT00000781Updated Nov 4, 2021

A Randomized, Double-Blind, Four-Arm Study Comparing Combination Nucleoside, Alternating Nucleoside, and Triple-Drug Therapy for the Treatment of Advanced HIV Disease (CD4 <= 50/mm3)

A Phase 2 interventional study of Nevirapine and Zidovudine in HIV Infections, sponsored by National Institute of Allergy and Infectious Diseases (NIAID). Completed at 96 sites in 2 countries. Open to participants aged 13 Years and older. Per ClinicalTrials.gov, last updated 2021-11-04.

Sponsored by National Institute of Allergy and Infectious Diseases (NIAID) · Phase 2, Interventional, and Treatment

Phase
Phase 2
Study type
Interventional
Enrollment
1,292
Ages
13 Years and older
Sex
All
01

Study summary

To determine the relative clinical efficacy of zidovudine ( AZT ) plus didanosine (ddI), AZT plus zalcitabine ( ddC ), AZT alternating monthly with ddI, and AZT/ddI plus nevirapine in HIV-infected patients with advanced disease.

The rapid emergence of resistant HIV strains has been observed in patients receiving monotherapy with a nucleoside analog or non-nucleoside reverse transcriptase inhibitor. Use of combination therapy with two nucleoside drugs or convergent combination therapy with two nucleosides and a non-nucleoside RT inhibitor may minimize the evolution of these resistant HIV strains. Since toxicity is a major problem in patients with advanced disease who are receiving combination nucleoside therapy, alternating the two drugs may provide a way of retaining several benefits of combination therapy while minimizing the increased toxicity.

Read the detailed description

The rapid emergence of resistant HIV strains has been observed in patients receiving monotherapy with a nucleoside analog or non-nucleoside reverse transcriptase inhibitor. Use of combination therapy with two nucleoside drugs or convergent combination therapy with two nucleosides and a non-nucleoside RT inhibitor may minimize the evolution of these resistant HIV strains. Since toxicity is a major problem in patients with advanced disease who are receiving combination nucleoside therapy, alternating the two drugs may provide a way of retaining several benefits of combination therapy while minimizing the increased toxicity.

Patients are randomized to receive either AZT/ddC, AZT/ddI, AZT alternating monthly with ddI, or AZT/ddI/nevirapine. Patients are evaluated at week 0 and every 4 weeks thereafter for 2 years. Pharmacologic, virologic, and macroneurologic substudies will be conducted. Patients who are already enrolled on protocol ACTG 193 will be given the option of continuing on their originally assigned ACTG 193 therapy for an additional 6 months or undergoing re-randomization to one of the four treatment arms on ACTG 193A.

02

Conditions studied

  • HIV Infections

Keywords

  • Zalcitabine
  • Didanosine
  • Drug Therapy, Combination
  • Acquired Immunodeficiency Syndrome
  • Zidovudine
  • Nevirapine
03

In context

HIV Infections

4,258 studies on the registry are indexed under HIV Infections; 240 are open to participants now.

This study's enrollment of 1,292 is above the median of 83 across 3,251 interventional studies indexed under HIV Infections.

Browse HIV Infections studies →

Lead sponsor

National Institute of Allergy and Infectious Diseases (NIAID) is the lead sponsor of 2,401 studies on the registry; 179 are open to participants now.

Of its 396 completed or terminated interventional studies of FDA-regulated products, 294 (74%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
13 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

Concurrent Medication:

Required:

  • PCP prophylaxis.

Allowed:

  • Erythropoietin maintenance.
  • G-CSF and GM-CSF.
  • Prophylaxis for Mycobacterium avium intracellulare.
  • Antifungal prophylaxis or treatment with specific drugs.
  • Maintenance therapy for opportunistic infection.
  • Over-the-counter medications or alternative therapies such as vitamins and herbs.
  • Antibiotics as clinically indicated.
  • Steroids for \< 21 days for acute problems.
  • Antipyretics, analgesics, allergy medication, antidepressants, sleep medications, oral contraceptives, or other appropriate medications.

Concurrent Treatment:

Allowed:

  • Radiation therapy for cutaneous Kaposi's sarcoma.
  • Acupuncture.

Patients must have:

  • Documented HIV infection.
  • CD4 count \<= 50 cells/mm3.
  • Either no prior nucleoside therapy OR a history of prior nucleoside therapy in the absence of high-grade intolerance.
  • Life expectancy of at least 6 months.
  • Consent of parent or guardian if \< 18 years of age.
  • Normal chest x-ray at baseline or within 6 months prior to study entry in the absence of new pulmonary or cardiac symptoms (per 12/28/94 amendment).

NOTE:

  • Patients who withdrew from protocol ACTG 193 therapy prior to activation of ACTG 193A are not eligible.

Exclusion criteria

Exclusion Criteria

Co-existing Condition:

Patients with the following symptoms or conditions are excluded:

  • Abnormal baseline chest x-ray.
  • New pulmonary or cardiac symptoms.
  • Psychological or emotional problems sufficient to prevent compliance with study medication.

Concurrent Medication:

Excluded:

  • Systemic chemotherapy for malignancy.
  • Acute or induction therapy for opportunistic infection.
  • Antiretroviral drugs other than study drugs.
  • Biological response modifiers.
  • Erythromycin, phenytoin, phenobarbital, warfarin, or coumadin.

Patients with the following prior conditions are excluded:

  • History of recurrent grade 3 or greater toxicity to AZT, ddI, or ddC on two or more occasions.
  • Evidence of active pulmonary disease within 6 months prior to study entry.
  • History of grade 3 or worse peripheral neuropathy.
  • History of acute or chronic pancreatitis.

Prior Medication:

Excluded:

  • Prior nevirapine.

Excluded within 7 days prior to study entry:

  • Acute therapy for opportunistic infection (maintenance therapy is permitted).
  • Acute systemic therapy for a nonopportunistic infection or other medical condition.
  • Antiretroviral drugs other than AZT, ddI, or ddC.
  • Biological response modifiers.
  • d4T therapy.
  • Nucleosides other than those used in the study.
  • Antibiotics containing clavulanate potassium.

Prior Treatment:

Excluded:

  • More than 4 units of blood in a 30-day period.

Active alcohol or drug abuse.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Masking
Double
Enrollment
1,292 participants

Interventions

  • DrugNevirapine
  • DrugZidovudine
  • DrugZalcitabine
  • DrugDidanosine
06

Study locations

96 sites
  • Univ of Alabama at Birmingham
    Birmingham, Alabama 35294, United States
  • Children's Hosp of Los Angeles
    Los Angeles, California 90027, United States
  • Univ of Southern California / LA County USC Med Ctr
    Los Angeles, California 900331079, United States
  • Huntington Memorial Hosp / Children's Hosp of Los Angeles
    Pasadena, California 91105, United States
  • Univ of California / San Diego Treatment Ctr
    San Diego, California 921036325, United States
  • San Francisco AIDS Clinic / San Francisco Gen Hosp
    San Francisco, California 941102859, United States
  • San Francisco Gen Hosp
    San Francisco, California 941102859, United States
  • Stanford at Kaiser / Kaiser Permanente Med Ctr
    San Francisco, California 94115, United States
  • Santa Clara Valley Med Ctr / AIDS Community Rsch Consortium
    San Jose, California 951282699, United States
  • San Mateo AIDS Program / Stanford Univ
    Stanford, California 943055107, United States
  • Stanford Univ Med Ctr
    Stanford, California 943055107, United States
  • Olive View Med Ctr
    Sylmar, California 91342, United States
  • Harbor UCLA Med Ctr
    Torrance, California 90502, United States
  • Denver Dept of Health and Hosps
    Denver, Colorado 80262, United States
  • Mountain States Reg Hemo Ctr / Univ of Colorado
    Denver, Colorado 80262, United States
  • Rose Med Ctr
    Denver, Colorado 80262, United States
  • Univ of Colorado Health Sciences Ctr
    Denver, Colorado 80262, United States
  • Yale Univ / New Haven
    New Haven, Connecticut 065102483, United States
  • HIV Ctr - District of Columbia Gen Hosp
    Washington, District of Columbia 200072197, United States
  • Whitman - Walker Clinic / Georgetown Univ Med Ctr
    Washington, District of Columbia 200072197, United States
  • Georgetown Univ Med Ctr
    Washington, District of Columbia 20007, United States
  • George Washington Univ / Hershey Med Ctr
    Washington, District of Columbia 20037, United States
  • Howard Univ
    Washington, District of Columbia 20059, United States
  • Univ of Miami School of Medicine
    Miami, Florida 331361013, United States
  • Univ of South Florida
    Tampa, Florida 33612, United States
  • Univ of Hawaii
    Honolulu, Hawaii 96816, United States
  • Northwestern Univ Med School
    Chicago, Illinois 60611, United States
  • Cook County Hosp
    Chicago, Illinois 60612, United States
  • Rush Presbyterian - Saint Luke's Med Ctr
    Chicago, Illinois 60612, United States
  • Louis A Weiss Memorial Hosp
    Chicago, Illinois 60640, United States
  • Indiana Univ Hosp
    Indianapolis, Indiana 462025250, United States
  • Methodist Hosp of Indiana / Life Care Clinic
    Indianapolis, Indiana 46202, United States
  • Univ of Louisville / East Tennesee Comprehensive Hem Ctr
    Louisville, Kentucky 40202, United States
  • Harvard (Massachusetts Gen Hosp)
    Boston, Massachusetts 02114, United States
  • Boston Med Ctr
    Boston, Massachusetts 02118, United States
  • Beth Israel Deaconess - West Campus
    Boston, Massachusetts 02215, United States
  • Worcester Memorial Hosp / Med Ctr of Cntrl MA-Memorial
    Worcester, Massachusetts 01605, United States
  • Hennepin County Med Clinic
    Minneapolis, Minnesota 55415, United States
  • Univ of Minnesota
    Minneapolis, Minnesota 55455, United States
  • St Paul Ramsey Med Ctr
    Saint Paul, Minnesota 55101, United States
  • St Louis Regional Hosp / St Louis Regional Med Ctr
    Saint Louis, Missouri 63112, United States
  • Univ of Nebraska Med Ctr
    Omaha, Nebraska 681985130, United States
  • Dartmouth - Hitchcock Med Ctr / Med Ctr Cntrl Massachusetts
    Lebanon, New Hampshire 03756, United States
  • Robert Wood Johnson Med School / Hershey Med Ctr
    New Brunswick, New Jersey 08903, United States
  • Univ of Medicine & Dentistry of New Jersey / Univ Hosp
    Newark, New Jersey 071032714, United States
  • Adirondack Med Ctr at Saranac Lake
    Albany, New York 122083479, United States
  • Albany Med College / Division of HIV Medicine A158
    Albany, New York 122083479, United States
  • Mid - Hudson Care Ctr
    Albany, New York 122083479, United States
  • Bronx Municipal Hosp Ctr/Jacobi Med Ctr
    Bronx, New York 10461, United States
  • Comprehensive Health Care Ctr / Bronx Municipal Hosp
    Bronx, New York 10461, United States
  • Montefiore Drug Treatment Ctr / Bronx Municipal Hosp
    Bronx, New York 10461, United States
  • Montefiore Family Health Ctr / Bronx Municipal Hosp
    Bronx, New York 10461, United States
  • Samaritan Village Inc / Bronx Municipal Hosp
    Bronx, New York 10461, United States
  • Jack Weiler Hosp / Bronx Municipal Hosp
    Bronx, New York 10465, United States
  • Montefiore Med Ctr / Bronx Municipal Hosp
    Bronx, New York 10467, United States
  • Montefiore Med Ctr Adolescent AIDS Program
    Bronx, New York 10467, United States
  • North Central Bronx Hosp / Bronx Municipal Hosp
    Bronx, New York 10467, United States
  • Bronx Veterans Administration / Mount Sinai Hosp
    Bronx, New York 10468, United States
  • SUNY / Health Sciences Ctr at Brooklyn
    Brooklyn, New York 112032098, United States
  • SUNY / Erie County Med Ctr at Buffalo
    Buffalo, New York 14215, United States
  • City Hosp Ctr at Elmhurst / Mount Sinai Hosp
    Elmhurst, New York 11373, United States
  • North Shore Univ Hosp
    Manhasset, New York 11030, United States
  • Beth Israel Med Ctr
    New York, New York 10003, United States
  • Bellevue Hosp / New York Univ Med Ctr
    New York, New York 10016, United States
  • Saint Clare's Hosp and Health Ctr
    New York, New York 10019, United States
  • Cornell Univ Med Ctr
    New York, New York 10021, United States
  • Mem Sloan - Kettering Cancer Ctr
    New York, New York 10021, United States
  • Mount Sinai Med Ctr / Hemophilia Treatment Ctr
    New York, New York 10029, United States
  • Mount Sinai Med Ctr
    New York, New York 10029, United States
  • Columbia Presbyterian Med Ctr
    New York, New York 100323784, United States
  • Harlem Hosp Ctr
    New York, New York 10037, United States
  • Univ of Rochester Medical Center
    Rochester, New York 14642, United States
  • SUNY / State Univ of New York
    Syracuse, New York 13210, United States
  • Univ of North Carolina
    Chapel Hill, North Carolina 275997215, United States
  • Moses H Cone Memorial Hosp
    Greensboro, North Carolina 27401, United States
  • Univ of Cincinnati
    Cincinnati, Ohio 452670405, United States
  • Univ of Kentucky Lexington
    Cincinnati, Ohio 45267, United States
  • Case Western Reserve Univ
    Cleveland, Ohio 44106, United States
  • MetroHealth Med Ctr
    Cleveland, Ohio 441091998, United States
  • Columbus Children's Hosp
    Columbus, Ohio 432052696, United States
  • Med College of Ohio
    Toledo, Ohio 43699, United States
  • Milton S Hershey Med Ctr
    Hershey, Pennsylvania 170330850, United States
  • Saint Michael's Med Ctr / Milton S Hershey Med Ctr
    Hershey, Pennsylvania 170330850, United States
  • Girard Med Ctr
    Philadelphia, Pennsylvania 191046073, United States
  • Univ of Pennsylvania at Philadelphia
    Philadelphia, Pennsylvania 19104, United States
  • Thomas Jefferson Univ Hosp
    Philadelphia, Pennsylvania 191075098, United States
  • Med Univ of South Carolina / UNC
    Charleston, South Carolina 29425, United States
  • Julio Arroyo
    West Columbia, South Carolina 29169, United States
  • Univ of Tennessee / E Tennessee Comprehensive Hemophilia Ctr
    Knoxville, Tennessee 37920, United States
  • Meharry Med College
    Nashville, Tennessee 37203, United States
  • Univ of Texas Galveston
    Galveston, Texas 775550435, United States
  • Univ Texas Health Science Ctr / Univ Texas Med School
    Houston, Texas 77030, United States
  • Univ of Washington
    Seattle, Washington 981224304, United States
  • Northern Wisconsin Hemophilia Ctr / Saint Vincent's Hosp
    Green Bay, Wisconsin 54301, United States
  • Great Lakes Hemophilia Foundation
    Wauwatosa, Wisconsin 532130127, United States
  • Univ of Puerto Rico
    San Juan, 009365067, Puerto Rico
07

References and documents

Publications

  • Henry K, Erice A, Tierney C, Balfour HH Jr, Fischl MA, Kmack A, Liou SH, Kenton A, Hirsch MS, Phair J, Martinez A, Kahn JO. A randomized, controlled, double-blind study comparing the survival benefit of four different reverse transcriptase inhibitor therapies (three-drug, two-drug, and alternating drug) for the treatment of advanced AIDS. AIDS Clinical Trial Group 193A Study Team. J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Dec 1;19(4):339-49. doi: 10.1097/00042560-199812010-00004. PubMed 9833742 ↗
  • Price RW, Yiannoutsos C, Zaborski L, Kmack A, Henry K, Tierney C, Clifford D. Neurological substudies of ACTG protocol 193A: quantitative neurological performance measures and treatment outcomes. Conf Retroviruses Opportunistic Infect. 1998 Feb 1-5;5th:176 (abstract no 516)
  • Robinson P, Cotton D, Curry R, Henry K, Hall D, Myers M. Analysis of nevirapine (NVP) effect on clinical endpoints (CEs) of HIV progression or death in ACTG trial 193A. Conf Retroviruses Opportunistic Infect. 1998 Feb 1-5;5th:210 (abstract no 700)
  • Henry K, Tierney C, Kahn J, Balfour H, Jiang Q, Kmack A, Fischl M. A randomized, double-blind, placebo-controlled study comparing combination nucleoside and triple therapy for the treatment of advanced HIV disease (CD4 less than or equal to 50/mm(3)). Conf Retroviruses Opportunistic Infect. 1997 Jan 22-26;4th:207 (abstract no LB6)
  • Coplan P, Nikas A, Saah A, Nessly M, Doll L, Leavitt R, Benson J, Guess H. No association observed between indinavir therapy for HIV/AIDS and myocardial infarction in 4 clinical trials with 2,825 subjects. Conf Retroviruses Opportunistic Infect. 1999 Jan 31-Feb 4;6th:191 (abstract no 658)
  • Erice A, Tierney C, Balfour HH Jr, Liou S, Kahn JO, Henry WK. Virologlc effect of therapy with reverse transcriptase inhibitors (RTIs) in patients with AIDS and less than 50 CD4+ T cells per mm(3): a substudy of ACTG 193a. Conf Retroviruses Opportunistic Infect. 1998 Feb 1-5;5th:204 (abstract no 662)
  • Price RW, Yiannoutsos CT, Clifford DB, Zaborski L, Tselis A, Sidtis JJ, Cohen B, Hall CD, Erice A, Henry K. Neurological outcomes in late HIV infection: adverse impact of neurological impairment on survival and protective effect of antiviral therapy. AIDS Clinical Trial Group and Neurological AIDS Research Consortium study team. AIDS. 1999 Sep 10;13(13):1677-85. doi: 10.1097/00002030-199909100-00011. PubMed 10509569 ↗
08

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Nov 4, 2021, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
09

Registry details

Key details

Study ID
NCT00000781
Lead sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
Bristol-Myers Squibb, Glaxo Wellcome
Responsible party
Sponsor
First posted
Aug 31, 2001
Completion
Sep 1996
Last update
Nov 4, 2021

Study contacts

Henry WK
study chair
Kahn JO
study chair
Balfour HH
study chair
View the source record on ClinicalTrials.gov ↗

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