An interventional study of Emtricitabine/Tenofovir disoproxil fumarate and Lopinavir/Ritonavir in HIV Infections, sponsored by Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections. Completed at 5 sites in 5 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2018-03-20.
Sponsored by Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections · Not applicable, Interventional, and Treatment
Most anti-HIV regimens include a non-nucleoside reverse transcriptase inhibitor (NNRTI); however, some individuals fail on these regimens. The purpose of this study is to evaluate the safety and effectiveness of the protease inhibitor (PI) lopinavir/ritonavir (LPV/r) in HIV infected individuals who are failing an anti-HIV regimen that includes an NNRTI.
Standard effective antiretroviral therapy for HIV infected individuals includes three-drug combinations of two nucleoside reverse transcriptase inhibitors (NRTIs) with either a PI or an NNRTI. However, three-drug regimens may not be ideal in resource-limited settings, where viral load and resistance testing may not be readily available. The purpose of this study is to evaluate the safety and efficacy of the PI LPV/r alone in treatment-experienced, PI-naive HIV infected individuals who are experiencing virologic failure on three-drug regimens.
This study will last 104 weeks. All participants will receive LPV/r twice daily for up to 104 weeks. Participants who experience virologic failure will receive emtricitabine/tenofovir disoproxil fumarate once daily in addition to LPV/r twice daily for the remainder of the study.
There will be 16 study visits for participants on LPV/r monotherapy and 12 study visits for participants who have intensified LPV/r with emtricitabine/tenofovir disoproxil fumarate. Blood collection and clinical assessment will occur at all visits; urine collection and resistance testing will occur at selected visits.
4,258 studies on the registry are indexed under HIV Infections; 240 are open to participants now.
This study's enrollment of 123 is above the median of 83 across 3,251 interventional studies indexed under HIV Infections.
Browse HIV Infections studies →Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections is the lead sponsor of 70 studies on the registry; 3 are open to participants now.
Of its 7 completed or terminated interventional studies of FDA-regulated products, 6 (86%) have results posted.
Counted across the registry records on this site, refreshed daily.
Inclusion Criteria for Step 1 Participants:
Laboratory values obtained within 30 days of study entry:
Inclusion Criteria for Step 2 Participants:
Exclusion Criteria for All Participants:
Exclusion Criteria for Step I Participants:
Exclusion Criteria for Step 2 Participants:
Participants will receive lopinavir/ritonavir twice daily for up to 104 weeks. Upon confirmation of virologic failure, emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) once a day will be added to their regimen.
Drug: Emtricitabine/Tenofovir disoproxil fumarate · Drug: Lopinavir/Ritonavir
Once daily
Also known as: Truvada
Twice daily
Also known as: Kaletra, Aluvia
Percentage of Enrolled Participants With Virologic Success at Week 24 on LPV/r Monotherapy
Virologic success at week 24 on LPV/r monotherapy was defined as remaining on LPV/r monotherapy at week 24 without prior virologic failure. Virologic failure was met with either of these two conditions: (i) failure to suppress HIV-1 RNA to \< 400 copies/mL by week 24 or (ii) confirmed HIV-1 RNA \>= 400 copies/mL after confirmed HIV-1 RNA \< 400 copies/mL.
Time frame: From study entry to week 24
Probability of Grade 3 or 4 Sign or Symptom, or Laboratory Toxicity Over 24 Weeks on Study.
Probability of Grade 3 or 4 sign or symptom, or laboratory toxicity over 24 weeks on study using Kaplan-Meier estimates of the cumulative probability of Grade 3 or 4 sign or symptom, or laboratory toxicity at week 24. Grading of adverse events (signs and symptoms and laboratory toxicities) was according to Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 1.0, December 2004.
Time frame: From study entry to week 24
Number of Screened Subjects With at Least One NNRTI, or NRTI-associated Resistance Mutation at A5230 Screening.
Number of screened subjects with at least one NNRTI, or NRTI-associated resistance mutation. Resistance interpretations used the November 30, 2011 Stanford algorithm.
Time frame: Screening
Time to Treatment Failure, Defined as the First Occurrence of Death, Disease Progression, or Virologic Failure.
25th percentile in weeks from study entry to treatment failure, defined as the first occurrence of death, disease progression, or virologic failure. Virologic failure was defined as HIV-1 \>= 400 copies/mL after week 24 or 2 consecutive HIV-1 RNA \>= 400 copies/mL after week 16 following suppression on LPV/r monotherapy.
Time frame: Study entry to Week 104
Number of Participants With Study-targeted Diagnoses and Clinical Events
Cardiac disorders, Infections and infestations, Metabolism and nutrition disorders, Neoplasms benign, malignant and unspecified (including cysts and polyps), Pregnancy, puerperium and perinatal conditions, Vascular disorders, were specified a priori as study-targeted events by the study chair.
Time frame: Study entry to week 104
Number of Subjects With at Least One New PI-associated Resistance Mutation at Time of Virologic Failure.
Number of subjects with at least one new PI-associated resistance mutation at time of virologic failure. Resistance interpretations used the May 6, 2009 Stanford algorithm.
Time frame: At time of virologic failure
Percentage of Subjects Reporting Not Skipping Medications in the Last Month.
The percentage of subjects reporting never missing medications in the last month.
Time frame: Study entry and weeks 2, 4, 8, 12, 16, 20, and 24
Time to First New Grade 3 or 4 Sign or Symptom or Laboratory Toxicity Following LPV/r Intensification
25th percentile in weeks from study entry to first new grade 3 or 4 sign or symptom or laboratory toxicity following LPV/r intensification. Grading of adverse events (signs and symptoms and laboratory toxicities) was according to Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 1.0, December 2004.
Time frame: From LPV/r intensification to week 104
Level of HIV-1 RNA as Ascertained From Paired DBS and Plasma
Proportion of DBS samples with HIV-1 RNA level \<= 400 copies/mL, proportion of plasma samples with HIV-1 RNA level \<= 400 copies/mL and proportion of paired DBS and plasma samples that are concordant (both \<= 400 copies/mL or both \> 400 copies/mL). Results are pooled over 4 different storage temperature conditions (-80C, -20C, 4C and room temperature).
Time frame: At study entry and weeks 24 and 48
HIV-1 Viral Sequence as Ascertained From Paired DBS and Plasma
HIV-1 viral sequencing as ascertained from paired DBS and plasma
Time frame: At study entry and virologic failure
Proportion of Participants With Plasma HIV-1 RNA Levels < 400 Copies/mL From Baseline to Week 104
Time frame: At Weeks 0, 12, 16, 20, 24, 32, 40, 48, 56, 68, 80, 92, 104
Change in CD4+ Cell Counts From Study Entry to Week 104
Time frame: Study entry and week 104
| Milestone | LPV/r Monotherapy |
|---|---|
| Started | 207 |
| Completed | 123 |
| Not completed | 84 |
| Withdrew: Did not meet eligibility criteria | 84 |
| Milestone | LPV/r Monotherapy |
|---|---|
| Started | 123 |
| Completed | 122 |
| Not completed | 1 |
| Withdrew: Death | 1 |
| Milestone | LPV/r Monotherapy |
|---|---|
| Started | 122 |
| Completed | 117 |
| Not completed | 5 |
| Withdrew: Death | 3 |
| Withdrew: Not able to get to clinic | 2 |
Virologic success at week 24 on LPV/r monotherapy was defined as remaining on LPV/r monotherapy at week 24 without prior virologic failure. Virologic failure was met with either of these two conditions: (i) failure to suppress HIV-1 RNA to \< 400 copies/mL by week 24 or (ii) confirmed HIV-1 RNA \>= 400 copies/mL after confirmed HIV-1 RNA \< 400 copies/mL.
| percentage of enrolled subjects | LPV/r Monotherapy |
|---|---|
| Percentage of Enrolled Participants With Virologic Success at Week 24 on LPV/r Monotherapy | 87 (81 to 92) |
Probability of Grade 3 or 4 sign or symptom, or laboratory toxicity over 24 weeks on study using Kaplan-Meier estimates of the cumulative probability of Grade 3 or 4 sign or symptom, or laboratory toxicity at week 24. Grading of adverse events (signs and symptoms and laboratory toxicities) was according to Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 1.0, December 2004.
| cumulative probability of grade 3 or 4 | LPV/r Monotherapy |
|---|---|
| Probability of Grade 3 or 4 Sign or Symptom, or Laboratory Toxicity Over 24 Weeks on Study. | 0.23 (0.16 to 0.31) |
Number of screened subjects with at least one NNRTI, or NRTI-associated resistance mutation. Resistance interpretations used the November 30, 2011 Stanford algorithm.
| number of screened subjects | All Screened Subjects With Available Sequences |
|---|---|
| At least one NNRTI-associated mutation | 201 |
| At least one NRTI-associated mutation | 197 |
25th percentile in weeks from study entry to treatment failure, defined as the first occurrence of death, disease progression, or virologic failure. Virologic failure was defined as HIV-1 \>= 400 copies/mL after week 24 or 2 consecutive HIV-1 RNA \>= 400 copies/mL after week 16 following suppression on LPV/r monotherapy.
| weeks | LPV/r Monotherapy |
|---|---|
| Time to Treatment Failure, Defined as the First Occurrence of Death, Disease Progression, or Virologic Failure. | 48.0 (40.0 to 80.0) |
Cardiac disorders, Infections and infestations, Metabolism and nutrition disorders, Neoplasms benign, malignant and unspecified (including cysts and polyps), Pregnancy, puerperium and perinatal conditions, Vascular disorders, were specified a priori as study-targeted events by the study chair.
| participants | LPV/r Monotherapy |
|---|---|
| Number of Participants With Study-targeted Diagnoses and Clinical Events | 39 |
Number of subjects with at least one new PI-associated resistance mutation at time of virologic failure. Resistance interpretations used the May 6, 2009 Stanford algorithm.
| participants | Virologic Failures by Week 24. |
|---|---|
| Number of Subjects With at Least One New PI-associated Resistance Mutation at Time of Virologic Failure. | 2 |
The percentage of subjects reporting never missing medications in the last month.
| percentage of subjects with data | LPV/r Monotherapy |
|---|---|
| week 2 (N=120) | 90 |
| week 4 (N=121) | 86.8 |
| week 8 (N=123) | 87.8 |
| week 12 (N=123) | 86.2 |
| week 16 (N=122) | 86.1 |
| week 20 (N=120) | 90.9 |
| week 24 (N=122) | 89.4 |
25th percentile in weeks from study entry to first new grade 3 or 4 sign or symptom or laboratory toxicity following LPV/r intensification. Grading of adverse events (signs and symptoms and laboratory toxicities) was according to Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 1.0, December 2004.
| weeks | LPV/r Monotherapy |
|---|---|
| Time to First New Grade 3 or 4 Sign or Symptom or Laboratory Toxicity Following LPV/r Intensification | 26.0 (13.1 to 53.3) |
Proportion of DBS samples with HIV-1 RNA level \<= 400 copies/mL, proportion of plasma samples with HIV-1 RNA level \<= 400 copies/mL and proportion of paired DBS and plasma samples that are concordant (both \<= 400 copies/mL or both \> 400 copies/mL). Results are pooled over 4 different storage temperature conditions (-80C, -20C, 4C and room temperature).
| proportion of samples | LPV/r Monotherapy |
|---|---|
| study entry DBS <= 400 cp/mL | 0.17 |
| study entry plasma <= 400 cp/mL | 0.00 |
| study entry DBS & plasma concordance | 0.83 |
| week 24 DBS <= 400 cp/mL | 0.82 |
| week 24 plasma <= 400 cp/mL | 0.80 |
| week 24 DBS & plasma concordance | 0.80 |
| week 48 DBS <= 400 cp/mL | 0.94 |
| week 48 plasma <= 400 cp/mL | 0.91 |
| week 48 DBS & plasma concordance | 0.97 |
HIV-1 viral sequencing as ascertained from paired DBS and plasma
No measurements were reported for this outcome.
| proportion of participants | LPV/r Monotherapy |
|---|---|
| week 0 (N=123) | 0.02 |
| week 12 (N=122) | 0.75 |
| week 16 (N=121) | 0.87 |
| week 20 (N=115) | 0.84 |
| week 24 (N=122) | 0.84 |
| week 32 (N=121) | 0.83 |
| week 40 (N=118) | 0.84 |
| week 48 (N=118) | 0.87 |
| week 56 (N=120) | 0.86 |
| week 68 (N=116) | 0.91 |
| week 80 (N=117) | 0.85 |
| week 92 (N=116) | 0.87 |
| week 104 (N=117) | 0.89 |
| cells/mm^3 | LPV/r Monotherapy |
|---|---|
| Change in CD4+ Cell Counts From Study Entry to Week 104 | 213 (111 to 326) |
Collected over From study entry up to 104 weeks.. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| LPV/r | — | 20/123 (16.3%) | 122/123 (99.2%) |
| Event | LPV/r |
|---|---|
| HyperglycaemiaMetabolism and nutrition disorders | 4/123 |
| GastroenteritisInfections and infestations | 2/123 |
| Blood triglycerides increasedInvestigations | 2/123 |
| HyperlipidaemiaMetabolism and nutrition disorders | 2/123 |
| Acute myocardial infarctionCardiac disorders | 1/123 |
| DiarrhoeaGastrointestinal disorders | 1/123 |
| DeathGeneral disorders | 1/123 |
| Pneumonia bacterialInfections and infestations | 1/123 |
| Blood cholesterol increasedInvestigations | 1/123 |
| Blood phosphorus decreasedInvestigations | 1/123 |
| Event | LPV/r |
|---|---|
| Blood cholesterol increasedInvestigations | 76/123 |
| Blood sodium decreasedInvestigations | 62/123 |
| Low density lipoprotein increasedInvestigations | 54/123 |
| Blood phosphorus decreasedInvestigations | 39/123 |
| Neutrophil count decreasedInvestigations | 38/123 |
| CoughRespiratory, thoracic and mediastinal disorders | 34/123 |
| Blood glucose increasedInvestigations | 31/123 |
| PyrexiaGeneral disorders | 27/123 |
| Blood bicarbonate decreasedInvestigations | 24/123 |
| Upper respiratory tract infectionInfections and infestations | 22/123 |
| Age, Categorical(Participants) | LPV/r Monotherapy |
|---|---|
| <=18 years | 0 |
| Between 18 and 65 years | 123 |
| >=65 years | 0 |
| Age, Continuous(years) | LPV/r Monotherapy |
|---|---|
| Mean | 39.4 ± 8.2 |
| Sex: Female, Male(Participants) | LPV/r Monotherapy |
|---|---|
| Female | 70 |
| Male | 53 |
| Region of Enrollment(participants) | LPV/r Monotherapy |
|---|---|
| South Africa | 22 |
| Thailand | 24 |
| India | 12 |
| Malawi | 40 |
| Tanzania | 25 |
This study is completed, as verified in Feb 2018. You cannot join it, but the record below documents what was studied.
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Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections