Study to Evaluate Changes in CD4 on Replacing TDF With ABC or DDI+TDF With ABC+3TC

Overview

The study aims to ascertain whether the sole replacement of tenofovir with abacavir once a day improves the immunological response obtained with tenofovir + ddI or whether it is better to perform a double replacement of tenofovir and ddI with abacavir + lamivudine (joint formulation) in a single daily dose to achieve these objectives.

Full Title of Study: “Study of Changes in CD4 Lymphocyte Count in Patients With a HAART Regimen Including DDI + Tenofovir and With Viral Suppression Following the Replacement of Tenofovir With Abacavir Once Daily or Following the Double Replacement of DDI + Tenofovir With Abacavir + Lamivudine in a Single Tablet”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: February 2007

Detailed Description

Different works have shown a high rate of virological failure among patients on abacavir + lamivudine + tenofovir or ddI + 3TC + tenofovir, thus rendering the use of these combinations actively unadvisable. Furthermore, recent studies have also shown that ABC+3TC are associated with a significantly higher increase in CD4 than the current treatment standard formed by AZT+3TC. This provides us with grounds to suppose that patients with TDF+ddI may recover their CD4 with ABC+3HT. Similarly, and recently, the existence of pharmacokinetic interactions between tenofovir + abacavir has begun to be questioned. Finally, the replacement of tenofovir with abacavir or tenofovir + ddI with abacavir + lamivudine does not detract from the potency of HAART, the toxicity profile is different and their behaviour at mitochondrial level is similar. This study aims to ascertain whether the sole replacement of tenofovir with abacavir once a day improves the immunological response obtained with tenofovir + ddI or whether it is better to perform a double replacement of tenofovir and ddI with abacavir + lamivudine (joint formulation) in a single daily dose to achieve these objectives.

Interventions

  • Drug: Abacavir
    • Change tenofovir to abacavir
  • Drug: Didanosine
    • Increase didanosine dose to 400 mg/day if weight is > 60 Kg. or to 250mg/day if weight is < 60 kg.
  • Drug: Abacavir+Lamivudine
    • Change tenofovir and didanosine to abacavir + lamivudine (600mg+300 mg/day in one single tablet).

Arms, Groups and Cohorts

  • No Intervention: 1
    • Maintain antiretroviral treatment
  • Experimental: 2
    • Change tenofovir to abacavir and increase didanosine dose to 400 mg/day if weight is > 60 Kg. or to 250mg/day if weight is < 60 kg.
  • Experimental: 3
    • Change tenofovir and didanosine to abacavir + lamivudine (600mg+300 mg/day in one single tablet).

Clinical Trial Outcome Measures

Primary Measures

  • Proportion of patients that increase their number of CD4 lymphocytes with regard to the baseline.
    • Time Frame: At 12, 24, 36 and 48 weeks

Secondary Measures

  • To evaluate the proportion of patients with viral load of HIV-1 <50 copies of the combinations studied during the follow-up period.
    • Time Frame: At 12, 24, 36 and 48 weeks.
  • Incidence of new clinical adverse events that appear .
    • Time Frame: during 48 weeks of follow-up
  • Evolution of the clinical adverse events that were already present at the time they were included in the study.
    • Time Frame: during the 48 weeks of follow-up
  • Rate of treatment drop-outs due to the appearance of adverse events
    • Time Frame: during the 48 weeks of follow-up
  • Incidence of new laboratory alterations that appear during the follow-up period (change in renal parameters, changes in lactate levels, modification of pancreatic enzymes, changes in lipid parameters).
    • Time Frame: during the follow-up period
  • Evolution of the laboratory alterations that were already present at the time they were included in the study.
    • Time Frame: during the 48 weeks of follow-up

Participating in This Clinical Trial

Inclusion Criteria

  • Age > 18 years. – HIV-1 infected patients. – Patients on triple HAART therapy including ddI + tenofovir plus a PI or NNRTI for at least 3 months. – Patients with an undetectable HIV-1 viral load (< 50 copies RNA / mL or < centre's limit of detection) over the last 6 months. – Not be on treatment with immunosuppressives, such as: hydroxyurea, interferon, ribavirin or cytostatics. – Not be on treatment with interleukin-2 or other immunomodulators. – Women may not be of fertile age (defined as at least one year from menopause or undergoing any surgical sterilisation technique), or must undertake to use a barrier contraceptive method during the study. – Signature of the informed consent. Exclusion Criteria:

  • Incapacity to give informed consent. – Bad adherence or treatment interruptions over the previous 6 months. – Prior exposure to abacavir. – HAART Therapy including ddI at a dose of 400mg + tenofovir if weight > 60 kg or ddI 250 mg + tenofovir if weight < 60 kg. – Suspicion of cross resistances to abacavir and lamivudine. – Hepatic or pancreatic analytical alterations 4 times above the limit of normality. – Presence of opportunistic infections and/or recent tumours (< 6 months). – Patients participating in another clinical trial.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 80 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Hospital de Granollers
  • Overall Official(s)
    • Enric Pedrol, MD, PhD, Principal Investigator, Fundació Hospital de Granollers

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