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Completed

NCT Number: NCT00389207

Nevirapine or Atazanavir/Ritonavir Given With Emtricitabine/Tenofovir in Human Immunodeficiency Virus (HIV)-1-infected Treatment Naive Adults

Primary purpose of this study is to compare the efficacy and safety of two different nevirapine (Viramune) dosing regimens (once daily (QD) and twice daily (BID) application) and of atazanavir/ritonavir (Reyataz/Norvir), all on an emtricitabine/tenofovir disoproxil fumarate (DF) (Truvada) background. Patients will receive either nevirapine (NVP) 200 mg twice daily, or NVP 400 mg once daily , or ritonavir-boosted atazanavir (ATZ/r), all in combination with emtricitabine (FTC) and tenofovir DF (TDF).

All patients receiving NVP will start at 200 mg once daily for 2 weeks, because it has been demonstrated that this lead-in dosing regimen reduces the frequency of NVP-induced rash. At Visit 3 (Week 2), patients increase the NVP dose to either 200 mg twice daily or to 400 mg once daily. Patients receiving ATZ/r will be treated with ATZ 300 mg once daily, boosted by 100 mg ritonavir (RTV) once daily. Background antiretroviral therapy for all patients consists of one tablet of Truvada. Treatment duration is 48 weeks (primary endpoint) with an extension to 144 weeks. Patients may also participate in the metabolic sub-study, comparing NVP and ATZ/r for signs and symptoms of lipodystrophy and serum lipid/glycaemic abnormalities.

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Key information

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 3

Primary location

1100.1470.54004 Boehringer Ingelheim Investigational Site, Capital Federal, Argentina

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Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Inclusion criteria

  • Signed informed consent in accordance with Good Clinical Practice (GCP) and local regulatory requirements prior to trial participation
  • HIV-1-infected males or females >= 18 years of age with positive serology confirmed by Western blot
  • No previous antiretroviral treatment (of more than 7 days)
  • Males with CD4+ counts of < 400 cells/mm3 and females with CD4+ counts of < 250 cells/mm3
  • NVP- and ATZ/r susceptibility based on HIV-1 genotypic resistance report
  • Adequate renal function defined as a calculated creatinine clearance (CLCr) >= 50 ml/min according to the Cockcroft-Gault formula
  • Karnofsky score >= 70
  • Acceptable medical history, as assessed by the investigator

Exclusion criteria

Exclusion criteria

  • Active drug abuse or chronic alcoholism at the investigator's discretion
  • Hepatic cirrhosis stage Child-Pugh B or C
  • Female patients of child-bearing potential who:
  • have a positive serum pregnancy test at screening or during the study,
  • are breast feeding,
  • are planning to become pregnant,
  • are not willing to use a barrier method of contraception, or are not willing to use methods of contraception other than ethinyl estradiol containing oral contraceptives
  • Laboratory parameters Division of Acquired Immunodeficiency Syndrome (DAIDS) > grade 2 (triglycerides > DAIDS grade 3; total cholesterol no restrictions)
  • Active hepatitis B or C disease, defined as HBsAg-positive or Hepatitis C-Virus-Ribo Nucleic Acid (HCV-RNA)- positive with Aspartate Transaminase/Alanine Transaminase (AST/ALT) > 2.5x Upper Limit of Normal (ULN) (DAIDS grade 1)
  • Hypersensitivity to any ingredients of the test products
  • Have therapy with nephrotoxic drugs (e.g., aminoglycosides, amphotericin B, vancomycin, cidofovir, foscarnet, cisplatin, pentamidine, tacrolimus, cyclosporine) or potential competitors of renal excretion (e.g., cidofovir, acyclovir, valacyclovir, ganciclovir, valganciclovir, probenecid, high-dose non-steroidal anti-inflammatory drugs (i.e., ibuprofen)) within 3 months prior to study screening or are expected to receive these during the study
  • Patients who are receiving other concomitant treatments which are not permitted
  • Use of other investigational medications within 30 days before study entry or during the trial
  • Use of immunomodulatory drugs within 30 days before study entry or during the trial (e.g., interferon, cyclosporin, hydroxyurea, interleukin 2, chronic treatment with prednisone)
  • Patients with Progressive Multifocal Leukoencephalopathy (PML), Visceral Kaposi's Sarcoma (KS), and/or any lymphoma
  • Any AIDS defining illness that is unresolved, symptomatic or not stable on treatment for at least 12 weeks at screening visit
  • Patients who are receiving systemic treatment for malignant disease

Treatment and study plan

nevirapine bid

Drug

nevirapine twice daily

nevirapine qd

Drug

nevirapine once daily

Atazanavir

Drug

atazanavir once daily

Primary outcomes

  1. Treatment Response at Week 48

    Time frame: From baseline to Week 48

    Treatment response is defined as a viral load (VL) <50 copies/mL measured at two consecutive visits prior to Week 48 and without subsequent rebound or change of antiretroviral (ARV) therapy prior to Week 48.

Secondary outcomes

  1. Treatment Response at Week 48 (TLOVR Algorithm)

    Time frame: From baseline to Week 48

    Treatment response is defined as a VL <50 copies/mL measured at two consecutive visits up to Week 48 and without subsequent rebound or change of ARV therapy up to Week 48, based on time to loss of virologic response (TLOVR) algorithm, as a sensitivity analysis for the primary analysis.

  2. Proportion of Patients With VL < 50 Copies/ml

    Time frame: From baseline to Weeks 4, 8, 12, 24, 36, 48, 60, 72, 84, 96, 108, 120, 132 and 144/EOT

    VL <50 copies/mL among observed patients on treatment at each visit, with the final visit at Week 144 or end of trial (EOT) for the patient

  3. Proportion of Patients With VL < 400 Copies/ml

    Time frame: From baseline to Weeks 4, 8, 12, 24, 36, 48, 60, 72, 84, 96, 108, 120, 132 and 144/EOT

    VL <400 copies/mL among observed patients on treatment at each visit, with the final visit at Week 144 or end of trial (EOT)

  4. Change in CD4+ Count From Baseline

    Time frame: From baseline to Weeks 4, 8, 12, 24, 36, 48, 60, 72, 84, 96, 108, 120, 132 and 144/EOT

    Change in CD4+ cell count from baseline among patients on treatment at each visit, with the final visit at Week 144 or EOT

  5. Change in Framingham Score From Baseline

    Time frame: From baseline to Weeks 48, 96 and 144/EOT

    Change in the estimated risk of cardiovascular disease using the Framingham algorithm from baseline to after 48, 96 and 144 weeks, last observation carried forward (LOCF). The score is based on age, gender, systolic blood pressure, total cholesterol, high density lipoprotein cholesterol and smoking status. Scores range from 0 to 21 with higher scores indicating a greater risk.

  6. Change in Mental Health Summary (MHS) Score From Baseline

    Time frame: From baseline to Weeks 48, 96 and 144/EOT

    Quality of life (QoL) assessment by change in MHS score from baseline to after 48, 96 and 144 weeks (observed cases), from the Medical Outcomes Study HIV Health Survey (MOS-HIV), a 35-item self-administered questionnaire including 10 scales covering: health perceptions, pain, physical functioning, role functioning, social and cognitive functioning, mental health, energy/fatigue, health distress, and QoL. The MHS is a weighted average of the 10 scales and ranges from 0 to 100 with higher scores indicating better QoL.

  7. Change in Physical Health Summary (PHS) Score From Baseline

    Time frame: From baseline to Weeks 48, 96 and 144/EOT

    QoL assessment by change in PHS score from baseline to after 48, 96 and 144 weeks (observed cases), from the MOS-HIV, a 35-item self-administered questionnaire including 10 scales covering: health perceptions, pain, physical functioning, role functioning, social and cognitive functioning, mental health, energy/fatigue, health distress, and QoL. The PHS is a weighted average of the 10 scales and ranges from 0 to 100 with higher scores indicating better QoL.

  8. Number of Patients Hospitalized

    Time frame: From baseline to Week 24, Week 24 to 48, Week 48 to 96, and Week 96 to 144/EOT

    Cost effectiveness assessment by number of patients hospitalized

  9. Non-scheduled Physician Visits

    Time frame: From baseline to Week 24, Week 24 to 48, Week 48 to 96, and Week 96 to 144/EOT

    Cost effectiveness assessment by number of patients with non-scheduled physician visits

  10. Genotypic Resistance Associated With Virologic Failure

    Time frame: From baseline to Week 48

    Number of treatment-emergent drug-associated substitutions in patients with virological failure up to Week 48. The total number of genotypic mutations in those patients who were virologic failures is given, not the number of patients with mutations.

  11. Treatment-emergent AIDS-defining Illness

    Time frame: From baseline to Week 144

    Treatment-emergent AIDS-defining illness (tr.-emerg. AIDS-def.illness) including worsening during treatment

  12. Treatment-emergent AIDS-defining Illness Leading to Death

    Time frame: From baseline to Week 144

    Patients with an AIDS-defining illness leading to death broken out by treatment. Statistical analysis shows time to death from AIDS-defining illness.

  13. Lipodystrophy

    Time frame: From baseline to Week 144

    Number of patients with AE lipodystrophy

  14. Serum Lipid Abnormalities

    Time frame: From baseline to Week 144

    Number of patients with AE elevated serum lipids (i.e. hypercholesterolaemia)

  15. Glycaemic Abnormalities

    Time frame: From baseline to Week 144

    Number of patients with AE elevated serum glucose

  16. Treatment Response at Week 96

    Time frame: From baseline to Week 96

    Treatment response is defined as a viral load (VL) <50 copies/mL measured at two consecutive visits prior to Week 96 and without subsequent rebound or change of antiretroviral (ARV) therapy prior to Week 96.

  17. Treatment Response at Week 144

    Time frame: From baseline to Week 144

    Treatment response is defined as a viral load (VL) <50 copies/mL measured at two consecutive visits prior to Week 144 and without subsequent rebound or change of antiretroviral (ARV) therapy prior to Week 144.

  18. Proportion of Patients With Virological Rebound With VL >=50 Copies/mL After CVR (Confirmed Virological Response) at Week 24, 48, 96, 144

    Time frame: at Week 24, 48, 96, 144

    The analyses of virologic rebound were performed on the original values at each visit(ORGV) rather than calculated results within time windows (CAL)

  19. Proportion of Patients With Virological Rebound With VL >=400 Copies/mL After CVR at Week 24, 48, 96, 144

    Time frame: at Week 24, 48, 96, 144

    The analyses of virologic rebound were performed on the original values at each visit(ORGV) rather than calculated results within time windows (CAL)

  20. Proportion of Patients With Virologic Failure at Week 48, 96, 144

    Time frame: at Week 48, 96, 144

  21. Time to Treatment Response (First Confirmed VL<50 Copies/mL)

    Time frame: baseline to week 144

    Time to treatment response was defined as the time from start of treatment until the first measurement of the first confirmed virological response

  22. Time to Loss of Virologic Response (Rebound)

    Time frame: Baseline to week 144

    Time to loss of virologic response (TLOVR) was defined as the time from start of treatment to the first measurement showing VL ≥ 50 copies/mL in the first virologic rebound, after having a confirmed virological response.

  23. Time to Treatment Failure

    Time frame: baseline to week 144

    Treatment failure is defined as the occurrence of the first of at least one of the following events: early discontinuation of trial drug, change in ARV therapy, failure to achieve an HIV RNA count < 50 copies/mL up to Visit 10 (week 48) or loss of virologic response

  24. Change in the Calculated Glomerular Filtration Rate (GFR) at Week 48, 96 and 144

    Time frame: From baseline to Week 48, 96, 144

    Calculations based on the MDRD algorithm.

  25. Proportion of Patients With >= DAIDS Grade 2 Laboratory Abnormalities

    Time frame: week 148

  26. Proportion of Patients Reporting Rash of Any Severity

    Time frame: week 148

    Proportion of Patients reporting rash of any severity

  27. Proportion of Patients Reporting Hepatic Events of Any Severity

    Time frame: week 148

    Proportion of Patients reporting hepatic events of any severity

  28. Proportion of Patients Reporting CNS (Central Nervous System) Side Effects of Any Severity

    Time frame: week 148

    Proportion of Patients reporting CNS (central nervous system) side effects of any severity

  29. Change of Cholesterol Values From Baseline to Week 48, 96, 144

    Time frame: baseline to week 48, 96, 144

    Changes frombaseline in total cholesterol, LDL-cholesterol(LDL-c) and HDL

  30. Changes of Apolipoprotein Values From Baseline to Week 48, 96, 144

    Time frame: baseline to week 48, 96, 144

    Changes frombaseline apolipoprotein A1 & B

  31. Change of hsCRP From Baseline to Week 48, 96, 144

    Time frame: baseline to week 48, 96, 144

    Change of hsCRP from baseline to week 48, 96, 144

  32. Change of Total Triglycerides From Baseline to Week 48, 96, 144

    Time frame: baseline to week 48, 96, 144

    Change of total triglycerides from baseline to week 48, 96, 144

  33. Change of Total Cholesterol to HDL-cholesterol Ratio From Baseline to Week 48, 96, 144

    Time frame: baseline to week 48, 96, 144

    Change of Total cholesterol to HDL-cholesterol ratio from baseline to week 48, 96, 144

Sponsors and collaborators

Lead sponsor

Boehringer Ingelheim

Industry

Registry information

Official study title

Randomized, Open Label Study Evaluating the Lipid Profile Difference and Efficacy of a Combined Therapy Including Tenofovir, Emtricitabine + Atazanavir / r or NVP in Naive HIV - 1 Infected Patients.

Important dates

Study start
2006
Primary completion
2011
First posted
Oct 18, 2006
Registry last updated
Jan 27, 2014

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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