Safety and Efficacy of Two Once Daily Anti Retroviral Treatment Regimens Along With Anti-tuberculosis Treatment
Recruitment status was Active, not recruiting
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Purpose
Protocol Summary
Title: Evaluation of safety and efficacy of two different once daily anti-retroviral treatment regimens along with anti-tuberculosis treatment in patients with HIV-1 and tuberculosis - Randomized Controlled Clinical Trial
Phase: Phase III trial
Population: 180 HIV-1 positive patients with tuberculosis
Number of Sites: Four.
- Tuberculosis Research Centre, Chennai
- Government Medical College, Vellore
- Government Hospital of Thoracic Medicine, Tambaram
- Government Rajaji Hospital, Madurai
Study Duration: 26 months including 24 months of ART.
Study Objectives:
Primary Objective To compare the efficacy and safety of two different once-daily anti-retroviral treatment regimens (along with standard anti-tuberculosis treatment) in patients with HIV-1 and tuberculosis, by using virologic end points.
Secondary Objective To compare the efficacy of antiretroviral treatment given under partial supervision with unsupervised treatment (once a month supply).
| Condition | Intervention | Phase |
|---|---|---|
|
Tuberculosis Human Immunodeficiency Virus Infections |
Drug: Didanosine, Lamivudine, Efavirenz Drug: Didanosine, Lamivudine, Nevirapine |
Phase 3 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Evaluation of Safety and Efficacy of Two Different Once Daily Anti Retroviral Treatment Regimens Along With Anti-tuberculosis Treatment in Patients With HIV-1 and Tuberculosis |
- Suppression of Viral load to < 400 copies/ml or a two log reduction in viral load from the baseline value at the end of 6 months and a viral load <400 copies/ml at 24 months of antiretroviral therapy [ Time Frame: Dec 2008 ] [ Designated as safety issue: No ]
- To compare the response to treatment between partially supervised drug administration and unsupervised drug administration. [ Time Frame: Dec 2009 ] [ Designated as safety issue: No ]
- To compare the tolerability and toxicity attributable to study drugs. [ Time Frame: Dec 2009 ] [ Designated as safety issue: Yes ]
| Estimated Enrollment: | 180 |
| Study Start Date: | June 2006 |
| Estimated Study Completion Date: | December 2011 |
| Estimated Primary Completion Date: | June 2009 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: 2
Didanosine + Lamivudine + Nevirapine
|
Drug: Didanosine, Lamivudine, Nevirapine
Didanosine 250 mg once daily for patients < 60kg, 400 mg OD patients > 60kg Lamivudine 300 mg once daily Nevirapine 400 mg once daily All drugs will be given for 24 months
|
|
Active Comparator: 1
Didanosine + Lamivudine + Efavirenz
|
Drug: Didanosine, Lamivudine, Efavirenz
Didanosine 250mg patients <60kg, 400mg patients > 60kg once daily Lamivudine 300 mg once daily Efavirenz 600 mg once daily All drugs will be given for 24 months
|
Detailed Description:
Description of Agent or Intervention:
The study intervention is to start patients with HIV and tuberculosis on anti-retroviral treatment along with the continuation phase of anti-tuberculosis treatment (ATT)ie after completion of first two months of treatment. The anti-TB regimen used in this trial will be 2EHRZ3/4RH3. Two different once-daily regimens are being compared for their efficacy and adverse event profile, namely ddI + 3TC + NVP versus ddI + 3TC + EFZ. The primary aim is to study the outcome of patients treated with both ART and ATT at 6 months (24 weeks of ART). A secondary objective is to compare the utility of partially supervised directly observed treatment with unsupervised administration of anti-retroviral drugs.
Patients with HIV-1 infection and active tuberculosis (pulmonary and extrapulmonary) will be started on a four-drug intermittent short-course anti-TB regimen on recruitment to the trial. They will be randomized at the end of intensive phase of ATT to receive either of the ART regimens and the outcome measured at the end of 6 months. During this phase, both ATT and ART will be given under supervision three times a week. Patients with viral load < 400 copies/ml(favourable outcome) at this time point will be randomized to receive ART either by partial observation of treatment (three times a week)or monthly supply (unsupervised administration) and final outcome will be measured at the end of 24 months of ART. The study will provide information on the comparative efficacy of the two regimens when given with anti-TB treatment as well as any added advantage that direct observation of treatment may provide.
Eligibility| Ages Eligible for Study: | 18 Years to 61 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Age > 18 years
a) Newly diagnosed sputum smear positive tuberculosis (at least 1 out of 6 sputum specimen should be positive by smear) b)Miliary tuberculosis, mediastinal/hilar lymphadenopathy, diagnosed by chest radiography or CT scan (irrespective of sputum smear status).
c)TB lymphadenitis with histopathological/bacteriological evidence of TB d)Pleural effusion with biochemical/cytological/bacteriological evidence of TB
- HIV-1 positivity (on 2 different rapid tests on the same blood sample)
- CD4 cell counts less than 250 cells/mm3
- Likely to remain in the same area for at least two years after start of treatment.
- Willingness to stay in the hospital for 2 weeks during initiation of ART, and attend the clinic thrice weekly for the entire period of the study (up to 2 years).
- Willingness for home visits, and to attend for investigations, supervised treatment and follow-up as required.
- Within the area of intake (25 kms from any of the TRC subcentres).
- Willingness to use contraception during trial period.
Exclusion Criteria:
- Resides outside area of intake.
- Pregnancy and lactation.
- Patients with major psychiatric illnesses and severe depression
- Major complications of HIV disease like encephalopathy, renal (Serum creatinine level > 1.2 mgs/dl) or hepatic disease (Serum bilirubin > 2.0 times upper limit of normal, Serum transaminases > 2.5 times upper limit of normal), serum amylase > 2 times upper limit of normal with serum lipase > 1.5 times upper limit of normal.
- Serious cardiac disease (CCF, IHD), uncontrolled diabetes mellitus, cancer, moribund state
- Previous antituberculosis treatment for more than 1 month.
- Previous antiretroviral treatment for more than 1 month
- Patients with CD4 cell count >250 cells/mm3.
- HIV-2 infection alone or in combination with HIV-1.
- Patients currently using alcohol, IV drugs & other substance abuse.
- Unwilling to use contraception & avoid pregnancy.
- Unwilling to HIV/TB screening and participation in trial.
Contacts and Locations| India | |
| Tuberculosis Research Centre | |
| Chennai, Tamilnadu, India, 600031 | |
| Principal Investigator: | Soumya Swaminathan, MD | Tuberculosis Research Centre, India |
| Study Director: | PR Narayanan, PhD | Tuberculosis Research Centre, India |
More Information
Additional Information:
Publications:
| Responsible Party: | Dr Soumya Swaminathan, Tuberculosis Research Centre |
| ClinicalTrials.gov Identifier: | NCT00332306 History of Changes |
| Other Study ID Numbers: | trc23 |
| Study First Received: | May 30, 2006 |
| Last Updated: | October 7, 2009 |
| Health Authority: | India: Indian Council of Medical Research |
Keywords provided by Tuberculosis Research Centre, India:
|
Once daily antiretroviral treatment Concomitant antituberculosis treatment HIV Infections |
Additional relevant MeSH terms:
|
Acquired Immunodeficiency Syndrome HIV Infections Immunologic Deficiency Syndromes Tuberculosis Virus Diseases Lentivirus Infections Retroviridae Infections RNA Virus Infections Sexually Transmitted Diseases, Viral Sexually Transmitted Diseases Slow Virus Diseases Immune System Diseases Mycobacterium Infections Actinomycetales Infections Gram-Positive Bacterial Infections |
Bacterial Infections Antitubercular Agents Didanosine Nevirapine Lamivudine Efavirenz Anti-Bacterial Agents Anti-Infective Agents Therapeutic Uses Pharmacologic Actions Antimetabolites Molecular Mechanisms of Pharmacological Action Reverse Transcriptase Inhibitors Nucleic Acid Synthesis Inhibitors Enzyme Inhibitors |
ClinicalTrials.gov processed this record on March 03, 2013
