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HIV InfectionsNCT00120510

Early Versus Standard Start of Anti-HIV Therapy for Treatment-Naive Adults in Haiti

A study testing Efavirenz and Lamivudine/Zidovudine in people with HIV Infections and Tuberculosis, run by National Institute of Allergy and Infectious Diseases (NIAID) at 1 site in Haiti.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Anti-HIV treatment consisting of lamivudine/zidovudine (3TC/ZDV) and efavirenz (EFV) is the current standard of care for initial treatment of HIV in most areas of the world. The purpose of this study is to determine the best time to start this anti-HIV treatment in treatment-naive adults in Haiti. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
HIV Infections, Tuberculosis
What is being tested?
Efavirenz and Lamivudine/Zidovudine
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
816 participants
Where
1 siteHaiti
Study dates
Jul 2007to Sep 2009
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • HIV-infected
  • Received pre- and post-test counseling at the GHESKIO Centers
  • CD4 count between 200 and 350 cells/mm3
  • World Health Organization (WHO) Stage I, II, or III HIV disease
  • Willing to use acceptable forms of contraception

Who cannot join

  • WHO Stage IV HIV disease (AIDS)
  • 7 or more days of cumulative ART prior to study entry OR on ART at time of study entry
  • Active TB, if diagnostic work-up for TB is incomplete OR if decision to treat TB has not been made. More information on this criterion can be found in the protocol.
  • Recurrent active TB OR history of interrupted or incomplete TB therapy. More information on this criterion can be found in the protocol.
  • Has not been evaluated for latent TB and decision to treat latent TB with isoniazid has not been made. More information on this criterion can be found in the protocol.
  • Requires ART in the next 3 months, in the opinion of the investigator
Show all 15Show fewer
  • Other serious medical illness requiring chronic maintenance therapy (e.g., hypertension, diabetes) UNLESS the individual has completed at least 14 days of therapy prior to study enrollment AND is clinically stable
  • Any psychological condition (e.g., severe depression, schizophrenia) that, in the opinion of the investigator, may interfere with the study
  • Any social condition (e.g., pending emigration, pending incarceration) that, in the opinion of the investigator, may interfere with the study
  • Active drug or alcohol use that, in the opinion of the investigator, may interfere with the study
  • Current inflammation of the pancreas
  • Allergy/sensitivity to any of study drugs or their formulations
  • Requires certain medications
  • Enrolled in another therapeutic or interventional clinical trial
  • Pregnant or breastfeeding

Trial locations and contacts

1 site in 1 country.

Haiti1 site
  • Les Centres GHESKIO CIPRA CRS

    Port-au-Prince, HT-6110

Other trials in Haiti

About this study

Official title: A Randomized Clinical Trial to Determine the Efficacy of Early Versus Standard Antiretroviral Therapy in HIV Infected Adults With CD4+ T Cell Counts Between 200 and 350 Cells/mm3

Anti-HIV treatment consisting of lamivudine/zidovudine (3TC/ZDV) and efavirenz (EFV) is the current standard of care for initial treatment of HIV in most areas of the world. The purpose of this study is to determine the best time to start this anti-HIV treatment in treatment-naive adults in Haiti.

Read the detailed description

In many parts of the world, initial standard of care for HIV includes 3TC/ZDV and the non-nucleoside reverse transcriptase inhibitor EFV. However, it is unclear if early (CD4 count less than 350 cells/mm3) or delayed (CD4 count less than 200 cells/mm3) therapy initiation leads to improved survival. This study will determine the most appropriate time to initiate ART in HIV infected individuals in Haiti. The study will enroll patients from the Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) Centers. Some participants in this study will have active pulmonary tuberculosis (TB).

This study will last at least 3 years. Participants will be randomly assigned to one of two groups at study entry. Group A participants will receive 3TC/ZDV twice daily and EFV once daily at study enrollment. Participants receiving TB therapy at the time of enrollment may be observed for 2 weeks prior to beginning early therapy. Dosage adjustment of EFV may be necessary for participants receiving rifampin as part of their TB therapy. Group B participants will receive 3TC/ZDV twice daily and EFV once daily when they develop clinical AIDS or their CD4 count drops below 200 cells/mm3 (WHO Stage IV). Directly observed therapy will be used for the first two months of treatment for every participant.

Group A participants will have 14 study visits after beginning treatment; the visits will occur at Months 1, 2, 3, and every 3 months thereafter. Medical and medication history, physical exams, and contraceptive counseling for women will occur at all visits. HIV counseling, blood collection, and HIV staging will occur at most visits. At some study visits, Group A participants will be asked to complete quality of life and adherence questionnaires. Group B participants will have 14 study visits after study entry and will begin treatment when they meet WHO criteria. Assessments will be the same as for Group A. Any participant who fails the first-line regimen during the study will switch to a second-line ART regimen.

Being tested
Efavirenz, Lamivudine/Zidovudine
Keywords
Treatment Naive, TB
Medical subject headings
HIV Infections, Tuberculosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • EfavirenzDrug

    Also called EFV

    Non-nucleoside reverse transcriptase inhibitor dosed at 600mg taken by mouth every 24 hours at bedtime

  • Lamivudine/ZidovudineDrug

    Also called 3TC/ZDV, 3TC/AZT

    Nucleoside reverse transcriptase inhibitor dosed at 150mg/300mg fixed dose combination taken by mouth every 12 hours

Study groups in NCT00120510
Study groupRoleWhat they receive
AExperimentalRandomly assigned group who will start an ART regimen of 3TC/ZDV and EFV twice daily at study entry
Receives: Drug: Efavirenz; Drug: Lamivudine/Zidovudine
BActive comparatorRandomly assigned group who will delay beginning ART regimen of 3TC/ZDV and EFC twice daily until they develop clinical AIDS or their CD4 count drops below 200 cells/mm3
Receives: Drug: Efavirenz; Drug: Lamivudine/Zidovudine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Survival

    Measured: At 36 months

Secondary outcomes (9)
  1. Safety and drug-associated side effects and toxicities of the study drugs

    Measured: Throughout study

  2. Pattern and frequency of antiretroviral drug resistance during ART

    Measured: Throughout study

  3. Occurrence and clinical outcome of opportunistic infections, viral coinfections, and immune reconstitution syndromes observed during ART

    Measured: Throughout study

  4. TB treatment outcomes in patients with active pulmonary TB at enrollment

    Measured: Throughout study

  5. Quality of life scores based on self-report questionnaires

    Measured: Throughout study

  6. Adherence based on self-report questionnaires and dosage count

    Measured: Throughout study

  7. Cost of therapy

    Measured: Throughout study

  8. Plasma HIV-1 RNA below limits of quantitation after initiating ART

    Measured: Every 6 months throughout study

  9. Absolute CD4 cell count change from baseline in subjects who initiate ART

    Measured: Every 6 months throughout study

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Jul 2005 (estimated)
  2. Study startJul 2007
  3. Primary completionSep 2009
  4. Study completionSep 2009

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
816 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00120510
Sponsor's protocol ID
CIPRA HT 001
Other IDs
5K24AI051966-03, 10403
Status last verified
Oct 2014
First submitted
14 Jul 2005
Last updated
15 Oct 2014
Results posted
No
Data monitoring committee
Yes

Publications

  • Blankson JN. Primary HIV-1 infection: to treat or not to treat? AIDS Read. 2005 May;15(5):245-6, 249-51.

    PubMed 15900634
  • Duncombe C, Kerr SJ, Ruxrungtham K, Dore GJ, Law MG, Emery S, Lange JM, Phanuphak P, Cooper DA. HIV disease progression in a patient cohort treated via a clinical research network in a resource limited setting. AIDS. 2005 Jan 28;19(2):169-78. doi: 10.1097/00002030-200501280-00009.

    PubMed 15668542
  • Pape JW. Tuberculosis and HIV in the Caribbean: approaches to diagnosis, treatment, and prophylaxis. Top HIV Med. 2004 Dec-2005 Jan;12(5):144-9.

    PubMed 15647610
  • Teck R, Ascurra O, Gomani P, Manzi M, Pasulani O, Kusamale J, Salaniponi FM, Humblet P, Nunn P, Scano F, Harries AD, Zachariah R. WHO clinical staging of HIV infection and disease, tuberculosis and eligibility for antiretroviral treatment: relationship to CD4 lymphocyte counts. Int J Tuberc Lung Dis. 2005 Mar;9(3):258-62.

    PubMed 15786887
  • Thorner A, Rosenberg E. Early versus delayed antiretroviral therapy in patients with HIV infection : a review of the current guidelines from an immunological perspective. Drugs. 2003;63(13):1325-37. doi: 10.2165/00003495-200363130-00001.

    PubMed 12825959
  • Joseph Y, Yao Z, Dua A, Severe P, Collins SE, Bang H, Antoine Jean-Juste M, Ocheretina O, Apollon A, McNairy ML, Dupnik K, Cremieux E, Byrne A, Pape JW, Koenig SP. Long-term mortality after tuberculosis treatment among persons living with HIV in Haiti. J Int AIDS Soc. 2021 Jul;24(7):e25721. doi: 10.1002/jia2.25721.

    PubMed 34235862
  • Collins SE, Jean Juste MA, Koenig SP, Secours R, Ocheretina O, Bernard D, Riviere C, Calnan M, Dunning A, Hurtado Rua SM, Johnson WD Jr, Pape JW, Fitzgerald DW, Severe P. CD4 deficit and tuberculosis risk persist with delayed antiretroviral therapy: 5-year data from CIPRA HT-001. Int J Tuberc Lung Dis. 2015 Jan;19(1):50-7. doi: 10.5588/ijtld.14.0217.

    PubMed 25519790
  • Haas DW, Severe P, Jean Juste MA, Pape JW, Fitzgerald DW. Functional CYP2B6 variants and virologic response to an efavirenz-containing regimen in Port-au-Prince, Haiti. J Antimicrob Chemother. 2014 Aug;69(8):2187-90. doi: 10.1093/jac/dku088. Epub 2014 Apr 2.

    PubMed 24695352
  • Koenig SP, Bang H, Severe P, Jean Juste MA, Ambroise A, Edwards A, Hippolyte J, Fitzgerald DW, McGreevy J, Riviere C, Marcelin S, Secours R, Johnson WD, Pape JW, Schackman BR. Cost-effectiveness of early versus standard antiretroviral therapy in HIV-infected adults in Haiti. PLoS Med. 2011 Sep;8(9):e1001095. doi: 10.1371/journal.pmed.1001095. Epub 2011 Sep 20.

    PubMed 21949643
  • Severe P, Juste MA, Ambroise A, Eliacin L, Marchand C, Apollon S, Edwards A, Bang H, Nicotera J, Godfrey C, Gulick RM, Johnson WD Jr, Pape JW, Fitzgerald DW. Early versus standard antiretroviral therapy for HIV-infected adults in Haiti. N Engl J Med. 2010 Jul 15;363(3):257-65. doi: 10.1056/NEJMoa0910370.

    PubMed 20647201

Questions about this trial

What is this clinical trial studying?

A study testing Efavirenz and Lamivudine/Zidovudine in people with HIV Infections and Tuberculosis, run by National Institute of Allergy and Infectious Diseases (NIAID) at 1 site in Haiti.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 15 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 15 Oct 2014. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Haiti. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Survival (time frame: At 36 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00120510, which also lists 10 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Oct 2014.

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