CSP #512 - Options in Management With Anti-Retrovirals

Not Applicable

Completed

Conditions: AIDS
HIV Infections

Interventions: Other: No Antiretroviral Drug-Free Period (No ARDFP) vs ARDFP
Drug: Standard ART vs Mega ART

Registration Number: NCT00050089

Lead Sponsor: US Department of Veterans Affairs

Brief Summary: This 'pragmatic' trial is a 2X2 open randomized study of patients in advanced HIV disease who have failed on conventional Highly Active Antiretroviral Therapy (HAART) regimens including all three classes of anti-HIV drugs. The first randomization will allocate patients to an intended 3-month antiretroviral drug-free period (ARDFP) or No ARDFP. The second randomization will allocate patients to Mega-ART (5+ drugs) or to Standard-ART (up to 4 drugs). The total study duration is 6.5 years with 5 years of intake and 1.5 year (minimum) of follow-up; median duration of patient follow-up is about 4 years. The target sample size is 390 patients and will provide 75% power to detect a 30% reduction in the hazard rate for the primary endpoint with mega-ART. Sixty-four sites will be participating in the trial--24 VA, 19 UK and 21 Canada.

Detailed Description: Primary Hypothesis:

Compared to patients in Standard Antiretroviral Therapy (ART), patients in Mega-ART assuming full compliance, will experience a 30% reduction in the hazard of reaching a clinical endpoint (AIDS event or death).

Secondary Hypotheses:

Time to development of a new, non-HIV related serious adverse event, health related quality of life, the incidence of grade 3 or 4 clinical or laboratory adverse events and changes in virological and immunological markers (CD4 cell count, viral load, resistance profiles) will vary between the different treatment strategies.

Interventions:

Eligible patients will be randomized to one of four treatment strategy arms:

1. No Antiretroviral Drug-Free Period (No ARDFP) and Standard-ART

2. No Antiretroviral Drug-Free Period (No ARDFP) and Mega-ART

3. Antiretroviral Drug-Free Period (ARDFP) and Standard-ART

4. Antiretroviral Drug-Free Period (ARDFP) and Mega-ART

Note: The 'first' randomization will be ARDFP vs No ARDFP. Patients randomized to No ARDFP will receive their 'second' randomization at the same time. However, patients randomized to an Antiretroviral Drug Free Period (ARDFP) will receive their 'second' randomized assignment (Standard or Mega-ART) at the end of the ARDFP.

Note: All Serious Adverse Events were coded using the MedDRA coding dictionary; other (not serious) Adverse Events were collected as part of the study but were not coded using MedDRA or any other standardized coding dictionary.

This is the first trial of a Tri-National collaboration effort between the UK MRC, the Canadian CIHR and the VA CSP. The OPTIMA Trial was reviewed and approved by CSEC on October 12, 2000. The pre-kickoff meeting was held on March 21, 2001 in Washington, DC. The VA study kickoff meeting was held in Dallas, TX on May 16-18, 2001 and the Canadian kickoff was held in Toronto on May 29, 2001. The UK will have individual site initiation. As of October 17, 2005 there have been 357 patients enrolled in OPTIMA, at 64 sites in the three countries (279 in the VA, 41 in Canada and 37 in the UK). To date there are 64 sites actively participating in the study (24 in the VA, 19 in UK and 21 in Canada). Last date of patient follow-up was December 31, 2007.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 368

Inclusion Criteria

Ability to provide informed consent
Age of 18 years or more
Serologic or virologic diagnosis of HIV infection
Failure of at least two different multi-drug regimens that include drugs of all 3 classes that the patient can tolerate or laboratory evidence of resistance to drugs in each of the 3 classes
Had at least 3 months of current ART and are still on treatment
Two most recent results (which can include screening) on current ART of CD4 count less than or equal to 300 cells/mm3 or less than or equal to 15%, and a plasma viral load greater than or equal to 5,000 copies/ml (Roche Amplicor, v1.0), or greater than or equal to 2,500 copies/ml (by bDNA: Bayer v3.0/Chiron v3.0 or PCR:Roche Amplicor Monitor/COBAS v1.5)

Exclusion Criteria

Pregnancy, breast-feeding or planned pregnancy
Likelihood of poor protocol follow-up or if Mega-Art is not feasible (due to significant intolerance of many ARV drugs)
Serious, uncontrolled major opportunistic infection (OI) within 14 days of screening
Likelihood of early death due to non-HIV disease

Study & Design

Study Type: INTERVENTIONAL

Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
ARDFP+Mega-ART	Standard ART vs Mega ART	Antiretroviral Drug-Free Period (ARDFP) and Mega-ART
No ARDFP+Standard-ART	Standard ART vs Mega ART	No Antiretroviral Drug-Free Period (No ARDFP) and Standard-ART
ARDFP+Standard-ART	Standard ART vs Mega ART	Antiretroviral Drug-Free Period (ARDFP) and Standard-ART
ARDFP+Mega-ART	No Antiretroviral Drug-Free Period (No ARDFP) vs ARDFP	Antiretroviral Drug-Free Period (ARDFP) and Mega-ART
ARDFP+Standard-ART	No Antiretroviral Drug-Free Period (No ARDFP) vs ARDFP	Antiretroviral Drug-Free Period (ARDFP) and Standard-ART
No ARDFP+Standard-ART	No Antiretroviral Drug-Free Period (No ARDFP) vs ARDFP	No Antiretroviral Drug-Free Period (No ARDFP) and Standard-ART
No ARDFP+Mega-ART	No Antiretroviral Drug-Free Period (No ARDFP) vs ARDFP	No Antiretroviral Drug-Free Period (No ARDFP) and Mega-ART
No ARDFP+Mega-ART	Standard ART vs Mega ART	No Antiretroviral Drug-Free Period (No ARDFP) and Mega-ART

Primary Outcome Measures

Name	Time	Method
Number of Participants With New or Recurrent AIDS Event, or Death	From date of randomization until onset of primary outcome or end of study follow-up (12/31/2007) whichever occured first, up to 6.5 years	New or recurrent AIDS event or Death were compared between No ARDFP (continuation)+Standard-ART (standard), No ARDFP (continuation)+Mega-ART (intensification), ARDFP (interruption)+Standard-ART (standard) and ARDFP (interruption)+Mega-ART (intensification)

Secondary Outcome Measures

Name	Time	Method
Number of Participants With a New, Non-HIV Related Serious Adverse Event	From date of randomization until onset of secondary outcome or end of study follow-up (12/31/2007) whichever occured first, up to 6.5 years	New, on-study non-HIV related Serious Adverse events were compared between Standard-ART (standard) and Mega-ART (intensification)
Number of Participants With New, Non-HIV Related Serious Adverse Event	From date of randomization until onset of secondary outcome or end of study follow-up (12/31/2007) whichever occured first, up to 6.5 years	New, on-study non-HIV related Serious Adverse events were compared between ARDFP (interruption) and No ARDFP (continuation)

Trial Locations

Locations (30): VA Palo Alto Health Care System
🇺🇸
Palo Alto, California, United States
VA Medical Center, Long Beach
🇺🇸
Long Beach, California, United States
VA Connecticut Health Care System (West Haven)
🇺🇸
West Haven, Connecticut, United States
New York Harbor HCS
🇺🇸
New York, New York, United States
VA Medical Center, San Juan
🇵🇷
San Juan, Puerto Rico
Carl T. Hayden VA Medical Center
🇺🇸
Phoenix, Arizona, United States
VA San Diego Healthcare System, San Diego
🇺🇸
San Diego, California, United States
Bay Pines VAMC (111J)
🇺🇸
St. Petersburg, Florida, United States
Jesse Brown VAMC (WestSide Division)
🇺🇸
Chicago, Illinois, United States
VA Medical Center, Cleveland
🇺🇸
Cleveland, Ohio, United States
VA Medical Center, Jamaica Plain Campus
🇺🇸
Boston, Massachusetts, United States
VA Medical Center, Durham
🇺🇸
Durham, North Carolina, United States
WJB Dorn Veterans Hospital, Columbia
🇺🇸
Columbia, South Carolina, United States
VA Medical Center, Cincinnati
🇺🇸
Cincinnati, Ohio, United States
VA Medical Center, Philadelphia
🇺🇸
Philadelphia, Pennsylvania, United States
VA North Texas Health Care System, Dallas
🇺🇸
Dallas, Texas, United States
Michael E. DeBakey VA Medical Center (152)
🇺🇸
Houston, Texas, United States
VA South Texas Health Care System, San Antonio
🇺🇸
San Antonio, Texas, United States
VA Medical Center, Portland
🇺🇸
Portland, Oregon, United States
VA Greater Los Angeles Healthcare System, West LA
🇺🇸
West Los Angeles, California, United States
North Florida/South Georgia Veterans Health System
🇺🇸
Gainesville, Florida, United States
VA Medical Center, DC
🇺🇸
Washington, District of Columbia, United States
VA Medical Center, Miami
🇺🇸
Miami, Florida, United States
VA Maryland Health Care System, Baltimore
🇺🇸
Baltimore, Maryland, United States
Edward Hines, Jr. VA Hospital
🇺🇸
Hines, Illinois, United States
VA New Jersey Health Care System, East Orange
🇺🇸
East Orange, New Jersey, United States
VA Medical Center, Bronx
🇺🇸
Bronx, New York, United States
West Palm Beach VA Medical Center
🇺🇸
West Palm Beach, Florida, United States
VA Ann Arbor Healthcare System
🇺🇸
Ann Arbor, Michigan, United States
Atlanta VA Medical and Rehab Center, Decatur
🇺🇸
Decatur, Georgia, United States