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A Randomized, Double-Blind, Four-Arm Study Comparing Combination Nucleoside, Alternating Nucleoside, and Triple-Drug Therapy for the Treatment of Advanced HIV Disease (CD4 <= 50/mm3)


Phase 2
13 Years
N/A
Not Enrolling
Both
HIV Infections

Thank you

Trial Information

A Randomized, Double-Blind, Four-Arm Study Comparing Combination Nucleoside, Alternating Nucleoside, and Triple-Drug Therapy for the Treatment of Advanced HIV Disease (CD4 <= 50/mm3)


The rapid emergence of resistant HIV strains has been observed in patients receiving
monotherapy with a nucleoside analog or non-nucleoside reverse transcriptase inhibitor. Use
of combination therapy with two nucleoside drugs or convergent combination therapy with two
nucleosides and a non-nucleoside RT inhibitor may minimize the evolution of these resistant
HIV strains. Since toxicity is a major problem in patients with advanced disease who are
receiving combination nucleoside therapy, alternating the two drugs may provide a way of
retaining several benefits of combination therapy while minimizing the increased toxicity.

Patients are randomized to receive either AZT/ddC, AZT/ddI, AZT alternating monthly with
ddI, or AZT/ddI/nevirapine. Patients are evaluated at week 0 and every 4 weeks thereafter
for 2 years. Pharmacologic, virologic, and macroneurologic substudies will be conducted.
Patients who are already enrolled on protocol ACTG 193 will be given the option of
continuing on their originally assigned ACTG 193 therapy for an additional 6 months or
undergoing re-randomization to one of the four treatment arms on ACTG 193A.

Inclusion Criteria


Inclusion Criteria

Concurrent Medication:

Required:

- PCP prophylaxis.

Allowed:

- Erythropoietin maintenance.

- G-CSF and GM-CSF.

- Prophylaxis for Mycobacterium avium intracellulare.

- Antifungal prophylaxis or treatment with specific drugs.

- Maintenance therapy for opportunistic infection.

- Over-the-counter medications or alternative therapies such as vitamins and herbs.

- Antibiotics as clinically indicated.

- Steroids for < 21 days for acute problems.

- Antipyretics, analgesics, allergy medication, antidepressants, sleep medications,
oral contraceptives, or other appropriate medications.

Concurrent Treatment:

Allowed:

- Radiation therapy for cutaneous Kaposi's sarcoma.

- Acupuncture.

Patients must have:

- Documented HIV infection.

- CD4 count <= 50 cells/mm3.

- Either no prior nucleoside therapy OR a history of prior nucleoside therapy in the
absence of high-grade intolerance.

- Life expectancy of at least 6 months.

- Consent of parent or guardian if < 18 years of age.

- Normal chest x-ray at baseline or within 6 months prior to study entry in the absence
of new pulmonary or cardiac symptoms (per 12/28/94 amendment).

NOTE:

- Patients who withdrew from protocol ACTG 193 therapy prior to activation of ACTG 193A
are not eligible.

Exclusion Criteria

Co-existing Condition:

Patients with the following symptoms or conditions are excluded:

- Abnormal baseline chest x-ray.

- New pulmonary or cardiac symptoms.

- Psychological or emotional problems sufficient to prevent compliance with study
medication.

Concurrent Medication:

Excluded:

- Systemic chemotherapy for malignancy.

- Acute or induction therapy for opportunistic infection.

- Antiretroviral drugs other than study drugs.

- Biological response modifiers.

- Erythromycin, phenytoin, phenobarbital, warfarin, or coumadin.

Patients with the following prior conditions are excluded:

- History of recurrent grade 3 or greater toxicity to AZT, ddI, or ddC on two or more
occasions.

- Evidence of active pulmonary disease within 6 months prior to study entry.

- History of grade 3 or worse peripheral neuropathy.

- History of acute or chronic pancreatitis.

Prior Medication:

Excluded:

- Prior nevirapine.

Excluded within 7 days prior to study entry:

- Acute therapy for opportunistic infection (maintenance therapy is permitted).

- Acute systemic therapy for a nonopportunistic infection or other medical condition.

- Antiretroviral drugs other than AZT, ddI, or ddC.

- Biological response modifiers.

- d4T therapy.

- Nucleosides other than those used in the study.

- Antibiotics containing clavulanate potassium.

Prior Treatment:

Excluded:

- More than 4 units of blood in a 30-day period.

Active alcohol or drug abuse.

Type of Study:

Interventional

Study Design:

Endpoint Classification: Efficacy Study, Masking: Double-Blind, Primary Purpose: Treatment

Principal Investigator

Henry WK

Investigator Role:

Study Chair

Authority:

United States: Federal Government

Study ID:

ACTG 193A

NCT ID:

NCT00000781

Start Date:

Completion Date:

September 1996

Related Keywords:

  • HIV Infections
  • Zalcitabine
  • Didanosine
  • Drug Therapy, Combination
  • Acquired Immunodeficiency Syndrome
  • Zidovudine
  • Nevirapine
  • HIV Infections
  • Acquired Immunodeficiency Syndrome

Name

Location

San Francisco Gen Hosp San Francisco, California  941102859
Bellevue Hosp / New York Univ Med Ctr New York, New York  10016
Mem Sloan - Kettering Cancer Ctr New York, New York  10021
Univ of Rochester Medical Center Rochester, New York  14642
Julio Arroyo West Columbia, South Carolina  29169
Univ of California / San Diego Treatment Ctr San Diego, California  921036325
San Francisco AIDS Clinic / San Francisco Gen Hosp San Francisco, California  941102859
Stanford at Kaiser / Kaiser Permanente Med Ctr San Francisco, California  94115
Olive View Med Ctr Sylmar, California  91342
Harbor UCLA Med Ctr Torrance, California  90502
Univ of Colorado Health Sciences Ctr Denver, Colorado  80262
Univ of Miami School of Medicine Miami, Florida  331361013
Rush Presbyterian - Saint Luke's Med Ctr Chicago, Illinois  60612
Northwestern Univ Med School Chicago, Illinois  60611
Indiana Univ Hosp Indianapolis, Indiana  462025250
Harvard (Massachusetts Gen Hosp) Boston, Massachusetts  02114
Beth Israel Deaconess - West Campus Boston, Massachusetts  02215
Boston Med Ctr Boston, Massachusetts  02118
Univ of Minnesota Minneapolis, Minnesota  55455
Bronx Municipal Hosp Ctr/Jacobi Med Ctr Bronx, New York  10461
Jack Weiler Hosp / Bronx Municipal Hosp Bronx, New York  10465
Bronx Veterans Administration / Mount Sinai Hosp Bronx, New York  10468
Montefiore Med Ctr / Bronx Municipal Hosp Bronx, New York  10467
SUNY / Erie County Med Ctr at Buffalo Buffalo, New York  14215
City Hosp Ctr at Elmhurst / Mount Sinai Hosp Elmhurst, New York  11373
Cornell Univ Med Ctr New York, New York  10021
Mount Sinai Med Ctr New York, New York  10029
SUNY / State Univ of New York Syracuse, New York  13210
Univ of North Carolina Chapel Hill, North Carolina  275997215
Med College of Ohio Toledo, Ohio  43699
Milton S Hershey Med Ctr Hershey, Pennsylvania  170330850
Univ of Tennessee / E Tennessee Comprehensive Hemophilia Ctr Knoxville, Tennessee  37920
Univ of Washington Seattle, Washington  98105
Great Lakes Hemophilia Foundation Milwaukee, Wisconsin  53233
Univ of South Florida Tampa, Florida  33612
St Louis Regional Hosp / St Louis Regional Med Ctr St Louis, Missouri  63112
Columbus Children's Hosp Columbus, Ohio  432052696
Univ of Alabama at Birmingham Birmingham, Alabama  35294
Univ of Southern California / LA County USC Med Ctr Los Angeles, California  900331079
Cook County Hosp Chicago, Illinois  60612
Hennepin County Med Clinic Minneapolis, Minnesota  55415
St Paul Ramsey Med Ctr St Paul, Minnesota  55101
Univ of Nebraska Med Ctr Omaha, Nebraska  681985130
Montefiore Drug Treatment Ctr / Bronx Municipal Hosp Bronx, New York  10461
Montefiore Family Health Ctr / Bronx Municipal Hosp Bronx, New York  10461
Samaritan Village Inc / Bronx Municipal Hosp Bronx, New York  10461
Comprehensive Health Care Ctr / Bronx Municipal Hosp Bronx, New York  10461
North Central Bronx Hosp / Bronx Municipal Hosp Bronx, New York  10467
Beth Israel Med Ctr New York, New York  10003
Saint Clare's Hosp and Health Ctr New York, New York  10019
Moses H Cone Memorial Hosp Greensboro, North Carolina  27401
Univ of Cincinnati Cincinnati, Ohio  452670405
Girard Med Ctr Philadelphia, Pennsylvania  191046073
Thomas Jefferson Univ Hosp Philadelphia, Pennsylvania  191075098
Univ of Pennsylvania at Philadelphia Philadelphia, Pennsylvania  19104
Children's Hosp of Los Angeles Los Angeles, California  90027
Huntington Memorial Hosp / Children's Hosp of Los Angeles Pasadena, California  91105
Santa Clara Valley Med Ctr / AIDS Community Rsch Consortium San Jose, California  951282699
Stanford Univ Med Ctr Stanford, California  943055107
San Mateo AIDS Program / Stanford Univ Stanford, California  943055107
Mountain States Reg Hemo Ctr / Univ of Colorado Denver, Colorado  80262
Denver Dept of Health and Hosps Denver, Colorado  80262
Rose Med Ctr Denver, Colorado  80262
Yale Univ / New Haven New Haven, Connecticut  065102483
Howard Univ Washington, District of Columbia  20059
Georgetown Univ Med Ctr Washington, District of Columbia  20007
Whitman - Walker Clinic / Georgetown Univ Med Ctr Washington, District of Columbia  200072197
HIV Ctr - District of Columbia Gen Hosp Washington, District of Columbia  200072197
George Washington Univ / Hershey Med Ctr Washington, District of Columbia  20037
Univ of Hawaii Honolulu, Hawaii  96816
Louis A Weiss Memorial Hosp Chicago, Illinois  60640
Methodist Hosp of Indiana / Life Care Clinic Indianapolis, Indiana  46202
Univ of Louisville / East Tennesee Comprehensive Hem Ctr Louisville, Kentucky  40202
Worcester Memorial Hosp / Med Ctr of Cntrl MA-Memorial Worcester, Massachusetts  01605
Dartmouth - Hitchcock Med Ctr / Med Ctr Cntrl Massachusetts Lebanon, New Hampshire  03756
Robert Wood Johnson Med School / Hershey Med Ctr New Brunswick, New Jersey  08903
Univ of Medicine & Dentistry of New Jersey / Univ Hosp Newark, New Jersey  071032714
Adirondack Med Ctr at Saranac Lake Albany, New York  122083479
Albany Med College / Division of HIV Medicine A158 Albany, New York  122083479
Mid - Hudson Care Ctr Albany, New York  122083479
Montefiore Med Ctr Adolescent AIDS Program Bronx, New York  10467
SUNY / Health Sciences Ctr at Brooklyn Brooklyn, New York  112032098
North Shore Univ Hosp Manhasset, New York  11030
Mount Sinai Med Ctr / Hemophilia Treatment Ctr New York, New York  10029
Harlem Hosp Ctr New York, New York  10037
Columbia Presbyterian Med Ctr New York, New York  100323784
Univ of Kentucky Lexington Cincinnati, Ohio  45267
MetroHealth Med Ctr Cleveland, Ohio  441091998
Case Western Reserve Univ Cleveland, Ohio  44106
Saint Michael's Med Ctr / Milton S Hershey Med Ctr Hershey, Pennsylvania  170330850
Med Univ of South Carolina / UNC Charleston, South Carolina  29425
Meharry Med College Nashville, Tennessee  37203
Univ of Texas Galveston Galveston, Texas  775550435
Univ Texas Health Science Ctr / Univ Texas Med School Houston, Texas  77030
Northern Wisconsin Hemophilia Ctr / Saint Vincent's Hosp Green Bay, Wisconsin  54301