Conditions: HIV Impaired Cognition
Keywords: HIV
Allocation: RANDOMIZED | Intervention model: PARALLEL
Enrollment: 60
Healthy volunteers: no

Brief summary:
The purpose of this study is to compare two different combination anti-HIV therapies over 48 weeks and to assess if differences in improvement in the function of the brain are observed over this period.

The study will compare anti-HIV therapy combinations which are currently in use.

The patients will not have had any previous treatment for their HIV infection.

Detailed description:
Impairment in neurocognitive(NC) function in HIV-infected subjects in the current anti-retroviraltreatment (cART) era has been associated with poor compliance with cART, reduced quality-of-life and increased mortality. Reported factors associated with the development of NC function impairment in HIV disease and risks associated with progression of such impairment include degree of immune suppression related to HIV infection, other chronic viral infections (such as chronic hepatitis C co-infection), age and central nervous system (CNS) antiretroviral drug exposure.

One modifiable factor which may be associated with the evolution of NC function impairment is the direct effect of cART on the central-nervous-system (CNS). Certain antiretroviral drugs such as zidovudine, lamivudine, abacavir, nevirapine, efavirenz and indinavir are known to achieve optimal exposure in the cerebro-spinal-fluid (CSF) whereas other drugs, such as the majority of the HIV-1 protease inhibitors penetrate less effectively. Studies to date suggest different cART regimens may have differing effects on NC performance. In the EuroSIDA study, the use of nucleoside-reverse-transcriptase inhibitors was found to specifically protect against the development of HIV related brain disease. More recently, in a small prospective study, ALTAIR, different effect on cerebral function was reported in subjects randomised to commence three different cART regimens.

The investigators propose, in a prospective, randomised study to assess the effects of two different antiretroviral regimens on NC function in HIV infected subjects commencing antiretroviral therapy for the first time.

Arms:
arm 1: treatment with:

* atazanavir 300 mg daily
* ritonavir 100 mg daily
* tenofovir 245 mg daily\*
* emtricitabine 200 mg daily\* \* as the fixed dose combination Truvada™ arm 2: * darunavir 800 mg daily
* ritonavir 100 mg daily
* lamivudine 300 mg daily\*\*
* abacavir 600 mg daily\*\*
* maraviroc 150 mg once daily \*\* as the fixed dose combination Kivexa ™

Interventions: intervention 1: standard care intervention 2: novel treatment
Intervention descriptions: intervention 1: * atazanavir 300 mg daily
* ritonavir 100 mg daily
* tenofovir 245 mg daily\*
* emtricitabine 200 mg daily\* intervention 2: * darunavir 800 mg daily
* ritonavir 100 mg daily
* lamivudine 300 mg daily\*\* and abacavir 600mgs daily\*\*
* maraviroc 150 mg once daily

Protocol document: