The RV254/SEARCH 010 study is an ongoing prospective, open-label study in Bangkok, Thailand (clinicaltrials.gov identification NCT00796146). The study was approved by the institutional review boards (IRBs) of Chulalongkorn University in Thailand and the Walter Reed Army Institute of Research in the United States. All subjects gave informed consent. Samples from subjects who had VCT for HIV at The Thai Red Cross Anonymous Clinic and at the Silom Community Clinic were screened in real-time by pooled NAT and sequential EIA according to published methods [13] (link). Thai subjects who fit the AHI laboratory criteria for Fiebig stages I to IV [14] (link) were enrolled (Figure 1 ) and had clinical and laboratory assessments at days 0, 2, 3, 5, 7, 10, weeks 2, 4, 8, 12, 16, 20, 24, and every 12 weeks thereafter up to 192 weeks. A checklist of ARS symptoms was employed by an HIV physician to assess all potential symptoms at the baseline and subsequent visits until all symptoms had resolved.
Laboratory assessments included CD4, HIV RNA, liver transaminases, creatinine, lipids and urinalysis. Plasma and peripheral blood mononuclear cells (PBMCs) were cryopreserved at all visits. Sampling of gut-associated lymphoid tissue (GALT) occurred at weeks 0 and 24 by sigmoidoscopy as an optional procedure (24 subjects at baseline and 13 subjects at week 24), and mucosal mononuclear cells (MMCs) were isolated from GALT.
Initiation of ART was voluntary and done as part of enrollment in an accompanying local protocol (clinicaltrials.gov identification NCT00796263), approved by the Chulalongkorn University IRB, and all subjects gave informed consent. Treatment was started on average 3 days (range 0–5 days) from enrollment. The regimen consisted of 5 antiretrovirals [tenofovir (TDF) 300 mg once daily, emtricitabine (FTC) 200 mg once daily, efavirenz (EFV) 600 mg once daily, raltegravir (RAL) 400 mg twice daily and maraviroc (MVC) 600 mg twice daily] for the first 24 weeks followed by simplification to 3 drugs with TDF, FTC and EFV. EFV was discontinued in subjects with intolerance or resistance, in which case dose adjustment of MVC to 300 mg twice daily was implemented. The first 10 subjects received the 5-drug regimen. Subsequently subjects were randomized 1∶1 (in a block of 30) to 5 drugs (MegaHAART) vs. 3 drugs (HAART with TDF, FTC, EFV) ART.
Laboratory assessments included CD4, HIV RNA, liver transaminases, creatinine, lipids and urinalysis. Plasma and peripheral blood mononuclear cells (PBMCs) were cryopreserved at all visits. Sampling of gut-associated lymphoid tissue (GALT) occurred at weeks 0 and 24 by sigmoidoscopy as an optional procedure (24 subjects at baseline and 13 subjects at week 24), and mucosal mononuclear cells (MMCs) were isolated from GALT.
Initiation of ART was voluntary and done as part of enrollment in an accompanying local protocol (clinicaltrials.gov identification NCT00796263), approved by the Chulalongkorn University IRB, and all subjects gave informed consent. Treatment was started on average 3 days (range 0–5 days) from enrollment. The regimen consisted of 5 antiretrovirals [tenofovir (TDF) 300 mg once daily, emtricitabine (FTC) 200 mg once daily, efavirenz (EFV) 600 mg once daily, raltegravir (RAL) 400 mg twice daily and maraviroc (MVC) 600 mg twice daily] for the first 24 weeks followed by simplification to 3 drugs with TDF, FTC and EFV. EFV was discontinued in subjects with intolerance or resistance, in which case dose adjustment of MVC to 300 mg twice daily was implemented. The first 10 subjects received the 5-drug regimen. Subsequently subjects were randomized 1∶1 (in a block of 30) to 5 drugs (MegaHAART) vs. 3 drugs (HAART with TDF, FTC, EFV) ART.
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