Immune Reconstitution of Lopinavir/Ritonavir-Based vs Efavirenz-based HAART in Advanced HIV Disease

DESIGN: ICE-001 is a phase IV, randomized, two-arm unblinded study, comparing the effect on immune reconstitution of open-label ritonavir (RTV)-enhanced lopinavir (LPV) to efavirenz (EFV), in combination with daily emtricitabine (FTC)/tenofovir (TDF) as initial therapy for HIV-1 infection in HIV-infected treatment naïve subjects with CD4+ T-cells less than 200 cells/ml. DURATION: Subjects will participate in ICE-001 for approximately 48 weeks after starting study treatment. SAMPLE SIZE: ICE-001 will enroll 60 subjects (30 per treatment arm). POPULATION: HIV-1-infected, antiretroviral (ARV) drug-naïve (≤7 days of ARV treatment at anytime prior to study entry) men and women between18 to 60 years of age with plasma HIV-1 RNA levels \>1000 copies/mL and CD4+ T-cell counts \< 200 cells/ml obtained within 90 days prior to study entry. STRATIFICATION: Subjects will be stratified at screening based on plasma HIV-1 RNA levels \<100,000 and ≥100,000 copies/mL. REGIMEN: At entry subjects will be randomized to one of the following: * ARM A: LPV 400 mg/RTV 100 mg BID + FTC 200 mg/TDF 300 mg QD * ARM B: EFV 600 mg QD/FTC 200 mg/TDF 300 mg fixed dose combination QD The objective is to determine the differences in the degree of immune reconstitution in HIV-infected patients with a CD4+ T-cell count \< 200 cells/ml who initiated treatment with LPV/RTV + FTC/TDF compared to EFV/FTC/TDF. Study visits will occur at screening, pre-entry, entry and weeks 1, 4, 8, 12, 24 and 48 after study entry. Study medications will be provided at entry after randomization. At most study visits, clinical assessments, including histories, physical exams and determination of drug adherence, will occur. Blood for hematologic and metabolic safety assessments and for the assessment of immune parameters will be obtained. Immune parameters that will be measured include levels of T-cell apoptosis, maturation and activation. Frequencies of various T-cell subsets and other lymphocyte populations will also be done. Response to vaccination with tetanus-diphtheria vaccine and 23-valent pneumococcal polysaccharide vaccine (both given at week 8) will be measured.