The purpose of this study is to evaluate whether a monotherapy of boosted darunavir is able to maintain the virological success until 48 weeks in comparison to a standard therapy 2 INTI + darunavir/r in HIV infected patients with full viral suppression.
The chronicity of the disease which will require treatment over decades, long-term adverse events associated with standard combined antiretroviral therapy, emphasize the need for simpler, alternative treatment strategies for HIV infection. The goal of antiretroviral therapy in 2006 is the durability of treatment with less toxicity and reduced exposure to drugs. Previous studies have shown that single boosted PI maintenance therapy such as lopinavir (LPV/r), were effective in maintaining virological efficacy. Furthermore, in case of virological failure, limited resistance has been described. darunavir/r, a new PI, has been shown to be highly potent, exhibits a high genetic barrier to resistance and appears to be well tolerated. This study aimed to evaluate whether darunavir/r can represent a potential strategy therapeutic as single therapy in patients who have full virologic suppression At entry, subjects with HIV RNA below 50 cp/ml switch from their current therapy which can be 2 NRTI and IP, 2 NRTI and NNRTI, 3 NRTI to darunavir/r with their 2 NRTIs for 8 weeks (Phase I). If patients remain below 50 cp/ml and has no intolerance to darunavir at week -4, they are included in the phase II and will be randomized either to receive darunavir/r alone or to continue 2 NRTI and darunavir/r for until W48 (Phase II). Patients will be monitored at W4, W8 and then every 8 weeks until W48 for the primary endpoint. To evaluate the durability and safety of this strategy, patients will be followed up to W96
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
225
Service des maladies infectieuses et tropicales Hopital Pitie salpetriere
Paris, France
Proportion of patients with virological success, the virological failure is defined as 2 consecutive plasma viral load measurements greater or equal to 400 cp/ml within 2 weeks at W48
Time frame: W48
Proportion of patients with virological success between W48 and W96,
Time frame: W96
Proportion of patients with HIV-1 RNA below 50 copies/mL, between 50 to 400 copies/mL and > 400 copies/ml from D0 to W96,
Time frame: W96
Time to virologic failure,
Time frame: between W0 and W96
PI genotypic resistance mutations occurring during the follow-up
Time frame: between W0 and W96
Change in proviral DNA at D0, W48 and W96,
Time frame: W0, W48 and W96
Change in CD4 count from D0 to W96.
Time frame: D0, W96
Comparing plasma HIV-1 RNA genotypic resistance with DNA genotypic resistance at entry
Time frame: D0
Quantification of HIV RNA in the genital compartment between D0 and W48 (sub-study with 40 patients enrolled, 20 patients in each arm of strategy).
Time frame: D0 and W48
Incidence of clinical endpoints
Time frame: W96
Modification of treatment strategies and withdrawal of study treatment.
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Time frame: between D0 and W96
Tolerance of Darunavir (Grade 3 and 4 laboratory abnormalities and signs and symptoms).
Time frame: between D0 and W96
Change in lipidic and glucidic profile and distribution of fat tissue by DEXA-scan (sub-study in 160 patients enrolled).
Time frame: W0, W48 and W96
Self-reported adherence and symptom self-evaluation.
Time frame: W0, W4, W24, W48, W96
The proportion of patients with HIV RNA below 50 copies/mL in darunavir/r monotherapy arm after resuming 2 previous NRTIs in case of virological failure.
Time frame: between W0 and W96
Search for predictive factors of virological failure (level of proviral DNA, Cmin LPV, …).
Time frame: between W0 and W96
evaluation of the mineral bone density by DEXA-scan (sub-study in 160 patients enrolled).
Time frame: W96