The purpose of the study is to investigate the benefits of switching away from a kind of drug called a boosted protease inhibitor (PI) to a new drug called dolutegravir on patients' cardiovascular health (the health of their hearts). Patients are currently taking two other anti-HIV drugs, called nucleoside reverse transcriptase inhibitors (NRTIs), with their boosted PIs; these NRTIs will not be changed throughout the study. In order to compare the boosted PI and dolutegravir more accurately, half of study participants will be switched to dolutegravir immediately, and the other half will be switched after 48 weeks of continuing on the boosted PI. Boosted PIs are associated with increased heart and circulation risk so it is hoped that switching from a boosted PI to dolutegravir will improve the health of the patients' hearts. Dolutegravir is a drug for HIV treatment which has been approved for use in HIV patients in the US and Europe. Clinical trials using dolutegravir have found that it is effective at suppressing the HIV virus, and it is at least as effective as the other drugs. This study will also investigate the safety (in terms of other side effects and the routine blood tests which the investigators ordinarily use to monitor patients' treatment) and monitor effectiveness, patients' viral load and CD4 counts, when patients switch treatment from a boosted PI to dolutegravir. Viral load is the amount of the HIV virus they have in their blood, and CD4 count is a measure of a type of cell that is in their immune system. We also aim to improve patients' cardiovascular health in general by providing them with information on how to live a healthy lifestyle (eg improving their diet, stopping smoking etc).
Study Design: Randomised, non-inferiority strategic trial over 96 weeks with early or delayed switch from an ARV regimen containing a boosted PI plus 2 NRTIs to dolutegravir (DTG) plus 2 NRTIs in patients having achieved complete virological suppression for more than 24 weeks (HIV-1 RNA \<50 c/ml). Patients will be randomised to switch at baseline or at 48 weeks. Study visits will take place at screening, baseline, weeks 4 (immediate switch group only), 12, 24, 36, 48, 52 (deferred switch group only), 60, 72, 84 and 96, plus a follow up visit 28 days after the last dose of study medication. Routine investigations will include viral load, CD4, haematology (including haemoglobin, white cell count and differential, platelets), biochemistry (including sodium, potassium, creatinine, albumin, glucose, ALT, ALP, total bilirubin, total cholesterol, HDL, LDL, triglycerides), quality of life questionnaires (EuroQL), urine sample (for haematuria, proteinuria, glycosuria, leukocytes, nitrate \& pregnancy test in WOCBP)
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
415
Dolutegravir 50mg once daily
Insititute Of Tropical Medicine Antwerp
Antwerp, Belgium
CHU Saint-Pierre
Brussels, Belgium
Universitaire Ziekenhuis Gent
Ghent, Belgium
Hopital de la Croix Rousse
Lyon, France
Service des Maladies Infectieuses et Tropicales du CHU de NANTES
Nantes, France
Hopital Saint Louis
Virological suppression
Maintenance of virological suppression (ie HIV-1 RNA \<50 c/ml) after 48 weeks
Time frame: 48 weeks
Total cholesterol
Change from baseline in total cholesterol at week 48
Time frame: 48 weeks
Virological Suppression
Maintenance of virological suppression (ie HIV-1 RNA \<50 c/ml) at week 24 and 96
Time frame: 24 - 96 weeks
CD4 count from baseline
Change in CD4 count from baseline to week 24, 48 and 96
Time frame: 24 - 96 weeks
Baseline in total cholesterol
Change from baseline in total cholesterol at weeks 24 and 96
Time frame: 24 - 96 weeks
Change from baseline to lipid values
Change from baseline to lipid values (LDL, HDL, triglycerides and TC:HDL ratio) and Framingham and DAD scores at weeks 24, 48 and 96
Time frame: 24 - 96 weeks
Safety
Safety (clinical and laboratory adverse events) at weeks 24, 48 and 96
Time frame: 24 - 96 weeks
Changes in markers of inflammation
Changes in markers of inflammation at baseline, week 48 and week 96
Time frame: 48 - 96 weeks
Tolerability
Tolerability (EuroQoL questionnaire) at weeks 24, 48 and 96
Time frame: 24 - 96 weeks
Changes in markers of coagulation
Changes in markers of coagulation at baseline, week 48 and week 96
Time frame: 48 - 96 weeks
Changes in markers of endothelial dysfunction
Changes in markers of endothelial dysfunction at baseline, week 48 and week 96
Time frame: 48 - 96 weeks
Change to arterial stiffness augmentation index at weeks 48 and 96
Change from baseline to arterial stiffness augmentation index at weeks 48 and 96
Time frame: 48 - 96 weeks
Change to average thickness of common carotid artery walls at weeks 48 and 96
Change from baseline to average thickness of common carotid artery walls at weeks 48 and 96
Time frame: 48 - 96 weeks
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Paris, France
Pitié-Salpêtrière Hospital
Paris, France
Hospital Bichat Claude-Bernard
Paris, France
Universitätsklinikum Bonn
Bonn, Germany
Universitätsklinikum Essen
Essen, Germany
...and 23 more locations