Long term toxicity of combination antiretroviral therapy (cART) is a substantial contributor to morbidity and mortality in chronically infected HIV positive individuals. To date it is still debated, whether long term nucleoside reverse transcriptase inhibitors (NRTI's) -sparing regimens are practicable or even superior compared to standard of care cART in terms of efficacy, safety and tolerability. In addition, data about efficacy of integrase inhibitor (INSTI) based monotherapy is lacking. We aim at investigating the efficacy of standard of care combination antiretroviral therapy with a simplified dolutegravir monotherapy in patients with a primary HIV-1 infection under suppressive early standard of care antiretroviral therapy. Briefly, hundred-thirty-eight patients with a documented primary HIV1- infection (PHI) will be recruited from the Zurich Primary HIV-1 Infection Study (ZHPI), which is an open label, non-randomized, observational, single-center study (http://clinicaltrials.gov, ID 5 NCT00537966). All subjects formerly underwent early cART consisting of either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a INSTI in combination with two NRTIs at the time point of enrolment in the ZPHI and must be under a fully suppressive ART (i.e., \<50 copies/ml) for at least 48 weeks at the time point of randomisation. The primary end point is the proportion of individuals with a viral failure at week 48 or before.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
101
92 patients will be simplified to once daily dolutegravir monotherapy
University Hospital Zurich, University of Zurich
Zurich, Switzerland
Proportion of individuals with a viral failure [defined as ≥2 plasma viremia levels >50copies/ml at least two weeks apart] at week 48 or before.
The study seeks primarily to determine the efficacy (i.e., proportion of patients with a viral failure \[defined as ≥2 plasma viremia levels \>50copies/ml at least two weeks apart\] at week 48 or before) of a simplified monotherapy (i.e., DTG) compared to a standard of care HIV triple-therapy in patients with a PHI treated with early ART under long term suppressive ART for at least 48 weeks.
Time frame: 48 weeks
Quantification of latent HIV-1 reservoir by measurement of proviral DNA and cell-associated RNA at baseline (time point of randomization), and at week 48
Time frame: Week48
Proportion of individuals with a CSF HIV-1 RNA <50copies/ml in the CSF at week 48 after treatment simplification.
Time frame: Week 48
Proportion of patients with an adverse event at week 48.
Time frame: Week 48
Proportion of patients with a severe adverse event at week 48.
Time frame: Week 48
Time to viral failure (defined as ≥2 plasma viremia levels >50copies/ml at least two weeks apart) at week 48.
Time frame: Week 48
Proportion of individuals with blips (defined as one viral load >50 and <400 copies/ml with a next viral load <50 copies/ml) at week 48.
Time frame: Week 48
Change from baseline CD4+ cell count from baseline at week 48.
Time frame: Week 48
Proportion of individuals with new onset of proximal tubular renal dysfunction at week 48.
Time frame: Week 48
Creatinine clearance change from baseline at week 48.
Time frame: Week 48
Lipidic profile changes from baseline at week 48.
Time frame: Week 48
Proportion of individuals developing a new CDC-event at week 48.
Time frame: Week 48
Proportion of individuals withdrawing consent at week 48.
Time frame: Week 48
Proportion of individuals being lost to follow-up at week 48.
Time frame: Week 48
Proportion of individuals switching assigned treatment for any cause at week 48.
Time frame: Week 48
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