The purpose of this study is to demonstrate the effectiveness of Symtuza® in a rapid reinitiation model of care in patients with HIV-1 infection and who are treatment-experienced but have been off of antiretroviral therapy (ART) for 12 or more weeks.
In the United States, only 49 percent of persons living with HIV infection are currently retained in care (Centers for Disease Control, 2018). Many individuals initially start antiretroviral therapy (ART) but fall out of care and discontinue treatment, only to reenter care at a later date. Gaps in care contribute to the likelihood that a patient might not have a recent viral load or CD4 count, as well as knowledge of previous ART regimens or resistance data. Furthermore, high plasma HIV-1 RNA is a major risk factor for HIV transmission, and effective ART can reduce viremia and transmission of HIV to sexual partners by more than 96% (Cohen et al., 2011; Palella et al., 1998). Thus, a secondary goal of ART is to reduce the risk of HIV transmission. Traditional models of care have an initial period where a person is brought back into care and assessed by a healthcare provider on various factors, including HIV RNA level, genotypic/ phenotypic resistance, immune status, renal/hepatic function, and general medical comorbidities before reinitiating ART. These steps can add weeks without treatment and, in turn, delay resupression of the virus and immune system improvement, as well as continuing to contribute to the community viral load and offering more opportunities for the person to fall out of care again. (Horburg et al., 2013) This traditional model places a burden on both the patient and the healthcare system as multiple visits are required, each one a potential point where the patient can be lost again to follow-up. A rapid reinitiation of ART for persons who have fallen out of care is a potential intervention that could improve retention rates, patient satisfaction, and clinical outcomes. Given these factors, the single-tablet regimen of D/C/F/TAF (Symtuza®) may serve as an ideal regimen for a Rapid Reinitiation model of care, combining potency, sustained efficacy, a high genetic barrier to resistance, with a well-described safety profile of the individual components, and practical, convenient dosing. This prospective, multicenter study will follow subjects for 48 weeks with subjects either returning to the site or having a virtual visit (TeleVisit) for Weeks 2, 4, 12, 24, 36, and 48. Baseline safety labs will dictate whether the ART regimen will need to be modified but will not be required to be completed at the initiation of ART. Assessment of drug accountability, reasons for non-adherence, recording of concomitant therapies, adverse events, weight, physical examinations (complete or symptom-directed), laboratory evaluations (for efficacy and safety), and health outcome assessments will be performed from baseline onwards.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
75
Participants will receive Symtuza®. An oral tablet containing Darunavir 800 mg /Cobicistat 150 mg /Emtricitabine 200 mg /Tenofovir Alafenamide 10 mg FDC, once daily within 24 hours of the screening/ baseline visit.
The Crofoot Research Center, Inc.
Houston, Texas, United States
The proportion of subjects who have HIV-1 RNA <50 copies/mL at week 48
The proportion of subjects who have HIV-1 RNA \<50 copies/mL at week 48 as defined by the FDA snapshot analysis (ITT)
Time frame: 48 week
Proportion of subjects who have HIV-1 RNA <50 copies/mL at week 48
Proportion of subjects who have HIV-1 RNA \<200 copies/mL at week 48 as defined by the per-protocol (PP) analysis set
Time frame: Week 48
Proportion of subjects who have HIV-1 RNA <50 copies/mL at week 48
Proportion of subjects who have HIV-1 RNA \<200 copies/mL at week 48 as defined by the FDA snapshot analysis (ITT)
Time frame: Week 48
Proportion of subjects who have HIV-1 RNA <200 copies/mL at week 24
Proportion of subjects who have HIV-1 RNA \<200 copies/mL at week 24 as defined by the FDA snapshot analysis (ITT)
Time frame: Week 24
Change from baseline in HIV-1 RNA viral load
Change from baseline in log10 HIV-1 RNA viral load at Weeks 24 and 48
Time frame: Weeks 24 and 48
Change in baseline CD4 cell count
Change in baseline CD4 cell count at Weeks 12, 24, and 48
Time frame: Weeks 12, 24, and 48
Discontinuation after enrollment based on study stopping rules
Proportion of subjects that required discontinuation after enrollment based on study stopping rules
Time frame: Week 48
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Discontinuation due to adverse events
Proportion of subjects discontinuing therapy due to adverse events
Time frame: Week 48
Proportion of subjects experiencing grade 3 and 4 adverse events
Proportion of subjects experiencing grade 3 and 4 adverse events
Time frame: Week 48
Proportion of subjects experiencing serious adverse events
Proportion of subjects experiencing serious adverse events
Time frame: Week 48
Proportion of subjects experiencing grade 3 and 4 laboratory abnormalities
Proportion of subjects experiencing grade 3 and 4 laboratory abnormalities
Time frame: Week 48
Proportion of subjects meeting resistance stopping rules requiring discontinuation of study drugs due baseline resistance findings
Proportion of subjects meeting resistance stopping rules requiring discontinuation of study drugs due baseline resistance findings
Time frame: Week 48
Proportion of subjects with baseline RT, INI, and PR (primary and secondary) RAMs
Proportion of subjects with baseline RT, INI, and PR (primary and secondary) RAMs
Time frame: Week 48
Proportion of subjects developing RAMs and loss of phenotypic susceptibility, when available, upon meeting PDVF
Proportion of subjects developing RAMs and loss of phenotypic susceptibility, when available, upon meeting PDVF
Time frame: Week 48
Proportion of subjects with PDVF at Week 24 and Week 48
Proportion of subjects with PDVF at Week 24 and Week 48
Time frame: Weeks 24 and 48
Proportion of subjects lost to follow-up throughout the 48 Weeks of treatment
Proportion of subjects lost to follow-up throughout the 48 Weeks of treatment
Time frame: Week 48
Proportion of subjects taking study drug at Week 48 who have a documented clinic visit with a healthcare provider within 90 days of Week 48 visit.
Proportion of subjects taking study drug at Week 48 who have a documented clinic visit with a healthcare provider within 90 days of Week 48 visit.
Time frame: Week 48
Mean total satisfaction scores on the HIVTSQs at Weeks 4, 24, and 48
Mean total satisfaction scores on the HIVTSQs at Weeks 4, 24, and 48
Time frame: Weeks 4, 24, and 48
Mean total depression scores on the PHQ-9 at baseline and Weeks 4, 24, and 48
Mean total depression scores on the PHQ-9 at baseline and Weeks 4, 24, and 48
Time frame: Weeks 4, 24, and 48
Adherence as measured by pill count at Weeks 4, 12, 24, and 48
Adherence as measured by pill count at Weeks 4, 12, 24, and 48
Time frame: Weeks 4, 12, 24, and 48