HIV-1 infected subjects that experience virological failure while on non nucleoside reverse-transcriptase inhibitors (NNRTIs), including those with the K103N mutation, are usually switched to a boosted Protease Inhibitor (PI)-based regimen or other antiretroviral (ARV) combinations. The same is true for subjects who need to start antiretroviral therapy and have acquired virus that is already resistant to antiretrovirals. These "second line" combinations are often associated with numerous issues that can have a potential impact on the quality of life (QoL) of these patients. Therefore a simpler and better tolerated alternative second line treatment option would be a useful tool for the clinical management of these patients. The aim of this study is to assess the efficacy and tolerability of a dual combined therapy of Dolutegravir (DTG) 50 mg Once Daily (OD) + Rilpivirine (RPV) 25 mg OD in virologically suppressed participants with previous virological failure with NNRTIs and having the clinically significant mutation K103N. The secondary objective of the study is to assess whether a simplification of the treatment in terms of pill burden, long term metabolic toxicity and potential for drug interactions improves the QOL of the participants. The study will also evaluate DTG \& RPV concentrations in the blood plus changes in cell associated virus. In order to compare the first line treatment (boosted PI and/or other antiretroviral combinations) and the DTG+RPV combination, two thirds of study participants will be switched to DTG+RPV immediately and receive DTG+RPV for 96 weeks. The other third will be switched after 48 weeks of continuing on their first line treatment and receive DTG+RPV for 48 weeks. All participants will then be followed up for a further 30 days. Participants will be recruited from sites across Europe, and randomised onto either arm of the study. After randomisation, participants will attend approximately 10 visits over the course of two years.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
140
Daily oral tablet
Institute of Tropical Medecine
Antwerp, Belgium
St Pierre University Hospital
Brussels, Belgium
CHU Hotel Dieu
Nantes, France
Hospital Saint Louis
Paris, France
Pitié-salpêtrière Hospital
Paris, France
University Bonn
Bonn, Germany
University Essen
Essen, Germany
Frankfurt University Hospital
Frankfurt, Germany
ICH Study Center, Hamburg
Hamburg, Germany
AAST delgi spedali civili di Brescia
Brescia, Italy
...and 19 more locations
Number of Participants With and Without Virological Suppression
Virological Suppression is defined as \<50 copies/ml HIV RNA
Time frame: 48 weeks
Number of Participants With and Without Virological Suppression
Virological Suppression is defined as \<50 copies/ml HIV RNA
Time frame: week 96
Changes in Blood Cell Counts - Red Blood Cells
red blood cell count evaluation
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Blood Cell Counts - White Blood Cells
white blood cell count evaluation
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Blood Cell Counts - Platelets
platelet count evaluation
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Blood Cell Counts - Haemoglobin
Haemoglobin count evaluation
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Change From Baseline in Sodium
Change from baseline in Sodium
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Liver Levels - Bilirubin
Liver level evaluation - bilirubin
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Liver Levels - Alanine Aminotransferase (ALT)
Liver level evaluation - ALT
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Renal Markers - Creatinine Clearance (Estimated Glomerular Filtration Rate(eGFR))
Renal markers evaluation- creatinine clearance (eGFR)
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Change From Baseline in Glucose
Change from baseline in Glucose
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Renal Markers - Creatinine
Renal markers evaluation - creatinine
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Bone Markers - Alkaline Phosphatase
Bone markers evaluation - Alkaline phosphatase
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Fasting Lipids From Baseline - Total Cholesterol
Fasting lipids level evaluation - total cholesterol
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Fasting Lipids From Baseline - High Density Lipoprotein (HDL)
Fasting lipids level evaluation - HDL
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Quality of Life Health Status Score
Questionnaire (EQ-5D-3L) Mobility, Self-care, Usual activities, Pain/Discomfort and Anxiety/Depression are recorded on 3 point scale (tick boxes), which indicates the severity of problems the participant has with each of these activities. Patients will select No problems, Some problems or Extreme problems/Unable to perform. Patients also report their current Health State on a Scale from 1 to 100 on which the best state you can imagine is marked 100 and the worst state you can imagine is marked 0.
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Patient Satisfaction - HIV Treatment Satisfaction Questionnaire (HIVTSQs)
HIV Treatment Satisfaction Questionnaire (HIVTSQs) Answers are recorded on a scale from 0 to 6, with 0 being least satisfied and 6 being most satisfied.
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Number of Participants With Adverse Events - Baseline to Week 48
Adverse Events reports (AEs, SAEs and treatment discontinuation)
Time frame: Baseline to week 48
Number of Drug Drug Interactions
Comparing the drug interaction outcomes between antiretroviral therapy and co-medications before and after the switch by using the www.hiv-druginteractions.org/ website (within the same study arm)
Time frame: Baseline, week 24, week 48, week 96
Changes in Fasting Lipids From Baseline - Triglycerides
Fasting lipids level evaluation - triglycerides
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Fasting Lipids From Baseline - Low Density Lipoprotein (LDL)
Fasting lipids level evaluation - LDL
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Vital Signs From Baseline - Systolic Blood Pressure
Changes in Vital Signs from baseline - Systolic Blood Pressure
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Vital Signs From Baseline - Diastolic Blood Pressure
Changes in Vital Signs from baseline - Diastolic Blood Pressure
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Vital Signs From Baseline - Pulse Rate
Changes in Vital Signs from baseline - Pulse rate
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Changes in Pittsburgh Sleep Quality Index (PSQI)
The PSQI measures several different aspects of sleep, with seven component scores and one composite score. The component scores include questions on subjective sleep quality, sleep latency (i.e., how long it takes to fall asleep), sleep duration, habitual sleep efficiency (i.e., the percentage of time in bed that one is asleep), sleep disturbances, use of sleeping medication, and daytime dysfunction. Each component score of the PSQI ranges from 0 to 3, with 3 indicating the greatest dysfunction or disturbance to sleep. The seven component scores are then summed to obtain a global PSQI score, which ranges from 0 to 21. Higher scores indicate poorer sleep quality, with a score greater than 5 suggesting significant sleep difficulties
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Number of Participants With Adverse Events - Week 48 to Week 96
Adverse Events reports (AEs, SAEs and treatment discontinuation)
Time frame: From Week 48 to week 96
Change From Baseline in CD4
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Change From Baseline in CD8 Cell Count
Change from baseline to week 48, Change from week 48 to week 96; Change from baseline to week 96 in participants in the DTG/RPV FDC Regimen and Continued ART Regimen arms
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Change From Baseline in Body Weight
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
Change From Baseline in BMI
Time frame: Changed assessed from baseline to week 48, week 48 to week 96, baseline to week 96
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