FTC/RPV/TDF on T-Cell Activation, CD4+ T-Cell Count, Inflammatory Biomarkers and Viral Reservoir

HIV-1 Infection Clinical Trial

Official title:

A Prospective, Single-Arm, Open-Label Study to Evaluate the Effect of Fixed-Dose Emtricitabine/Rilpivirine/Tenofovir Disoproxil Fumarate on T-Cell Activation, Absolute CD4+ T-Cell Count, Inflammatory Biomarkers and Viral Reservoir in Treatment-Naïve HIV-1 Controllers

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01777997
• Other study ID #: ACTG A5308
• Secondary ID: 1U01AI068636
• Status: Completed
• Phase: Phase 4
• Start date: April 25, 2013
• Est. completion date: February 7, 2017

Study information

• Verified date: December 2017
• Source: AIDS Clinical Trials Group
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study was done with people who were infected with HIV, but did not show any signs of having HIV. They were also feeling well without taking HIV medication and had low or undetectable levels of the virus in the blood. The purpose of this study was to see if taking HIV medication (antiretroviral therapy [ART]) would reduce immune activation (a signal that the body is fighting an infection) in people who have HIV, but did not show symptoms. Also this study helped determine how safe the drug was and how well people reacted to the drug.

For this study, the following antiretroviral therapy (ART) was be provided in the form of a single tablet that contains three different drugs: emtricitabine/rilpivirine/tenofovir disoproxil fumarate (FTC/RPV/TDF). These drugs were combined as one tablet which was approved by the Food and Drug Administration (FDA) as a single pill to treat HIV infection. The HIV medication provided was one of the recommended treatments for HIV, including people with low viral loads (how much HIV you have in your body) who were taking HIV drugs for the first time. The risks seen with this HIV medication were the same that one would encounter when taking these drugs outside of the study.

Description:

AIDS Clinical Trials Group (ACTG) A5308 was a single-arm clinical trial to evaluate the effect of initiating fixed-dose combination (FDC) FTC/RPV/TDF on CD8+ T-cell activation and other immunologic and virologic biomarkers among treatment-naïve HIV-1 controllers with any absolute CD4+ T-cell count. At study entry, these participants were followed off ART for a 12-week lead-in period, and then at week 12, participants initiated FDC FTC/RPV/TDF and had 48 weeks of follow-up to evaluate the primary endpoint.

All participants who completed Step 1 (48 weeks of ART) had the option to register to Step 2, for an additional 48 weeks of follow-up, and had the choice of either continuing FDC FTC/RPV/TDF or follow-up with no study treatment.

Participants underwent safety and tolerability evaluations throughout the study, including physical examinations and clinical assessments. Pregnancy tests were performed on women of childbearing potential. Collection of stored blood plasma/peripheral blood mononuclear cell (PBMC) samples occurred at entry and weeks 0, 4, 12, 24, 36, 48, 60, 72 and 96 on ART.

Only participants who were on intervention (ART) for at least 24 weeks had samples sent for testing of immunologic and virologic biomarkers.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 38
• Est. completion date: February 7, 2017
• Est. primary completion date: February 19, 2016
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

Step 1

• HIV-1 infection

• ART-naïve defined as =7 days of antiretroviral (ARV) treatment at any time prior to entry

• Documentation of HIV-1 RNA <500 copies/mL verified by at least two measurements prior to the screening RNA specimen

• Screening HIV-1 RNA <500 copies/mL using an US FDA-approved assay obtained within 60 days prior to study entry by any laboratory that has a CLIA certification or its equivalent

• Laboratory values obtained within 60 days prior to entry by any laboratory that has a CLIA certification or its equivalent:

• Absolute neutrophil count (ANC) >=500/mm^3

• Hemoglobin >=8.0 g/dL

• Platelet count >=40,000/mm^3

• Aspartate aminotransferase (AST) (SGOT), alanine aminotransferase (ALT) (SGPT), and alkaline phosphatase <=5 X Upper Limit of Normal (ULN)

• Total bilirubin <=2.5 X ULN

• Calculated creatinine clearance (CrCl) >=60 mL/min

• For females of reproductive potential, negative serum or urine pregnancy test within 48 hours prior to study entry by any clinic or laboratory that has a CLIA certification or its equivalent

• Female subjects of reproductive potential, who are participating in sexual activity that could lead to pregnancy, must agree to use at least one reliable form of contraceptive (ie, condoms (male or female) with or without a spermicidal agent; a diaphragm or cervical cap with spermicide; an intrauterine device (IUD); or hormone-based contraceptive) while receiving the protocol-specified treatment and for 6 weeks after stopping the medications

• No evidence of any exclusionary resistance mutations based on results from any genotype assay from any laboratory that has a Clinical Laboratory Improvement Amendments (CLIA) certification or its equivalent

Step 2

• Completion of Step 1

• Ability and willingness of subject to choose to receive either open-label ART FDC (FTC/RPV/TDF) or no study treatment for an additional 48 weeks

• For females of reproductive potential, negative serum or urine pregnancy test within 48 hours prior to the week 60 visit by any clinic or laboratory that has a CLIA certification or its equivalent

Exclusion Criteria:

Step 1

• Chronic hepatitis B virus (HBV) infection (documented by hepatitis B surface antigen (HBsAg) seropositivity)

• Breastfeeding

• Use of immunomodulators (eg, interleukins, interferons, cyclosporine), topical imiquimod, HIV vaccine, systemic cytotoxic chemotherapy, or investigational therapy within 30 days prior to study entry or plans to start immunomodulators, topical imiquimod, HIV vaccine, systemic cytotoxic chemotherapy, or investigational therapy during the study

• Known allergy/sensitivity or any hypersensitivity to components of study drug(s) or their formulation

• Active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements

• Acute or serious illness requiring systemic treatment and/or hospitalization within 30 days prior to entry

• Symptomatic HIV disease and/or AIDS-defining illness.

• Vaccinations within 7 days prior to study entry

• Plans to initiate hepatitis C treatment during the study

• Perinatally-acquired HIV

• Use of any of the following medications within 7 days prior to study entry:

• St. John's wort (Hypercium perforatum)

• Anticonvulsants (eg, oxacarbazepine, phenobarbital, phenytoin)

• Anti-infectives (eg, rifabutin, rifampin, rifapentine)

• Corticosteroids (eg, dexamethasone (more than 1 dose))

• Proton pump inhibitors (eg, esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole)

Step 2

• Plans to start immunomodulators, topical imiquimod, HIV vaccine, systemic cytotoxic chemotherapy, or investigational therapy during Step 2 of the study

• Plans to initiate hepatitis C treatment during Step 2 of the study

NOTE: Please refer to the protocol for detailed eligibility criteria.

Related Conditions & MeSH terms

• HIV-1 Infection

Intervention

Drug:
• Emtricitabine/rilpivirine/tenofovir disoproxil fumarate
Step 1: From entry through week 12, the participants received no study treatment. From week 12 through week 60, the participants received one fixed dose combination emtricitabine/rilpivirine/tenofovir disoproxil fumarate (FTC/RPV/TDF) tablet daily. Step 2 (Optional): From week 60 through week 108, the participants either received one FTC/RPV/TDF tablet daily or no study treatment.

Locations

Country	Name	City	State
United States	The Ponce de Leon Ctr. CRS (5802)	Atlanta	Georgia
United States	IHV Baltimore Treatment CRS (4651)	Baltimore	Maryland
United States	31788 Alabama CRS	Birmingham	Alabama
United States	Brigham and Women's Hosp. ACTG CRS (107)	Boston	Massachusetts
United States	Massachusetts General Hospital ACTG CRS (101)	Boston	Massachusetts
United States	Bronx-Lebanon Hosp. Ctr. CRS (31469)	Bronx	New York
United States	Unc Aids Crs (3201)	Chapel Hill	North Carolina
United States	Northwestern University CRS (2701)	Chicago	Illinois
United States	Rush Univ. Med. Ctr. ACTG CRS (2702)	Chicago	Illinois
United States	University of Cincinnati CRS (2401)	Cincinnati	Ohio
United States	Metro Health CRS (2503)	Cleveland	Ohio
United States	Moses H. Cone Memorial Hospital CRS (3203)	Greensboro	North Carolina
United States	Houston AIDS Research Team CRS (31473)	Houston	Texas
United States	Hosp. of the Univ. of Pennsylvania CRS (6201)	Philadelphia	Pennsylvania
United States	Pitt CRS (1001)	Pittsburgh	Pennsylvania
United States	The Miriam Hosp. ACTG CRS (2951)	Providence	Rhode Island
United States	University of Rochester Adult HIV Therapeutic Strategies Network CRS (31787)	Rochester	New York
United States	801 University of California, San Francisco HIV/AIDS CRS	San Francisco	California
United States	Whitman Walker Health CRS (31791)	Washington	District of Columbia

Sponsors (2)

Lead Sponsor	Collaborator
AIDS Clinical Trials Group	National Institute of Allergy and Infectious Diseases (NIAID)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in Levels of CD8+ T-cell Activation (Defined as the Percentage HLA-DR+/CD38+) From Baseline to Weeks 24 and 48 on ART	Mean change from baseline (pre-ART [study entry] and week 0 on ART [study week 12]), estimated with a repeated measures analysis (jointly to weeks 24 and 48 on ART) using generalized estimating equations (GEE)	From baseline (pre-ART and week 0 on ART) to weeks 24 and 48 on ART
Secondary	Plasma HIV-1 RNA Level Measured by Single Copy Assay Using Primer in Integrase (iSCA) as the Proportion of Participants Below the Limit of the Assay	At a specific week, the proportion of participants with HIV-1 RNA by iSCA less than assay limit of detection (0.6 copies/mL)	At pre-ART and weeks 0, 4, 12, 24, 36 and 48 on ART
Secondary	Change in CD4+ T-cell Count	Change equals each specific week CD4+ T-cell count, respectively, minus the baseline CD4+ T-cell count (mean of the two measurements obtained prior to the start of ART)	From baseline (pre-ART and week 0 on ART) to weeks 12, 24, 36 and 48 on ART
Secondary	Change in Levels of CD8+ T-cell Activation	Change equals each specific week percentage, respectively, minus the baseline percentage (mean of the two measurements obtained prior to the start of ART)	From baseline (pre-ART and week 0 on ART) to weeks 4, 12, 24 and 48 on ART
Secondary	Change in Levels of CD4+ T-cell Activation (Defined as the Percentage HLA-DR+/CD38+)	Change equals each specific week percentage, respectively, minus the baseline percentage (mean of the two measurements obtained prior to the start of ART)	From baseline (pre-ART and week 0 on ART) to weeks 4, 12, 24 and 48 on ART
Secondary	Change in Levels of Interleukin (IL)-6	Change equals each specific week result, respectively, minus the baseline result (mean of the two log10-transformed measurements obtained prior to the start of ART)	From baseline (pre-ART and week 0 on ART) to weeks 4, 12, 24 and 48 on ART
Secondary	Change in Levels of D-dimer	Change equals each specific week result, respectively, minus the baseline result (mean of the two log10-transformed measurements obtained prior to the start of ART)	From baseline (pre-ART and week 0 on ART) to weeks 4, 24 and 48 on ART
Secondary	Change in Quality of Life (QoL) Index	QoL index was obtained by averaging the five responses on the Euro-Quality of Life questionnaire (EQ-5D), where a response of 0 indicates "no problems/no discomfort", 1 indicates "some problems/moderate discomfort" and 2 indicates "unable to perform activities/extreme discomfort". Change equals each specific week index, respectively, minus the baseline index (mean of the two averages obtained prior to the start of ART)	From baseline (pre-ART and week 0 on ART) to weeks 4, 24 and 48 on ART
Secondary	Number of Subjects Who Experience Grade 3 or 4 Signs and Symptoms or Laboratory Abnormalities, Diagnoses (Any Grade), or Other Serious Adverse Events (SAEs)	Grading uses the Division of AIDS (DAIDS) 2004 (clarification 2009) Severity of Adverse Events Table, where Grade 1=Mild, 2=Moderate, 3=Severe, 4=Potentially life-threatening.	From initiation of treatment to study completion at week 60 or 108 or premature study discontinuation

External Links

•   Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events (DAIDS AE Grading Table), Version 1.0, December 2004 (Clarification, August 2009)
•   Requirements, definitions, and methods for expedited reporting of Adverse Events (AEs) in Version 2.0 of the DAIDS EAE Manual