HIV Infections Clinical Trial
Official title:
Randomized Non-inferiority Study Comparing a Strategy Maintaining Current Enfuvirtide-based Antiretroviral Therapy to a Strategy Replacing Enfuvirtide by an Integrase Inhibitor (Raltegravir) in HIV-1 Infected Subjects With Plasma Hiv-1 RNA Levels Below 400 Copies Per ml.ANRS 138 EASIER
Switching from enfuvirtide to raltegravir in the treatment of HIV-infected patients who sustain viral suppression with a combination therapy including enfuvirtide (or : with an enfuvirtide-based combination therapy)
In patients who have failed under the three main classes of antiretroviral agents (NRTI,
NNRTI and PI) and in whom the control of viral replication in the plasma has ultimately been
achieved with enfuvirtide, the aim is to sustain this virological success for as long as
possible to thus enable satisfactory immune reconstitution, avoid further accumulation of
viral mutations conferring resistance to the drugs and protect the patient from the risk of
opportunistic disease and death.
Indeed, enfuvirtide is the lead compound in the new class of antiretroviral drugs which
inhibit the fusion of HIV-1 virus with its target cell. Its in vivo efficacy was
demonstrated during the pivotal studies TORO 1 and 2. Despite its efficacy, maintaining
long-term treatment with enfuvirtide is nonetheless difficult for patients because of the
constraints related to twice-daily subcutaneous parenteral injections. Furthermore, these
subcutaneous injections are associated with inflammatory reactions at the injection site in
98 per cent of patients, without any reduction in frequency or severity over time. It is
thus critical for patients who are well controlled by enfuvirtide to be able to simplify
their treatment by replacing enfuvirtide with another active compound taken by mouth, which
would enable maintenance of the virological response and acceptable safety in patients who
have usually failed under the three main classes of antiretroviral drugs. A new antiviral
compound, viral integrase inhibitor called raltegravir, could be proposed instead of
enfuvirtide.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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