Protease Inhibitor Monotherapy Versus Ongoing Triple-therapy in the Long Term Management of HIV Infection (PIVOT) (PIVOT)
Primary Purpose
HIV Infection, Acquired Immunodeficiency Syndrome
Status
Unknown status
Phase
Phase 4
Locations
Study Type
Interventional
Intervention
Protease Inhibitor
Standard-of-care Antiretroviral therapy
Sponsored by
About this trial
This is an interventional treatment trial for HIV Infection focused on measuring Protease Inhibitors, RNA virus infections, Virus diseases, Sexually Transmitted Diseases viral, Immune system diseases, Anti-infective Agents, Drug resistance
Eligibility Criteria
Inclusion Criteria:
Vl < 50 for 24 weeks prior to screening CD4 > 100 at screening
Exclusion Criteria:
- Known major protease resistance mutation(s) documented on prior resistance testing if performed (prior resistance testing is not mandatory for trial participation).
- Previous change in ART drug regimen for reasons of unsatisfactory virological response (patients who have changed regimen for prevention or management of toxicity or to improve regimen convenience are permitted to enter the trial).
- Previous allergic reaction to a PI.
- Patient currently using or likely to require use of concomitant medication with known interaction with PIs.
- Patient requiring treatment with radiotherapy, cytotoxic chemotherapy, or is anticipated to need these during the trial period.
- Treatment for acute opportunistic infection within 3 months prior to trial screening.
- Pregnant or trying to become pregnant at the time of trial entry.
- History of active substance abuse or psychiatric illness that, in the opinion of the investigator, would preclude compliance with the protocol, dosing schedule or assessments.
- History of HIV encephalopathy with current deficit >1 in any domain of the Neuropsychiatric AIDS Rating Scale (see Appendix 7).
- Past or current history of cardiovascular disease, or 10 year absolute coronary heart disease risk of >30%, or risk of >20% if the patient has diabetes or a family history of premature ischaemic heart disease or stroke.
- History of insulin-dependent diabetes mellitus.
- Patient currently receiving interferon therapy for Hepatitis C virus infection or planning to start treatment for Hepatitis C at the time of trial entry.
- Co-infection with hepatitis B, defined as Hepatitis BsAg positive at screening or at any time since HIV diagnosis, unless the patient has had a documented Hepatitis B DNA measurement of less than 1000 copies/ml taken whilst off Hepatitis B active drugs.
- Any other active clinically significant condition, or findings during screening medical history or examination, or abnormality on screening laboratory blood tests that would, in the opinion of the investigator, compromise the patient's safety or outcome in the trial.
- Fasting plasma glucose >7.0mmol/L at trial screening.
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
Protease Inhibitor Monotherapy
Control
Arm Description
Ritonavir-boosted protease inhibitor
Standard-of-care triple-therapy regimen
Outcomes
Primary Outcome Measures
Loss of future drug options
The first occurrence of intermediate to high level resistance to any one or more of the standard antiretroviral drugs (limited to licensed drugs in contemporary use) to which the patient's virus was considered to be sensitive at trial entry (i.e. excluding drug resistance that was known to be present on previous resistance testing).
Secondary Outcome Measures
Death from any cause
Serious AIDS-defining illness
Serious non-AIDS defining illness
Adverse events
Confirmed Virological rebound
CD4+ count change
Health-related Quality of Life change
Neurocognitive function change
Cardiovascular risk change
Health care costs
HIV VL in Genital Secretions
In a sub-set of participants (n=73):-
Compare prevalence of detectable VL and magnitude of viral replication in genital secretions in patients taking PI monotherapy and triple therapy; to test if PI monotherapy is non-inferior to triple therapy.
Compare drug levels in genital secretions and plasma.
Describe the profile of drug resistance (if any) in patients with detectable VL in genital secretions and to compare this with any previous or subsequent resistance profile in plasma.
(Genital Secretions substudy REC # 09/H0305/58)
HIV VL in CSF
In a subset of participants on PI monotherapy (n=40).
Estimate the proportion of patients who have detectable HIV viral load in CSF after 48 weeks on PI monotherapy, and to refute the hypothesis that this proportion is greater than 20%.
Assess whether CSF markers of CNS immune activation, inflammation and neuronal degeneration are elevated after 48 weeks on PI monotherapy.
Assess whether CSF HIV viral load and markers of immune activation, inflammation and neuronal degeneration are elevated in patients with symptomatic CNS disease.
(CNS substudy REC # 09/H0305/58).
Full Information
NCT ID
NCT01230580
First Posted
October 27, 2010
Last Updated
October 9, 2012
Sponsor
Medical Research Council
Collaborators
NHS Health Technology Assessment Programme
1. Study Identification
Unique Protocol Identification Number
NCT01230580
Brief Title
Protease Inhibitor Monotherapy Versus Ongoing Triple-therapy in the Long Term Management of HIV Infection (PIVOT)
Acronym
PIVOT
Official Title
A Randomised Controlled Trial of a Strategy of Switching to Boosted PI Monotherapy Versus Continuing Combination ART for the Long-term Management of HIV-1 Infected Patients Who Have Achieved Sustained Virological Suppression on HAART
Study Type
Interventional
2. Study Status
Record Verification Date
October 2010
Overall Recruitment Status
Unknown status
Study Start Date
November 2008 (undefined)
Primary Completion Date
November 2013 (Anticipated)
Study Completion Date
November 2013 (Anticipated)
3. Sponsor/Collaborators
Name of the Sponsor
Medical Research Council
Collaborators
NHS Health Technology Assessment Programme
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The PIVOT trial aims to determine whether a strategy of switching to PI monotherapy is non-inferior to continuing triple-therapy, in terms of the proportion of patients who maintain all the drug treatment options that were available to them at baseline after at least 3 years of follow-up, and to compare clinical events, safety, toxicity and health economic parameters between the two strategies.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infection, Acquired Immunodeficiency Syndrome
Keywords
Protease Inhibitors, RNA virus infections, Virus diseases, Sexually Transmitted Diseases viral, Immune system diseases, Anti-infective Agents, Drug resistance
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
587 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Protease Inhibitor Monotherapy
Arm Type
Experimental
Arm Description
Ritonavir-boosted protease inhibitor
Arm Title
Control
Arm Type
Active Comparator
Arm Description
Standard-of-care triple-therapy regimen
Intervention Type
Drug
Intervention Name(s)
Protease Inhibitor
Intervention Description
Switch to a regimen comprising a single ritonavir-boosted Protease Inhibitor
Intervention Type
Drug
Intervention Name(s)
Standard-of-care Antiretroviral therapy
Intervention Description
Regimen should consist of 3 drugs: 2 nucleoside reverse transcriptase inhibitors with either a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor
Primary Outcome Measure Information:
Title
Loss of future drug options
Description
The first occurrence of intermediate to high level resistance to any one or more of the standard antiretroviral drugs (limited to licensed drugs in contemporary use) to which the patient's virus was considered to be sensitive at trial entry (i.e. excluding drug resistance that was known to be present on previous resistance testing).
Time Frame
Up to 5 years
Secondary Outcome Measure Information:
Title
Death from any cause
Time Frame
Up to 5 years
Title
Serious AIDS-defining illness
Time Frame
Up to 5 years
Title
Serious non-AIDS defining illness
Time Frame
Up to 5 years
Title
Adverse events
Time Frame
Up to 5 years
Title
Confirmed Virological rebound
Time Frame
Up to 5 years
Title
CD4+ count change
Time Frame
Up to 5 years
Title
Health-related Quality of Life change
Time Frame
Up to 5 years
Title
Neurocognitive function change
Time Frame
Up to 5 years
Title
Cardiovascular risk change
Time Frame
Up to 5 years
Title
Health care costs
Time Frame
Up to 5 years
Title
HIV VL in Genital Secretions
Description
In a sub-set of participants (n=73):-
Compare prevalence of detectable VL and magnitude of viral replication in genital secretions in patients taking PI monotherapy and triple therapy; to test if PI monotherapy is non-inferior to triple therapy.
Compare drug levels in genital secretions and plasma.
Describe the profile of drug resistance (if any) in patients with detectable VL in genital secretions and to compare this with any previous or subsequent resistance profile in plasma.
(Genital Secretions substudy REC # 09/H0305/58)
Time Frame
Week 96
Title
HIV VL in CSF
Description
In a subset of participants on PI monotherapy (n=40).
Estimate the proportion of patients who have detectable HIV viral load in CSF after 48 weeks on PI monotherapy, and to refute the hypothesis that this proportion is greater than 20%.
Assess whether CSF markers of CNS immune activation, inflammation and neuronal degeneration are elevated after 48 weeks on PI monotherapy.
Assess whether CSF HIV viral load and markers of immune activation, inflammation and neuronal degeneration are elevated in patients with symptomatic CNS disease.
(CNS substudy REC # 09/H0305/58).
Time Frame
Week 96
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Vl < 50 for 24 weeks prior to screening CD4 > 100 at screening
Exclusion Criteria:
Known major protease resistance mutation(s) documented on prior resistance testing if performed (prior resistance testing is not mandatory for trial participation).
Previous change in ART drug regimen for reasons of unsatisfactory virological response (patients who have changed regimen for prevention or management of toxicity or to improve regimen convenience are permitted to enter the trial).
Previous allergic reaction to a PI.
Patient currently using or likely to require use of concomitant medication with known interaction with PIs.
Patient requiring treatment with radiotherapy, cytotoxic chemotherapy, or is anticipated to need these during the trial period.
Treatment for acute opportunistic infection within 3 months prior to trial screening.
Pregnant or trying to become pregnant at the time of trial entry.
History of active substance abuse or psychiatric illness that, in the opinion of the investigator, would preclude compliance with the protocol, dosing schedule or assessments.
History of HIV encephalopathy with current deficit >1 in any domain of the Neuropsychiatric AIDS Rating Scale (see Appendix 7).
Past or current history of cardiovascular disease, or 10 year absolute coronary heart disease risk of >30%, or risk of >20% if the patient has diabetes or a family history of premature ischaemic heart disease or stroke.
History of insulin-dependent diabetes mellitus.
Patient currently receiving interferon therapy for Hepatitis C virus infection or planning to start treatment for Hepatitis C at the time of trial entry.
Co-infection with hepatitis B, defined as Hepatitis BsAg positive at screening or at any time since HIV diagnosis, unless the patient has had a documented Hepatitis B DNA measurement of less than 1000 copies/ml taken whilst off Hepatitis B active drugs.
Any other active clinically significant condition, or findings during screening medical history or examination, or abnormality on screening laboratory blood tests that would, in the opinion of the investigator, compromise the patient's safety or outcome in the trial.
Fasting plasma glucose >7.0mmol/L at trial screening.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nick Paton, MD
Organizational Affiliation
Medical Research Council
Official's Role
Principal Investigator
12. IPD Sharing Statement
Citations:
PubMed Identifier
23646111
Citation
Winston A, Arenas-Pinto A, Stohr W, Fisher M, Orkin CM, Aderogba K, De Burgh-Thomas A, O'Farrell N, Lacey CJ, Leen C, Dunn D, Paton NI; PIVOT Trial Team. Neurocognitive function in HIV infected patients on antiretroviral therapy. PLoS One. 2013 Apr 30;8(4):e61949. doi: 10.1371/journal.pone.0061949. Print 2013.
Results Reference
derived
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Protease Inhibitor Monotherapy Versus Ongoing Triple-therapy in the Long Term Management of HIV Infection (PIVOT)
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