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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
Medical Research Council
About
Eligibility
Locations
Arms
Outcomes
Full info

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

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Vl < 50 for 24 weeks prior to screening CD4 > 100 at screening

Exclusion Criteria:

  1. Known major protease resistance mutation(s) documented on prior resistance testing if performed (prior resistance testing is not mandatory for trial participation).
  2. 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).
  3. Previous allergic reaction to a PI.
  4. Patient currently using or likely to require use of concomitant medication with known interaction with PIs.
  5. Patient requiring treatment with radiotherapy, cytotoxic chemotherapy, or is anticipated to need these during the trial period.
  6. Treatment for acute opportunistic infection within 3 months prior to trial screening.
  7. Pregnant or trying to become pregnant at the time of trial entry.
  8. 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.
  9. History of HIV encephalopathy with current deficit >1 in any domain of the Neuropsychiatric AIDS Rating Scale (see Appendix 7).
  10. 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.
  11. History of insulin-dependent diabetes mellitus.
  12. Patient currently receiving interferon therapy for Hepatitis C virus infection or planning to start treatment for Hepatitis C at the time of trial entry.
  13. 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.
  14. 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.
  15. 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

    First Posted
    October 27, 2010
    Last Updated
    October 9, 2012
    Sponsor
    Medical Research Council
    Collaborators
    NHS Health Technology Assessment Programme
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    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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