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Treatment of Acute HIV Infection With Quad Fixed-dose Combination (FDC) Tablet (PHI04)

Primary Purpose

HIV

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
(FDC) ELV/COBI/FTC/TDF
Sponsored by
Duke University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Acute HIV infection is defined as:

  1. A positive 4th generation HIV Ag/Ab Combination Assay and HIV RNA (NAAT or viral load) and one of the following within 30 days of study entry:

    • a negative HIV rapid test
    • negative/indeterminate Western Blot

    OR

  2. A negative or indeterminate HIV antibody, antigen, or nucleic acid amplification test (NAAT) and any one of the following within 30 days of study entry:

    • A detectable HIV nucleic acid in blood confirmed by a second NAAT
    • Positive p24 antigen
    • A positive HIV antibody test according to standard criteria obtained within 45 days after an initial negative or indeterminate HIV antibody, antigen, or nucleic acid amplification.

Inclusion Criteria:

  1. Acute HIV Infection (as defined above) within 30 days of study entry.
  2. Age >18 years.
  3. ART-naive (<14 days of previous antiretroviral treatment. Exceptions are: Post-exposure prophylaxis (PEP) if participant was documented as HIV-negative at least 3 months after completion of PEP.
  4. Lab values within 30 days prior to study entry:

    1. Absolute neutrophil count >500/mm3
    2. Hemoglobin > 8.5 g/dL for men and > 8.0 g/dL for women
    3. Platelet count >50,000/mm3
    4. AST (SGOT)> .2.5 x ULN
    5. ALT (SGPT)> .2.5 x ULN
    6. Total bilirubin <2.5 x ULN
    7. Calculated creatinine clearance (Cockcroft-Gault formula) > 70mL/min:
  5. For women of reproductive potential, a negative pregnancy test within 72 hours prior to initiating antiretroviral study medications. Reproductive potential is defined as females who have reached menarche and have not been post-menopausal for at least 24 consecutive months, or have not undergone surgical sterilization.
  6. Female study participants must use a reliable form of barrier contraception, such as a condom, even if they also use other methods of birth control. All participants must continue to use contraception for 12 weeks after stopping study medications. Acceptable methods of barrier contraception include: condoms (male or female), diaphragm, or cervical cap. These can be used alone or in tandem with hormonal or IUD method.
  7. Ability and willingness of participant to give written informed consent.

Exclusion Criteria:

  1. Women who are pregnant or breast-feeding.
  2. Women with a positive pregnancy test prior to study drug administration.
  3. Men who have sex with women, and women of reproductive potential unwilling or unable to use an acceptable, reliable barrier method of contraception for the entire study period and 12 weeks afterwards.
  4. Use of immunomodulators (e.g., interleukins, interferons, cyclosporine), HIV vaccine, systemic cytotoxic chemotherapy, or investigational therapy within 30 days of study entry (Prednisone 10 mg QD or less is permitted.
  5. Known allergy/sensitivity to study drugs
  6. Difficulty swallowing pills
  7. Inability to communicate effectively with study personnel
  8. Incarceration; prisoner recruitment and participation are not permitted
  9. Active drug or alcohol use that, in the opinion of the site investigator, would interfere with participation in the study
  10. Any active psychiatric illness that, in the opinion of the investigator, could confound the analysis of the neurological examination or neuropsychological test results
  11. Active brain infection (except for HIV-1), brain neoplasm, space-occupying brain lesion requiring acute or chronic therapy
  12. Serious illness requiring systemic treatment and/or hospitalization until patient either completes therapy or is clinically stable on therapy for at least 7 days prior to study entry
  13. Known cardiac conduction disease
  14. Prior treatment with any other experimental drug within 30 days of initiating study treatment
  15. Unable to discontinue any current medications that are excluded during study treatment
  16. Life expectancy less than twelve months
  17. Acute Viral Hepatitis, including, but not limited to, Hepatitis A, B, or C
  18. Chronic Hepatitis B Infection documented by a detectable serum Hepatitis B surface antigen (HBsAg) or plasma HBV DNA
  19. Calculated creatinine clearance (Cockcroft-Gault formula) <70mL/min

Sites / Locations

  • UNC at Chapel Hill
  • Duke University Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Quad FDC

Arm Description

FDC elvitegravir + cobicistat + tenofovir + emtricitabine STR once daily for 48 weeks

Outcomes

Primary Outcome Measures

Number of Participants With a Viral Load Measurement of <200 Copies/mL at Week 24
Virologic Efficacy of the Fixed Dose Combination (FDC) ELV/COBI/FTC/TDF Given Once Daily to Participants With Acute HIV Infection as Determined by the Proportion of Treated Participants With HIV-1 RNA to <50 Copies/mL at Week 48

Secondary Outcome Measures

Immune Activation as Measured by the Proportion of CD4+ and CD8+ Cells Expressing HLA-DR and CD38+
Rate of Virologic Decline in the First 48 Weeks of Treatment Comparing FDC ELV/COBI/FTC/TDF to FDC EFV/FTC/TDF

Full Information

First Posted
September 21, 2012
Last Updated
March 14, 2017
Sponsor
Duke University
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1. Study Identification

Unique Protocol Identification Number
NCT01694420
Brief Title
Treatment of Acute HIV Infection With Quad Fixed-dose Combination (FDC) Tablet
Acronym
PHI04
Official Title
Treatment of Acute HIV Infection With the Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Disoproxil Fumarate, A Pilot Study of Response to Therapy and HIV Pathogenesis
Study Type
Interventional

2. Study Status

Record Verification Date
March 2017
Overall Recruitment Status
Completed
Study Start Date
September 2012 (undefined)
Primary Completion Date
April 2016 (Actual)
Study Completion Date
February 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Duke University

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a multicenter, single arm, 48-week open-label study of FDC ELV/COBI/FTC/TDF [Stribild] in acute HIV infection. Study sites will be members of the Duke-UNC Acute HIV Infection Study Consortium. Participants will be enrolled for 96 weeks. Clinical care and study drug (ELV/COBI/FTC/TDF) will be provided for the first 48 weeks. After week 48, clinical care but not study drug will be provided through week 96. A study participant suppressed at week 48 can continue on FDC ELV/COBI/FTC/TDF. The primary hypothesis is that once daily fixed-dose combination elvitegravir (ELV), cobicistat (COBI), emtricitabine (FTC), and tenofovir disoproxil fumarate (TDF) will rapidly reduce viral replication to <50 copies RNA/ml in participants with acute HIV infection. The secondary hypotheses to be considered are 1) virologic response rates as measured by plasma HIV RNA levels will be non-inferior or superior to a historical group of participants from the PHI cohort treated with EFV/FTC/TDF, 2) compared to historical controls treated with EFV/FTC/TDF, plasma HIV RNA will decrease more rapidly in PHI participants treated with ELV/COBI/FTC/TDF, 3) compared to historical controls treated with EFV/FTC/TDF, immune activation as measured by the proportion CD4+ and CD8+ cells expressing HLA-DR and CD38+ will decrease more rapidly in PHI participants treated with ELV/COBI/FTC/TDF, 4)in a subset of participants samples will be obtained from compartments such as the gastrointestinal tract, and lymphoid tissues to assess changes over time in parameters such as HIV-1 RNA, immunologic responses to HIV, and tissue and anatomic reservoirs. We hypothesize that treatment with the ELV/COBI/FTC/TDF will demonstrate improved viral clearance in these compartments as compared to historical controls treated with EFV/FTC/TDF. 5) in a subset of participants who remain suppressed on therapy, resting CD4 cells with replication-competent HIV-1 (latent reservoir) will be quantitated and compared to similar measurements in PHI participants treated with EFV/FTC/TDF. In addition, we will compare these results to those measured in HIV-1 infected participants treated and 6) ELV/COBI/FTC/TDF will be well tolerated, and the proportion of participants who require treatment modification will be less than that observed in participants treated with EFV/FTC/TDF.
Detailed Description
None desired

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
33 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Quad FDC
Arm Type
Experimental
Arm Description
FDC elvitegravir + cobicistat + tenofovir + emtricitabine STR once daily for 48 weeks
Intervention Type
Drug
Intervention Name(s)
(FDC) ELV/COBI/FTC/TDF
Other Intervention Name(s)
STRIBILD
Intervention Description
Antiretroviral treatment
Primary Outcome Measure Information:
Title
Number of Participants With a Viral Load Measurement of <200 Copies/mL at Week 24
Time Frame
24 weeks
Title
Virologic Efficacy of the Fixed Dose Combination (FDC) ELV/COBI/FTC/TDF Given Once Daily to Participants With Acute HIV Infection as Determined by the Proportion of Treated Participants With HIV-1 RNA to <50 Copies/mL at Week 48
Time Frame
48 weeks
Secondary Outcome Measure Information:
Title
Immune Activation as Measured by the Proportion of CD4+ and CD8+ Cells Expressing HLA-DR and CD38+
Time Frame
48 weeks
Title
Rate of Virologic Decline in the First 48 Weeks of Treatment Comparing FDC ELV/COBI/FTC/TDF to FDC EFV/FTC/TDF
Time Frame
48 weeks
Other Pre-specified Outcome Measures:
Title
Number of Participants With Grade 3 or Grade 4 Adverse Events
Time Frame
48 weeks
Title
Number of Participants With Adverse Events Related to Study Drug
Time Frame
48 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Acute HIV infection is defined as: A positive 4th generation HIV Ag/Ab Combination Assay and HIV RNA (NAAT or viral load) and one of the following within 30 days of study entry: a negative HIV rapid test negative/indeterminate Western Blot OR A negative or indeterminate HIV antibody, antigen, or nucleic acid amplification test (NAAT) and any one of the following within 30 days of study entry: A detectable HIV nucleic acid in blood confirmed by a second NAAT Positive p24 antigen A positive HIV antibody test according to standard criteria obtained within 45 days after an initial negative or indeterminate HIV antibody, antigen, or nucleic acid amplification. Inclusion Criteria: Acute HIV Infection (as defined above) within 30 days of study entry. Age >18 years. ART-naive (<14 days of previous antiretroviral treatment. Exceptions are: Post-exposure prophylaxis (PEP) if participant was documented as HIV-negative at least 3 months after completion of PEP. Lab values within 30 days prior to study entry: Absolute neutrophil count >500/mm3 Hemoglobin > 8.5 g/dL for men and > 8.0 g/dL for women Platelet count >50,000/mm3 AST (SGOT)> .2.5 x ULN ALT (SGPT)> .2.5 x ULN Total bilirubin <2.5 x ULN Calculated creatinine clearance (Cockcroft-Gault formula) > 70mL/min: For women of reproductive potential, a negative pregnancy test within 72 hours prior to initiating antiretroviral study medications. Reproductive potential is defined as females who have reached menarche and have not been post-menopausal for at least 24 consecutive months, or have not undergone surgical sterilization. Female study participants must use a reliable form of barrier contraception, such as a condom, even if they also use other methods of birth control. All participants must continue to use contraception for 12 weeks after stopping study medications. Acceptable methods of barrier contraception include: condoms (male or female), diaphragm, or cervical cap. These can be used alone or in tandem with hormonal or IUD method. Ability and willingness of participant to give written informed consent. Exclusion Criteria: Women who are pregnant or breast-feeding. Women with a positive pregnancy test prior to study drug administration. Men who have sex with women, and women of reproductive potential unwilling or unable to use an acceptable, reliable barrier method of contraception for the entire study period and 12 weeks afterwards. Use of immunomodulators (e.g., interleukins, interferons, cyclosporine), HIV vaccine, systemic cytotoxic chemotherapy, or investigational therapy within 30 days of study entry (Prednisone 10 mg QD or less is permitted. Known allergy/sensitivity to study drugs Difficulty swallowing pills Inability to communicate effectively with study personnel Incarceration; prisoner recruitment and participation are not permitted Active drug or alcohol use that, in the opinion of the site investigator, would interfere with participation in the study Any active psychiatric illness that, in the opinion of the investigator, could confound the analysis of the neurological examination or neuropsychological test results Active brain infection (except for HIV-1), brain neoplasm, space-occupying brain lesion requiring acute or chronic therapy Serious illness requiring systemic treatment and/or hospitalization until patient either completes therapy or is clinically stable on therapy for at least 7 days prior to study entry Known cardiac conduction disease Prior treatment with any other experimental drug within 30 days of initiating study treatment Unable to discontinue any current medications that are excluded during study treatment Life expectancy less than twelve months Acute Viral Hepatitis, including, but not limited to, Hepatitis A, B, or C Chronic Hepatitis B Infection documented by a detectable serum Hepatitis B surface antigen (HBsAg) or plasma HBV DNA Calculated creatinine clearance (Cockcroft-Gault formula) <70mL/min
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mehri McKellar, MD
Organizational Affiliation
Duke University
Official's Role
Principal Investigator
Facility Information:
Facility Name
UNC at Chapel Hill
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27514
Country
United States
Facility Name
Duke University Medical Center
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27705
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
21487250
Citation
Gay CL, Mayo AJ, Mfalila CK, Chu H, Barry AC, Kuruc JD, McGee KS, Kerkau M, Sebastian J, Fiscus SA, Margolis DM, Hicks CB, Ferrari G, Eron JJ; Duke-UNC Acute HIV Infection Consortium. Efficacy of NNRTI-based antiretroviral therapy initiated during acute HIV infection. AIDS. 2011 Apr 24;25(7):941-9. doi: 10.1097/QAD.0b013e3283463c07.
Results Reference
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Treatment of Acute HIV Infection With Quad Fixed-dose Combination (FDC) Tablet

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