search
Back to results

Bone Mineral Density Changes in HIV-positive Females With Osteopenia Switching to Raltegravir (RALBAT)

Primary Purpose

HIV Infection, Osteopenia

Status
Terminated
Phase
Phase 4
Locations
Italy
Study Type
Interventional
Intervention
raltegravir and atazanavir and ritonavir
tenofovir/emtricitabine and atazanavir and ritonavir
Sponsored by
Giovanni Di Perri
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infection focused on measuring HIV, osteopenia, t-score, DEXA, tenofovir, raltegravir

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Adult HIV-positive female patients;
  • osteopenia (t-score from -1 to -2.5);
  • On antiretroviral treatment with tenofovir/emtricitabine and atazanavir/ritonavir (300/100 mg) for at least six months;
  • Plasma HIV RNA below 50 copies/ml since six months;
  • Premenopausal women: female patients at any phase of the reproductive period with regular menstrual cycles and normal FSH (< 25 ng/mL) That would probably exclude patients with ovarian or endocrinological dysfunctions. Pre and postmenopausal should be therefore well-characterized.
  • Women in menopausal period (the menopause was defined as 12 months of amenorrhoea without any pathological or physiological cause and using the endocrinological definition of ovary insufficiency (LH (Luteic hormone) >25ng/mL, FSH (follicule stimulating hormone)>25ng/mL and E2 (Estradiol)<30ng/mL).
  • Each premenopausal sexually active subject of child-bearing potential must agree to use a medically accepted method of contraception while receiving protocol-specified medication and for 3 months after stopping the medication.Medically accepted methods of contraception include condoms (male or female) with or without a spermicidal agent, diaphragm or cervical cap with spermicide, medically prescribed IUD (intrauterine device), inert or copper-containing IUD, hormone-releasing IUD, systemic hormonal contraceptive, and surgical sterilization (eg, hysterectomy or tubal ligation).
  • Postmenopausal women are not required to use contraception.

Exclusion Criteria:

  • History or current evidence of any condition, therapy, laboratory abnormality or other circumstance that might confound the results of the study, or interfere with the patient's participation for the full duration of the study, such that it is not in the best interest of the patient to participate.
  • Documented resistance to Raltegravir or/and Atazanavir.
  • Patient with significant hypersensitivity or other contraindication to any of the components of the study drugs.
  • Patient has a current (active) diagnosis of acute hepatitis due to any cause
  • Patient with coinfection HIV/HBV (Human Hepatitis virus B)
  • Liver cirrhosis
  • Osteoporosis (t-score less than 2.5).
  • Secondary endocrinological cause of low BMD (Bone mineral density)
  • Chronic steroid intake;
  • Chronic kidney disease (estimated glomerular filtration rate below 60 ml/min);
  • Concomitant use of bisphosphonate.

Sites / Locations

  • University of Milano
  • University of Torino

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

raltegravir

tenofovir/emtricitabine

Arm Description

raltegravir and atazanavir and ritonavir

tenofovir/emtricitabine and atazanavir and ritonavir

Outcomes

Primary Outcome Measures

Variations from baseline in DEXA-measured bone mineral density (t-score, spine and femur)

Secondary Outcome Measures

variations from baseline in CTX (C-terminal telopeptide of type I collagen) and OC (Osteocalcin)
To assess the variation in renal function
glomerular filtration rate, urinary markers of tubular dysfunction (nondiabetic glucosuria, altered resorption of phosphorus, hyperaminoaciduria, b2-micro-globuline excretion and abnormal uric acid excretion.) and urinary retinol binding protein

Full Information

First Posted
July 10, 2013
Last Updated
October 14, 2018
Sponsor
Giovanni Di Perri
Collaborators
University of Turin, Italy, University of Milan
search

1. Study Identification

Unique Protocol Identification Number
NCT01902186
Brief Title
Bone Mineral Density Changes in HIV-positive Females With Osteopenia Switching to Raltegravir
Acronym
RALBAT
Official Title
Switching HIV-positive Women on Tenofovir/Emtricitabine Plus Boosted Atazanavir to RALtegravir Plus Boosted ATazanavir: A Pilot Randomized Clinical Trial Investigating 48-weeks Changes in Bone Mineral Density
Study Type
Interventional

2. Study Status

Record Verification Date
October 2018
Overall Recruitment Status
Terminated
Why Stopped
Low enrollment
Study Start Date
September 2014 (undefined)
Primary Completion Date
December 2016 (Actual)
Study Completion Date
December 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Giovanni Di Perri
Collaborators
University of Turin, Italy, University of Milan

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Given the high prevalence of bone alteration in the course of HIV infection or antiretroviral treatment and the favourable properties of raltegravir the investigators designed this pilot randomized and controlled study. Adult female HIV-positive patients on successful treatment with tenofovir/emtricitabine plus atazanavir plus ritonavir will be randomized either to continue such a regimen or to switch to raltegravir plus atazanavir plus ritonavir. Bone mineral density changes will be compared in the two groups at 48 weeks: the hypothesis is that removing tenofovir and using tenofovir will increase bone mineral density at 48 weeks.
Detailed Description
The objective is to assess the improvement in Bone Mineral Density and markers of bone turnover in women on TDF/FTC (tenofovir disoproxil fumarate/ emtricitabine)+ ATV/r (atazanavir/ritonavir) in a switch arm (RAL (raltegravir) + ATV/r) vs. an unchanged arm (TDF/FTC + ATV/r). The clinical hypothesis is that removing tenofovir (associated to a boosted PI, and therefore in the worst clinical scenario) in both pre-menopausal and menopausal women could be beneficial and being associated with reduced bone mineral density loss measured by DEXA (densitometry)scan scores and markers of bone turnover. The underlying mechanism is believed to be the reduction in hyper-phosphaturia induced by proximal tubular dysfunction: therefore measuring renal tubular markers and hormones involved in calcium and phosphorus homeostasis (such as vitamin D and parathormone) will explain the suspected mechanism.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infection, Osteopenia
Keywords
HIV, osteopenia, t-score, DEXA, tenofovir, raltegravir

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
4 (Actual)

8. Arms, Groups, and Interventions

Arm Title
raltegravir
Arm Type
Experimental
Arm Description
raltegravir and atazanavir and ritonavir
Arm Title
tenofovir/emtricitabine
Arm Type
Active Comparator
Arm Description
tenofovir/emtricitabine and atazanavir and ritonavir
Intervention Type
Drug
Intervention Name(s)
raltegravir and atazanavir and ritonavir
Other Intervention Name(s)
Isentress (raltegravir), Reyataz (atazanavir), Norvir (ritonavir)
Intervention Description
switch tenofovir/emtricitabine to raltegravir
Intervention Type
Drug
Intervention Name(s)
tenofovir/emtricitabine and atazanavir and ritonavir
Other Intervention Name(s)
tenofovir/emtricitabine (Truvada), atazanavir (Reyataz), ritonavir (norvir)
Intervention Description
no change in antiretroviral treatment; patients will continue their regimen (tenofovir/emtricitabine and atazanavir and ritonavir)
Primary Outcome Measure Information:
Title
Variations from baseline in DEXA-measured bone mineral density (t-score, spine and femur)
Time Frame
48 weeks
Secondary Outcome Measure Information:
Title
variations from baseline in CTX (C-terminal telopeptide of type I collagen) and OC (Osteocalcin)
Time Frame
24 and 48 weeks
Title
To assess the variation in renal function
Description
glomerular filtration rate, urinary markers of tubular dysfunction (nondiabetic glucosuria, altered resorption of phosphorus, hyperaminoaciduria, b2-micro-globuline excretion and abnormal uric acid excretion.) and urinary retinol binding protein
Time Frame
48 weeks
Other Pre-specified Outcome Measures:
Title
Cholesterol changes at 48 weeks in the two arms
Description
Changes in Cholesterol levels in the two arms
Time Frame
48 weeks
Title
Triglycerides changes in the two arms
Description
Changes in Tryglicerdies levels in the two arms
Time Frame
48 weeks
Title
Glucose Fasting Levels changes in the two arms
Description
Changes in Glucose Fasting Levels in the two arms
Time Frame
48 weeks
Title
Insulin changes in the two arms
Description
Changes in Insulin levels in the two arms
Time Frame
48 weeks
Title
Parathyroid hormone changes in the two arms
Description
Changes in Parathyroid hormone levels in the two arms
Time Frame
48 weeks
Title
Vitamine D (25-OH-Vitamine D) changes in the two arms
Description
Changes in Vitamine D (25-OH-Vitamine D)levels in the two arms
Time Frame
48 weeks

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adult HIV-positive female patients; osteopenia (t-score from -1 to -2.5); On antiretroviral treatment with tenofovir/emtricitabine and atazanavir/ritonavir (300/100 mg) for at least six months; Plasma HIV RNA below 50 copies/ml since six months; Premenopausal women: female patients at any phase of the reproductive period with regular menstrual cycles and normal FSH (< 25 ng/mL) That would probably exclude patients with ovarian or endocrinological dysfunctions. Pre and postmenopausal should be therefore well-characterized. Women in menopausal period (the menopause was defined as 12 months of amenorrhoea without any pathological or physiological cause and using the endocrinological definition of ovary insufficiency (LH (Luteic hormone) >25ng/mL, FSH (follicule stimulating hormone)>25ng/mL and E2 (Estradiol)<30ng/mL). Each premenopausal sexually active subject of child-bearing potential must agree to use a medically accepted method of contraception while receiving protocol-specified medication and for 3 months after stopping the medication.Medically accepted methods of contraception include condoms (male or female) with or without a spermicidal agent, diaphragm or cervical cap with spermicide, medically prescribed IUD (intrauterine device), inert or copper-containing IUD, hormone-releasing IUD, systemic hormonal contraceptive, and surgical sterilization (eg, hysterectomy or tubal ligation). Postmenopausal women are not required to use contraception. Exclusion Criteria: History or current evidence of any condition, therapy, laboratory abnormality or other circumstance that might confound the results of the study, or interfere with the patient's participation for the full duration of the study, such that it is not in the best interest of the patient to participate. Documented resistance to Raltegravir or/and Atazanavir. Patient with significant hypersensitivity or other contraindication to any of the components of the study drugs. Patient has a current (active) diagnosis of acute hepatitis due to any cause Patient with coinfection HIV/HBV (Human Hepatitis virus B) Liver cirrhosis Osteoporosis (t-score less than 2.5). Secondary endocrinological cause of low BMD (Bone mineral density) Chronic steroid intake; Chronic kidney disease (estimated glomerular filtration rate below 60 ml/min); Concomitant use of bisphosphonate.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Giovanni Di Perri, MD, PhD
Organizational Affiliation
University of Turin, Italy
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Milano
City
Milano
Country
Italy
Facility Name
University of Torino
City
Torino
Country
Italy

12. IPD Sharing Statement

Learn more about this trial

Bone Mineral Density Changes in HIV-positive Females With Osteopenia Switching to Raltegravir

We'll reach out to this number within 24 hrs