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Same-Day Treatment With Genvoya vs. EFV/TDF/3TC

Primary Purpose

HIV/AIDS

Status
Withdrawn
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Elvitegravir, Cobicistat, TAF, FTC
Efavirenz, TDF, and 3TC
Sponsored by
Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV/AIDS focused on measuring HIV/AIDS, Same-Day ART, Genvoya, Efavirenz

Eligibility Criteria

18 Years - 99 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Documentation of positive HIV status (test conducted at GHESKIO);
  • At least 18 years of age;
  • Unaware of HIV diagnosis prior to date of enrollment, and ART-naïve;
  • Ability and willingness to give written informed consent;
  • Ready to initiate same-day ART, according to two criteria: (1) HIV medication readiness questionnaire; and (2) social worker assessment;
  • WHO Stage 1 or 2 disease, as defined by the following conditions: asymptomatic; persistent generalized lymphadenopathy; unexplained weight loss (under 10%); recurrent upper respiratory tract infections; herpes zoster; angular chelitis; recurrent oral ulcerations; papular pruritic eruptions; seborrheic dermatitis; or fungal nail infections.
  • Female participants may be enrolled if they are either: (1) post-menopausal; (2) physically incapable of becoming pregnant due to tubal ligation, hysterectomy, or bilateral oophorectomy; or (3) are of childbearing potential, and agree to use one of the following methods to avoid pregnancy throughout the duration of the study:

Complete abstinence from intercourse; Double barrier method, such as male condom/spermicide, male condom/diaphragm, or diaphragm/spermicide; Hormonal contraception plus a barrier method; Intrauterine device (IUD); Male partner sterilization (if participant has only one sexual partner);

Exclusion Criteria:

  • Pregnancy or breastfeeding at the screening visit;
  • Active drug, alcohol use, or mental condition that would interfere with the ability to adhere to study requirements, in the opinion of the study physician;
  • World Health Organization Stage 3 or 4 disease, as defined by the following conditions: unexplained severe weight loss (over 10% of presumed or measured body weight); unexplained chronic diarrhea for longer than 1 month; unexplained persistent fever (intermittent or constant for longer than 1 month); persistent oral candidiasis; oral hairy leukoplakia; pulmonary tuberculosis; severe bacterial infections (e.g. pneumonia, empyema, meningitis, pyomyositis, bone or joint infection, bacteremia, severe pelvic inflammatory disease); or acute necrotizing ulcerative stomatitis, gingivitis or periodontitis.
  • Clinical evidence of cirrhosis (ascites or encephalopathy);
  • Anticipated need for hepatitis C therapy during the study period;
  • Baseline CrCl <30 mL/minute by the Cockcroft-Gault equation (late exclusion, as creatinine results will not be available at the time of enrollment);
  • Either the K65R mutation or more than 3 thymidine analogue mutations on baseline resistance testing (late exclusions, after baseline resistance results are available).
  • Planning to transfer care to another clinic during the study period;

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Active Comparator

    Arm Label

    Elvitegravir-Cobicistat-TAF-FTC

    EFV-TDF-3TC

    Arm Description

    Elvitegravir 150mg po QD Cobicistat 150 mg po QD TAF 10 mg po QD FTC 200 mg QD

    EFV 600 mg po QD TDF 300 mg po QD 3TC 300 mg po QD

    Outcomes

    Primary Outcome Measures

    48-week viral suppression
    To compare the proportion of participants who are retained in care with a plasma HIV-1 RNA level <200 copies/ml

    Secondary Outcome Measures

    12-week viral suppression
    Proportion of participants who are retained in care with a plasma HIV-1 RNA level <200 copies/ml
    Baseline resistance to ART medications
    Genotypic resistance to EFV and/or nucleoside reverse transcriptase inhibitors
    Change in CD4 count
    Median change in CD4 count over the study period (baseline to 48 weeks)
    Virologic failure
    Proportion of patients meeting the WHO definition for ART treatment failure over the study period
    Adverse events
    Proportion of participants with a new Division of AIDS Grade 3 or 4 adverse event or laboratory abnormality that is at least a one-grade increase from baseline
    Neurologic or psychiatric adverse event
    Proportion of participants with a new Division of AIDS Grade 1 to 4 neurologic or psychiatric disorder that is at least a one-grade increase from baseline
    Sleep Quality
    Mean scores on the Pittsburgh Sleep Quality Index
    Depression
    Mean scores on the Patient Health Questionnaires (PHQ-9) Questionnaire
    Change in ART drugs
    Proportion of participants who discontinue any drug in the original ART regimen

    Full Information

    First Posted
    December 24, 2017
    Last Updated
    March 16, 2020
    Sponsor
    Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic
    Collaborators
    Gilead Sciences, Brigham and Women's Hospital, Weill Medical College of Cornell University, Analysis Group, Inc.
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    1. Study Identification

    Unique Protocol Identification Number
    NCT03405194
    Brief Title
    Same-Day Treatment With Genvoya vs. EFV/TDF/3TC
    Official Title
    An Open-Label, Randomized Comparison of Elvitegravir-Cobicistat-Tenofovir Alafenamide-Emtricitabine Versus Efavirenz-Tenofovir Disoproxil Fumarate-Lamivudine in Patients Starting Antiretroviral Therapy on the Day of HIV Diagnosis
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    March 2020
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    Haiti gained access to dolutegravir as first-line ART, so we cancelled the study before any patient was enrolled (we didn't want SOC group to receive EFV)
    Study Start Date
    May 1, 2018 (Anticipated)
    Primary Completion Date
    May 1, 2020 (Anticipated)
    Study Completion Date
    July 1, 2020 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic
    Collaborators
    Gilead Sciences, Brigham and Women's Hospital, Weill Medical College of Cornell University, Analysis Group, Inc.

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Product Manufactured in and Exported from the U.S.
    Yes
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    Randomized, open-label study comparing Elvitegravir-Cobicistat-Tenofovir Alafenamide-Emtricitabine (Genvoya) vs. Efavirenz-Tenofovir Disoproxil Fumarate-Lamivudine (EFV-TDF-3TC) in patients starting ART on the day of HIV diagnosis.
    Detailed Description
    Patients with WHO Stage 1 or 2 disease at HIV diagnosis will be randomized in a 1:1 ratio to either the Genvoya group or the EFV-TDF-3TC group. ART will be initiated on the day of HIV diagnosis. Participants who are found to have a contraindication to their assigned treatment regimen will change ART, and be classified as a failure for their assigned treatment arm. Participants in the EFV-TDF-3TC group with CrCl of 30-50 mL/minute, or with baseline mutations that significantly reduce the susceptibility of EFV will switch to Genvoya. Participants in the Genvoya group who are diagnosed with TB after enrollment will be switched to an ART regimen that can be administered with rifampin. If the study physician determines that a treatment change is indicated due to intolerability or side effects, the relevant clinical data will be presented to a safety committee that is blinded to group assignment. The ART regimen will be changed if the safety committee determines that it is indicated, and the participant will be considered a failure to their assigned treatment group. Patients will be followed for 48 weeks.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    HIV/AIDS
    Keywords
    HIV/AIDS, Same-Day ART, Genvoya, Efavirenz

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Model Description
    Same-Day ART with Genvoya vs. EFV/TDF/3TC
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Elvitegravir-Cobicistat-TAF-FTC
    Arm Type
    Experimental
    Arm Description
    Elvitegravir 150mg po QD Cobicistat 150 mg po QD TAF 10 mg po QD FTC 200 mg QD
    Arm Title
    EFV-TDF-3TC
    Arm Type
    Active Comparator
    Arm Description
    EFV 600 mg po QD TDF 300 mg po QD 3TC 300 mg po QD
    Intervention Type
    Drug
    Intervention Name(s)
    Elvitegravir, Cobicistat, TAF, FTC
    Intervention Description
    Started on day of HIV diagnosis
    Intervention Type
    Drug
    Intervention Name(s)
    Efavirenz, TDF, and 3TC
    Intervention Description
    Started on day of HIV diagnosis
    Primary Outcome Measure Information:
    Title
    48-week viral suppression
    Description
    To compare the proportion of participants who are retained in care with a plasma HIV-1 RNA level <200 copies/ml
    Time Frame
    48 weeks after enrollment
    Secondary Outcome Measure Information:
    Title
    12-week viral suppression
    Description
    Proportion of participants who are retained in care with a plasma HIV-1 RNA level <200 copies/ml
    Time Frame
    12 weeks after enrollment
    Title
    Baseline resistance to ART medications
    Description
    Genotypic resistance to EFV and/or nucleoside reverse transcriptase inhibitors
    Time Frame
    Baseline
    Title
    Change in CD4 count
    Description
    Median change in CD4 count over the study period (baseline to 48 weeks)
    Time Frame
    48 weeks after enrollment
    Title
    Virologic failure
    Description
    Proportion of patients meeting the WHO definition for ART treatment failure over the study period
    Time Frame
    48 weeks after enrollment
    Title
    Adverse events
    Description
    Proportion of participants with a new Division of AIDS Grade 3 or 4 adverse event or laboratory abnormality that is at least a one-grade increase from baseline
    Time Frame
    48 weeks after HIV testing
    Title
    Neurologic or psychiatric adverse event
    Description
    Proportion of participants with a new Division of AIDS Grade 1 to 4 neurologic or psychiatric disorder that is at least a one-grade increase from baseline
    Time Frame
    48 weeks
    Title
    Sleep Quality
    Description
    Mean scores on the Pittsburgh Sleep Quality Index
    Time Frame
    4, 12, 24, and 48 weeks after enrollment
    Title
    Depression
    Description
    Mean scores on the Patient Health Questionnaires (PHQ-9) Questionnaire
    Time Frame
    4, 12, 24, and 48 weeks after enrollment
    Title
    Change in ART drugs
    Description
    Proportion of participants who discontinue any drug in the original ART regimen
    Time Frame
    48 weeks after HIV testing after enrollment

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    99 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Documentation of positive HIV status (test conducted at GHESKIO); At least 18 years of age; Unaware of HIV diagnosis prior to date of enrollment, and ART-naïve; Ability and willingness to give written informed consent; Ready to initiate same-day ART, according to two criteria: (1) HIV medication readiness questionnaire; and (2) social worker assessment; WHO Stage 1 or 2 disease, as defined by the following conditions: asymptomatic; persistent generalized lymphadenopathy; unexplained weight loss (under 10%); recurrent upper respiratory tract infections; herpes zoster; angular chelitis; recurrent oral ulcerations; papular pruritic eruptions; seborrheic dermatitis; or fungal nail infections. Female participants may be enrolled if they are either: (1) post-menopausal; (2) physically incapable of becoming pregnant due to tubal ligation, hysterectomy, or bilateral oophorectomy; or (3) are of childbearing potential, and agree to use one of the following methods to avoid pregnancy throughout the duration of the study: Complete abstinence from intercourse; Double barrier method, such as male condom/spermicide, male condom/diaphragm, or diaphragm/spermicide; Hormonal contraception plus a barrier method; Intrauterine device (IUD); Male partner sterilization (if participant has only one sexual partner); Exclusion Criteria: Pregnancy or breastfeeding at the screening visit; Active drug, alcohol use, or mental condition that would interfere with the ability to adhere to study requirements, in the opinion of the study physician; World Health Organization Stage 3 or 4 disease, as defined by the following conditions: unexplained severe weight loss (over 10% of presumed or measured body weight); unexplained chronic diarrhea for longer than 1 month; unexplained persistent fever (intermittent or constant for longer than 1 month); persistent oral candidiasis; oral hairy leukoplakia; pulmonary tuberculosis; severe bacterial infections (e.g. pneumonia, empyema, meningitis, pyomyositis, bone or joint infection, bacteremia, severe pelvic inflammatory disease); or acute necrotizing ulcerative stomatitis, gingivitis or periodontitis. Clinical evidence of cirrhosis (ascites or encephalopathy); Anticipated need for hepatitis C therapy during the study period; Baseline CrCl <30 mL/minute by the Cockcroft-Gault equation (late exclusion, as creatinine results will not be available at the time of enrollment); Either the K65R mutation or more than 3 thymidine analogue mutations on baseline resistance testing (late exclusions, after baseline resistance results are available). Planning to transfer care to another clinic during the study period;
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Jean W Pape, MD
    Organizational Affiliation
    Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic
    Official's Role
    Principal Investigator
    First Name & Middle Initial & Last Name & Degree
    Serena P Koenig, MD
    Organizational Affiliation
    Brigham and Women's Hospital
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Learn more about this trial

    Same-Day Treatment With Genvoya vs. EFV/TDF/3TC

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