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Antiretroviral Therapy for Acute HIV Infection

Primary Purpose

HIV Infections

Status
Withdrawn
Phase
Not Applicable
Locations
Uganda
Study Type
Interventional
Intervention
Genvoya 150Mg-150Mg-200Mg-10Mg Tablet
Sponsored by
Henry M. Jackson Foundation for the Advancement of Military Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infections

Eligibility Criteria

18 Years - 50 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. First identified as an incident HIV infection within one year of estimated time of infection in RV 217.
  2. Willing to begin Genvoya® as soon as entering this study but not later than 7 days from study enrollment.
  3. Successfully passed Test of Understanding (TOU) with a score of 80% or more on ten questions after three attempts.
  4. Adult from 18 to 50 years of age.
  5. Able to participate for 96 weeks of study visits
  6. In general good health as determined by the PI or his/her designee
  7. Willing to have photo or fingerprint taken for identification purposes
  8. No history of ART for any reason, i.e., treatment naïve and no HIV-post-exposure prophylaxis (PEP) or HIV-pre-exposure prophylaxis (PrEP)) within 90 days prior to enrollment
  9. Willing to have blood samples collected and stored.
  10. Adequate renal function: estimated creatine clearance of >50 mL/min according to the Cockroft Gault formula 2 weeks prior to enrollment
  11. Urine clean catch: glucose < trace and protein <1+ or as per site-specification 2 weeks prior to enrollment
  12. Weight is > 35 kg
  13. Female (only women of childbearing potential) Specific Criteria:

Negative pregnancy test 48 hours prior to enrollment:

Commits to continued use of adequate birth control method for 96 weeks of the study and prior to receiving study ART. Adequate birth control is defined as follows: Contraceptive medications delivered orally, intramuscularly, vaginally, or implanted, underneath the skin, surgical methods (hysterectomy or bilateral tubal ligation), condoms, diaphragms, intrauterine device (IUD), or abstinence. If depending on hormonal contraception, check package insert for drug interactions and/or consider adding a second barrier method.

Exclusion Criteria:

  1. Any chronic or clinically significant medical condition that in the opinion of investigator would jeopardize the safety or rights of the volunteer, including but not limited to chronic hepatitis, renal insufficiency or failure; clinically significant forms of drug or alcohol abuse, mental illness, severe asthma, psychiatric disorders, heart disease, or cancer; or a physical finding on examination considered indicative of significant disease such as murmur (other than functional), hepatosplenomegaly, focal neurological deficit, etc.
  2. Untreated AIDS-related opportunistic infection
  3. An AIDS defining condition diagnosed within 30 days
  4. Positive Hepatitis B surface antigen at any time in the past
  5. Requiring use of any medication that is contraindicated with Genvoya®. See Appendix I and the package insert
  6. Women who are breast-feeding

There are no inclusion/exclusion criteria based on CD4 count because CD4 count can be transiently diminished during acute HIV infection and ART initiation during early or acute HIV infection offers the potential benefit of limiting reservoir seeding and preventing immune destruction regardless of peripheral CD4 count at the time of treatment initiation.

Sites / Locations

  • Makerere University--Walter Reed Project (MUWRP)

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Genvoya 150Mg-150Mg-200Mg-10Mg Tablet

Arm Description

Genvoya® (Elvitegravir, corbiscistat, Emtricitabine and Tenofovir Alafenamide): once a day antiretroviral pill starting within 1 week of enrollment.

Outcomes

Primary Outcome Measures

Plasma viral load
The number of study participants with plasma viral load <50 copies/mL
Plasma viral load
The number of study participants with plasma viral load <50 copies/mL
Drug-related AEs and SAEs
Occurrence of drug-related adverse events and serious adverse events at any time from enrollment up to 96 weeks after enrollment early HIV infection.
Treatment Discontinuation for AEs up to 96 weeks
Tolerability of treatment as measured by treatment discontinuation for AEs up to 96 weeks

Secondary Outcome Measures

CD4+ T cell count change
CD4+ T cell count change over first 48 weeks as compared to baseline.following the initiation of Genvoya®
Frequency of HIV-related illnesses
Frequency of HIV-related illnesses (including acute retroviral syndrome)
Duration of HIV-related illnesses
Duration of HIV-related illnesses (including acute retroviral syndrome)

Full Information

First Posted
September 26, 2018
Last Updated
April 24, 2019
Sponsor
Henry M. Jackson Foundation for the Advancement of Military Medicine
Collaborators
Gilead Sciences
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1. Study Identification

Unique Protocol Identification Number
NCT03877536
Brief Title
Antiretroviral Therapy for Acute HIV Infection
Official Title
Antiretroviral Therapy for Acute HIV Infection
Study Type
Interventional

2. Study Status

Record Verification Date
April 2019
Overall Recruitment Status
Withdrawn
Why Stopped
Feeder cohort study closed.
Study Start Date
March 17, 2019 (Anticipated)
Primary Completion Date
September 14, 2023 (Anticipated)
Study Completion Date
September 14, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Henry M. Jackson Foundation for the Advancement of Military Medicine
Collaborators
Gilead Sciences

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
No

5. Study Description

Brief Summary
This study will evaluate the virologic effect, safety and tolerability of Genvoya® in adults during early acute HIV infection.
Detailed Description
This is a prospective, open-label study to describe the effects of early antiretroviral (ART) therapy on 1) viral load, 2) safety and tolerability of Genvoya®, 3) clinical outcomes and secondarily on HIV-specific immune responses. This study is a sub-study of RV 217 that will recruit participants with incident HIV diagnoses from the parent RV 217 cohort. Potential RV 392 volunteers will be recruited from the RV 217 ECHO cohort if they have been diagnosed with incident HIV Infection. Screening procedures for HIV in RV 217 are designed to identify participants during acute HIV infection (AHI) or early HIV infection. Participants will initiate Genvoya®, a once a day antiretroviral pill within 1 week of enrollment. RV 392 follow-up visits will largely overlap with RV 217 visits for the study duration of 96 weeks, but additional visits will occur early after initiation of Genvoya®. RV 392 participants will remain co-enrolled in RV 217 (i.e., RV 217 visits also continue); blood collection will be coordinated by the RV 392 team by prioritizing safety labs and then research labs within the allotted blood volumes while still meeting scientific objectives for both RV 217 and RV 392. Blood tests that are required for both protocols will only be collected once and will not be duplicated across the two protocols.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
prospective, open-label study
Masking
None (Open Label)
Allocation
N/A
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Genvoya 150Mg-150Mg-200Mg-10Mg Tablet
Arm Type
Experimental
Arm Description
Genvoya® (Elvitegravir, corbiscistat, Emtricitabine and Tenofovir Alafenamide): once a day antiretroviral pill starting within 1 week of enrollment.
Intervention Type
Drug
Intervention Name(s)
Genvoya 150Mg-150Mg-200Mg-10Mg Tablet
Intervention Description
Participants will receive 1 tablet per day throughout study duration (96 weeks).
Primary Outcome Measure Information:
Title
Plasma viral load
Description
The number of study participants with plasma viral load <50 copies/mL
Time Frame
Measured at 48 weeks after enrollment
Title
Plasma viral load
Description
The number of study participants with plasma viral load <50 copies/mL
Time Frame
Measured at 96 weeks after enrollment
Title
Drug-related AEs and SAEs
Description
Occurrence of drug-related adverse events and serious adverse events at any time from enrollment up to 96 weeks after enrollment early HIV infection.
Time Frame
Measured through week 96
Title
Treatment Discontinuation for AEs up to 96 weeks
Description
Tolerability of treatment as measured by treatment discontinuation for AEs up to 96 weeks
Time Frame
Measured through week 96
Secondary Outcome Measure Information:
Title
CD4+ T cell count change
Description
CD4+ T cell count change over first 48 weeks as compared to baseline.following the initiation of Genvoya®
Time Frame
Measured over 48 weeks
Title
Frequency of HIV-related illnesses
Description
Frequency of HIV-related illnesses (including acute retroviral syndrome)
Time Frame
Measured through week 96
Title
Duration of HIV-related illnesses
Description
Duration of HIV-related illnesses (including acute retroviral syndrome)
Time Frame
Measured through week 96
Other Pre-specified Outcome Measures:
Title
Changes in HIV-specific immune responses over time
Description
Description of changes in HIV-specific immune responses over time as characterized by intracellular cytokine staining (ICS)
Time Frame
Measured through week 96
Title
Host humoral (IgG) responses
Description
Characterization of evolution in host humoral (IgG) responses to HIV envelope over time including development of neutralizing antibody responses
Time Frame
Measured through week 96
Title
Markers of Immune Activation
Description
Description of markers of immune activation (soluble and cellular markers) by ICS.
Time Frame
Measured through week 96
Title
HIV reservoir size
Description
Evaluation of the HIV reservoir size by measurement of 1) single copy HIV RNA quantification in samples with HIV RNA <50 copies/mL and 2) total HIV DNA and integrated HIV DNA in peripheral blood
Time Frame
Measured through week 96
Title
Neuropsychological battery performance
Description
Evaluation of neuropsychological battery performance at week 48 and 96; and to later compare to RV 217 data from pre-infection and baseline early or acute HIV infection timepoints.
Time Frame
Measured through week 96

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: First identified as an incident HIV infection within one year of estimated time of infection in RV 217. Willing to begin Genvoya® as soon as entering this study but not later than 7 days from study enrollment. Successfully passed Test of Understanding (TOU) with a score of 80% or more on ten questions after three attempts. Adult from 18 to 50 years of age. Able to participate for 96 weeks of study visits In general good health as determined by the PI or his/her designee Willing to have photo or fingerprint taken for identification purposes No history of ART for any reason, i.e., treatment naïve and no HIV-post-exposure prophylaxis (PEP) or HIV-pre-exposure prophylaxis (PrEP)) within 90 days prior to enrollment Willing to have blood samples collected and stored. Adequate renal function: estimated creatine clearance of >50 mL/min according to the Cockroft Gault formula 2 weeks prior to enrollment Urine clean catch: glucose < trace and protein <1+ or as per site-specification 2 weeks prior to enrollment Weight is > 35 kg Female (only women of childbearing potential) Specific Criteria: Negative pregnancy test 48 hours prior to enrollment: Commits to continued use of adequate birth control method for 96 weeks of the study and prior to receiving study ART. Adequate birth control is defined as follows: Contraceptive medications delivered orally, intramuscularly, vaginally, or implanted, underneath the skin, surgical methods (hysterectomy or bilateral tubal ligation), condoms, diaphragms, intrauterine device (IUD), or abstinence. If depending on hormonal contraception, check package insert for drug interactions and/or consider adding a second barrier method. Exclusion Criteria: Any chronic or clinically significant medical condition that in the opinion of investigator would jeopardize the safety or rights of the volunteer, including but not limited to chronic hepatitis, renal insufficiency or failure; clinically significant forms of drug or alcohol abuse, mental illness, severe asthma, psychiatric disorders, heart disease, or cancer; or a physical finding on examination considered indicative of significant disease such as murmur (other than functional), hepatosplenomegaly, focal neurological deficit, etc. Untreated AIDS-related opportunistic infection An AIDS defining condition diagnosed within 30 days Positive Hepatitis B surface antigen at any time in the past Requiring use of any medication that is contraindicated with Genvoya®. See Appendix I and the package insert Women who are breast-feeding There are no inclusion/exclusion criteria based on CD4 count because CD4 count can be transiently diminished during acute HIV infection and ART initiation during early or acute HIV infection offers the potential benefit of limiting reservoir seeding and preventing immune destruction regardless of peripheral CD4 count at the time of treatment initiation.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Christina Polyak, MD, MPH
Organizational Affiliation
Henry M. Jackson Foundation in support of MHRP
Official's Role
Study Chair
Facility Information:
Facility Name
Makerere University--Walter Reed Project (MUWRP)
City
Kampala
Country
Uganda

12. IPD Sharing Statement

Plan to Share IPD
No

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Antiretroviral Therapy for Acute HIV Infection

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