Raltegravir Switch for Toxicity or Adverse Events (RaSTA)

Study Description

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Brief Summary:

This study aims to verify the persistent control of the virus replication at 48 weeks after the simplification to tenofovir + emtricitabine + raltegravir or to lamivudine+abacavir+raltegravir in patients with optimal virological suppression without any virological failure to previous combined antiretroviral therapies needing a therapeutic switch for toxicity related issues or adverse events.

Condition or disease	Intervention/treatment	Phase
HIV/AIDS; Antiretroviral Therapy; HIV Infections	Drug: tenofovir emtricitabine raltegravir; Drug: Lamivudine Abacavir Raltegravir; Drug: Abacavir free	Phase 2

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	40 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	Phase IIb Pilot Study for the Evaluation of the Safety and the Feasibility of Treatment Simplification to Tenofovir+Emtricitabine+Raltegravir or to Lamivudine+Abacavir+Raltegravir in Patients With Optimal Virological Control and Toxicity to the Current Combined Antiretroviral Regimen
Study Start Date :	August 2009
Actual Primary Completion Date :	November 2010
Actual Study Completion Date :	December 2010

Arms and Interventions

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
Experimental: Tenofovir Emtricitabine Raltegravir; Patients switching to raltegravir with tenofovir+emtricitabine as backbone	Drug: tenofovir emtricitabine raltegravir; switch from current antiretroviral regimen to raltegravir with tenofovir/emtricitabine as backbone
Experimental: Lamivudine Abacavir Raltegravir; Switch from current antiretroviral regimen to raltegravir with abacavir/lamivudine as backbone	Drug: Lamivudine Abacavir Raltegravir; Switch from current antiretroviral regimen to raltegravir with abacavir/lamivudine as backbone
Experimental: Abacavir free; Patients switched to raltegravir whose backbone therapy should not be randomized in order to avoid the use of abacavir (HLA-B*5701 positive patients,Framingham score 20% or higher)	Drug: Abacavir free; Patients will receive raltegravir with tenofovir/emtricitabine; data will be added to those of Tenofovir Emtricitabine Raltegravir arm in a separate longitudinal analysis comparing data at baseline and at 48 weeks. In this separate analysis, data will not be compared to those obtained from the Lamivudine Abacavir Raltegravir arm. The number of patients in this arm is not pre-established.

Outcome Measures

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Primary Outcome Measures :

1. To verify the persistent control of the virus replication after the simplification to tenofovir+emtricitabine+raltegravir or to lamivudine+abacavir+raltegravir in patients with optimal virological suppression without any previous virological failure [ Time Frame: 48 weeks ]

Secondary Outcome Measures :

1. Time to virological failure (two consecutive HIV-RNA levels > 50 copies/mL or a single value >1000 copies/mL) at survival analysis [ Time Frame: 48 weeks ]
2. Proportion of patients with viral load lower than 50 copies/mL at 48 weeks at the intention to treat analysis [ Time Frame: 48 weeks ]
3. Evolution of CD4 cell count during the 48 weeks of study [ Time Frame: 48 weeks ]
4. Evolution of adherence and quality of life during the 48 weeks of study [ Time Frame: 48 weeks ]
5. Evolution of raltegravir plasma concentrations during the 48 weeks of study [ Time Frame: 48 weeks ]
6. Evolution of metabolic parameters during the 48 weeks of study [ Time Frame: 48 weeks ]
7. Change of the results of neurocognitive tests at 48 weeks of study [ Time Frame: 48 weeks ]
8. Change of bone density and of adipose tissue by DEXA analysis at 48 weeks of study [ Time Frame: 48 weeks ]

Eligibility Criteria

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Ages Eligible for Study:	18 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• Patients treated with a combined antiretroviral therapy from at least 1 year
• Aged 18 years or older

• With one or more of the following conditions:

  • Grade 3 or 4 Dyslipidemia
  • Any Hyperglycemia
  • Lipodystrophy (patient's self report, confirmed by physician's physical examination)
  • Moderate/severe cardiovascular risk, defined as a calcium score higher than 40 or a Framingham score higher than 10 (estimated 10 years cardiovascular risk: 10%)
  • Diarrhea (at least 3 emissions of loose stool every day for at least 3 days every week)
• With at least two HIV-RNA levels <50 copies/mL on two consecutive determinations at least 3 months apart
• With CD4 cell count >200 cells/ μL for at least 6 months and absence of any opportunistic infection or AIDS-related disease during the last year before screening.
• Who gave informed consent to the participation to the study

Exclusion Criteria:

• Pregnancy or breast feeding, desire of pregnancy in the short term
• Previous virological failure (two consecutive HIV-RNA levels > 50 copies/mL or a single value >1000 copies/mL) to antiretroviral therapy and/or previous exposure to mono- or dual therapies with reverse transcriptase nucleoside analogues except for patients with subsequent genotypic resistance tests showing no resistance mutations to any of the study drugs.
• Previous exposure to inhibitors of HIV-1 integrase
• Previous major toxicity to any of the study drugs
• Spontaneous treatment interruptions in disagreement with the treating physician in the last year or loss to follow-up for at least 6 months, at least once in the last two years
• Current alcohol or drug abuse or any other condition which, in the judgment of the treating physician, may impair the patient's adherence to the new drug regimen and/or to the protocol's procedures
• Patients with grade 3 or 4 laboratory abnormalities at screening (except for lipid and glucose levels)

Contacts and Locations

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Locations

Italy
Policlinico A. Gemelli
Rome, Italy, 00168

Sponsors and Collaborators

Catholic University of the Sacred Heart

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Responsible Party:	Simona Di Giambenedetto, Dr, Catholic University of the Sacred Heart
ClinicalTrials.gov Identifier:	NCT00958100 History of Changes
Other Study ID Numbers:	2009−014316−35
First Posted:	August 13, 2009
Last Update Posted:	February 4, 2015
Last Verified:	February 2015

Keywords provided by Simona Di Giambenedetto, Catholic University of the Sacred Heart:

raltegravir switch toxicity; treatment experienced

Additional relevant MeSH terms:

HIV Infections; Lentivirus Infections; Retroviridae Infections; RNA Virus Infections; Virus Diseases; Sexually Transmitted Diseases, Viral; Sexually Transmitted Diseases; Immunologic Deficiency Syndromes; Immune System Diseases; Tenofovir; Lamivudine; Raltegravir Potassium; Emtricitabine	Abacavir; Dideoxynucleosides; Antiviral Agents; Anti-Infective Agents; Reverse Transcriptase Inhibitors; Nucleic Acid Synthesis Inhibitors; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action; Anti-Retroviral Agents; Anti-HIV Agents; HIV Integrase Inhibitors; Integrase Inhibitors; Antimetabolites