Renal Transplantation and Raltegravir in HIV-Infected Patients (ANRS153TREVE)
The aim of this study is to evaluate the incidence of acute renal graft rejection 6 months after transplantation in HIV-infected patients under three antiretroviral drugs regimen including Raltegravir.
|Study Design:||Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||National, Multicenter, Phase III Prospective Trial About Clinical and Immunological Follow-up After Renal Transplantation in HIV-1 Infected Patients With End Stage Chronic Renal Insufficiency|
- Incidence of acute clinical renal graft rejection [ Time Frame: 6 months ] [ Designated as safety issue: Yes ]Incidence of acute clinical renal graft rejection defined by 20% increase of serum creatinine, associated to histological features (Banff classification) 6 months after renal transplantation
- Incidence of acute clinical and subclinical renal graft rejection [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]Incidence of acute clinical and subclinical renal graft rejection up to 1 year after renal transplantation defined only by renal histology (without creatinine modification). Histology is performed on routine renal graft biopsy 3 months and 1 year after transplantation.
- One year graft survival [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]One year graft survival, compared to non HIV-infected transplanted patients, using data provided by French Biomedicines Agency
- Patients' survival [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]
Patients survival, compared to:
- chronic dialysis HIV patients still listed on the transplantation waiting list - transplanted non-HIV patients using data provide by French Biomedicine Agency
- Phenotyping of lymphocytic infiltrates in case of acute rejection [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]The aim of the immunological phenotyping is to analyse the expression of activation markers between different TCD4 and TCD8 sub-population, this phenotyping will be compared to those observed in acute cell-mediated rejection occurring in the historical cohort of Non-HIV patients. In addition, the rate and expression of Treg population will be evaluated.
- Incidence of AIDS defined diseases and severe morbidity diseases after renal transplantation [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]Severe morbidity diseases include: pathological infections, malignancies, metabolic and cardiovascular diseases.
- Immunological and virologic status after renal transplantation [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]Immunological (lymphocyte activation and inflammatory parameters) and virologic status (kinetics of viral replication: HIV RNA in blood, total HIV DNA in PBMC) monitoring after renal transplantation. These parameters will be compared with pre-transplant status.
- Evaluation of the switch by raltegravir at the time of renal transplantation [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]Assessment of ARV medications change and introduction of raltegravir at the time of renal transplantation in terms of reduction of pharmacokinetic interaction between antiretroviral regimen including raltegravir and immunosupressive treatments. In addition, virological efficacy of antiretroviral treatment including Raltegravir will be evaluated.
- Viral load control after switch by antiretroviral treatment including raltegravir after renal transplantation [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]The aim of this study is to evaluate at the time of renal transplantation the virologic efficiency after the switch by an antiretroviral regimen including Raltegravir in terms of viral load control an virological failure as Raltegravir is known for its low genetic barrier.
- Survival and waiting period of HIV patients registered on French biomedicine agency for renal transplantation [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]Assessment of HIV patients' waiting period until renal transplantation and survival of patients registered on French biomedicine agency waiting-list compared to Non-HIV population (data provided by French Biomedicine Agency )
- Measurement of Area under plasma concentration (AUC) variability of immunosuppressive drugs after introduction of antiretroviral regimen containing Raltegravir [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]Area under plasma concentration (AUC) of Raltegravir and immunosuppressive drugs (Tacrolimus and Mycophenolate Mophetyl) will be measured as well as residual concentration of Tacrolimus. This study is performed in order to verify immunosupressive treatments dosage adaptation.
|Study Start Date:||December 2011|
|Estimated Study Completion Date:||November 2016|
|Estimated Primary Completion Date:||November 2015 (Final data collection date for primary outcome measure)|
Raltegravir associated to an antiretroviral regimen without ritonavir boosted antiprotease
Introduction of Raltegravir 2 days after renal transplantation within an antiretroviral regimen without ritonavir boosted antiprotease
Other Name: Isentress
Antiretroviral treatment of HIV-1 Infection might interact with immunosuppressive treatments which increase rejection of renal graft incidence.
In addition HIV infection may be modified together with cardiovascular risk. Patients participating to this study will receive after transplantation antiretroviral regimen including Raltegravir.
Raltegravir treatment does not interact with immunosuppressive drugs and thus seems to be the treatment of choice to be associated with immunosuppressive drugs.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01453192
|Hôpital Pellegrin, Service de Nephrologie, Transplantation Rénale, Dialyse|
|Bordeaux, France, 33076|
|CHU De Caen, Service de Néphrologie Hémodialyse|
|Caen, France, 14033|
|Hôpital Henri Mondor, Service de Néphrologie Transplantation|
|Créteil, France, 94010|
|Hôpital Kremlin Bicêtre, Service de Néphrologie|
|Kremlin Bicêtre, France, 94275|
|CHRU Lille, Service de néphrologie|
|Lille, France, 59037|
|CHU de Nantes, Service de Néphrologie et Immunologie Clinique|
|Nantes, France, 44093|
|Hôpital Pasteur, Service de Néphrologie - Transplantation|
|Nice, France, 06002|
|Hôpital Necker, Service de Néphrologie adulte|
|Paris, France, 75743|
|Hôpital TENON, Urgences Néphrologiques et Transplantation Rénale|
|Paris, France, 75970|
|Hopital Saint Louis, Service de Néphrologie|
|Paris, France, 75010|
|Hôpital civil, Service de Néphrologie et Transplantation|
|Strasbourg, France, 67091|
|Hôpital Foch, Service de Néphrologie Transplantation|
|Suresnes, France, 92151|
|Hôpital Rangueil, Service de Néphrologie, HTA, Dialyse, Transplantation|
|Toulouse, France, 31059|
|Hôpital Bretonneau, Service de Néphrologie|
|Tours, France, 37044|
|Principal Investigator:||Philippe GRIMBERT, MD||CHU Henri-Mondor|
|Study Director:||Dominique COSTAGLIOLA, PHD||INSERM U943|