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Treatment of Acute HIV Infection With Quad Fixed-dose Combination (FDC) Tablet (PHI04)

This study has been completed.
Information provided by (Responsible Party):
Duke University Identifier:
First received: September 21, 2012
Last updated: March 14, 2017
Last verified: March 2017

This is a multicenter, single arm, 48-week open-label study of FDC ELV/COBI/FTC/TDF [Stribild] in acute HIV infection. Study sites will be members of the Duke-UNC Acute HIV Infection Study Consortium. Participants will be enrolled for 96 weeks. Clinical care and study drug (ELV/COBI/FTC/TDF) will be provided for the first 48 weeks. After week 48, clinical care but not study drug will be provided through week 96. A study participant suppressed at week 48 can continue on FDC ELV/COBI/FTC/TDF.

The primary hypothesis is that once daily fixed-dose combination elvitegravir (ELV), cobicistat (COBI), emtricitabine (FTC), and tenofovir disoproxil fumarate (TDF) will rapidly reduce viral replication to <50 copies RNA/ml in participants with acute HIV infection. The secondary hypotheses to be considered are 1) virologic response rates as measured by plasma HIV RNA levels will be non-inferior or superior to a historical group of participants from the PHI cohort treated with EFV/FTC/TDF, 2) compared to historical controls treated with EFV/FTC/TDF, plasma HIV RNA will decrease more rapidly in PHI participants treated with ELV/COBI/FTC/TDF, 3) compared to historical controls treated with EFV/FTC/TDF, immune activation as measured by the proportion CD4+ and CD8+ cells expressing HLA-DR and CD38+ will decrease more rapidly in PHI participants treated with ELV/COBI/FTC/TDF, 4)in a subset of participants samples will be obtained from compartments such as the gastrointestinal tract, and lymphoid tissues to assess changes over time in parameters such as HIV-1 RNA, immunologic responses to HIV, and tissue and anatomic reservoirs. We hypothesize that treatment with the ELV/COBI/FTC/TDF will demonstrate improved viral clearance in these compartments as compared to historical controls treated with EFV/FTC/TDF. 5) in a subset of participants who remain suppressed on therapy, resting CD4 cells with replication-competent HIV-1 (latent reservoir) will be quantitated and compared to similar measurements in PHI participants treated with EFV/FTC/TDF. In addition, we will compare these results to those measured in HIV-1 infected participants treated and 6) ELV/COBI/FTC/TDF will be well tolerated, and the proportion of participants who require treatment modification will be less than that observed in participants treated with EFV/FTC/TDF.

Condition Intervention Phase
Phase 3

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: No masking
Primary Purpose: Treatment
Official Title: Treatment of Acute HIV Infection With the Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Disoproxil Fumarate, A Pilot Study of Response to Therapy and HIV Pathogenesis

Resource links provided by NLM:

Further study details as provided by Duke University:

Primary Outcome Measures:
  • Number of Participants With a Viral Load Measurement of <200 Copies/mL at Week 24 [ Time Frame: 24 weeks ]
  • Virologic Efficacy of the Fixed Dose Combination (FDC) ELV/COBI/FTC/TDF Given Once Daily to Participants With Acute HIV Infection as Determined by the Proportion of Treated Participants With HIV-1 RNA to <50 Copies/mL at Week 48 [ Time Frame: 48 weeks ]

Secondary Outcome Measures:
  • Immune Activation as Measured by the Proportion of CD4+ and CD8+ Cells Expressing HLA-DR and CD38+ [ Time Frame: 48 weeks ]
  • Rate of Virologic Decline in the First 48 Weeks of Treatment Comparing FDC ELV/COBI/FTC/TDF to FDC EFV/FTC/TDF [ Time Frame: 48 weeks ]

Other Outcome Measures:
  • Number of Participants With Grade 3 or Grade 4 Adverse Events [ Time Frame: 48 weeks ]
  • Number of Participants With Adverse Events Related to Study Drug [ Time Frame: 48 weeks ]

Enrollment: 33
Study Start Date: September 2012
Study Completion Date: February 2017
Primary Completion Date: April 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Quad FDC
FDC elvitegravir + cobicistat + tenofovir + emtricitabine STR once daily for 48 weeks
Antiretroviral treatment
Other Name: STRIBILD

Detailed Description:
None desired

Ages Eligible for Study:   18 Years to 75 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Acute HIV infection is defined as:

  1. A positive 4th generation HIV Ag/Ab Combination Assay and HIV RNA (NAAT or viral load) and one of the following within 30 days of study entry:

    • a negative HIV rapid test
    • negative/indeterminate Western Blot


  2. A negative or indeterminate HIV antibody, antigen, or nucleic acid amplification test (NAAT) and any one of the following within 30 days of study entry:

    • A detectable HIV nucleic acid in blood confirmed by a second NAAT
    • Positive p24 antigen
    • A positive HIV antibody test according to standard criteria obtained within 45 days after an initial negative or indeterminate HIV antibody, antigen, or nucleic acid amplification.

Inclusion Criteria:

  1. Acute HIV Infection (as defined above) within 30 days of study entry.
  2. Age >18 years.
  3. ART-naive (<14 days of previous antiretroviral treatment. Exceptions are: Post-exposure prophylaxis (PEP) if participant was documented as HIV-negative at least 3 months after completion of PEP.
  4. Lab values within 30 days prior to study entry:

    1. Absolute neutrophil count >500/mm3
    2. Hemoglobin > 8.5 g/dL for men and > 8.0 g/dL for women
    3. Platelet count >50,000/mm3
    4. AST (SGOT)> .2.5 x ULN
    5. ALT (SGPT)> .2.5 x ULN
    6. Total bilirubin <2.5 x ULN
    7. Calculated creatinine clearance (Cockcroft-Gault formula) > 70mL/min:
  5. For women of reproductive potential, a negative pregnancy test within 72 hours prior to initiating antiretroviral study medications. Reproductive potential is defined as females who have reached menarche and have not been post-menopausal for at least 24 consecutive months, or have not undergone surgical sterilization.
  6. Female study participants must use a reliable form of barrier contraception, such as a condom, even if they also use other methods of birth control. All participants must continue to use contraception for 12 weeks after stopping study medications. Acceptable methods of barrier contraception include: condoms (male or female), diaphragm, or cervical cap. These can be used alone or in tandem with hormonal or IUD method.
  7. Ability and willingness of participant to give written informed consent.

Exclusion Criteria:

  1. Women who are pregnant or breast-feeding.
  2. Women with a positive pregnancy test prior to study drug administration.
  3. Men who have sex with women, and women of reproductive potential unwilling or unable to use an acceptable, reliable barrier method of contraception for the entire study period and 12 weeks afterwards.
  4. Use of immunomodulators (e.g., interleukins, interferons, cyclosporine), HIV vaccine, systemic cytotoxic chemotherapy, or investigational therapy within 30 days of study entry (Prednisone 10 mg QD or less is permitted.
  5. Known allergy/sensitivity to study drugs
  6. Difficulty swallowing pills
  7. Inability to communicate effectively with study personnel
  8. Incarceration; prisoner recruitment and participation are not permitted
  9. Active drug or alcohol use that, in the opinion of the site investigator, would interfere with participation in the study
  10. Any active psychiatric illness that, in the opinion of the investigator, could confound the analysis of the neurological examination or neuropsychological test results
  11. Active brain infection (except for HIV-1), brain neoplasm, space-occupying brain lesion requiring acute or chronic therapy
  12. Serious illness requiring systemic treatment and/or hospitalization until patient either completes therapy or is clinically stable on therapy for at least 7 days prior to study entry
  13. Known cardiac conduction disease
  14. Prior treatment with any other experimental drug within 30 days of initiating study treatment
  15. Unable to discontinue any current medications that are excluded during study treatment
  16. Life expectancy less than twelve months
  17. Acute Viral Hepatitis, including, but not limited to, Hepatitis A, B, or C
  18. Chronic Hepatitis B Infection documented by a detectable serum Hepatitis B surface antigen (HBsAg) or plasma HBV DNA
  19. Calculated creatinine clearance (Cockcroft-Gault formula) <70mL/min
  Contacts and Locations
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Please refer to this study by its identifier: NCT01694420

United States, North Carolina
UNC at Chapel Hill
Chapel Hill, North Carolina, United States, 27514
Duke University Medical Center
Durham, North Carolina, United States, 27705
Sponsors and Collaborators
Duke University
Principal Investigator: Mehri McKellar, MD Duke University
  More Information

Responsible Party: Duke University Identifier: NCT01694420     History of Changes
Other Study ID Numbers: Pro00035447
IN-US-236-0124 ( Other Grant/Funding Number: Funder )
Study First Received: September 21, 2012
Results First Received: October 31, 2016
Last Updated: March 14, 2017

Additional relevant MeSH terms:
HIV Infections
Acquired Immunodeficiency Syndrome
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Slow Virus Diseases
Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination
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
Cytochrome P-450 CYP3A Inhibitors
Cytochrome P-450 Enzyme Inhibitors processed this record on April 21, 2017