Safety and Efficacy of Cobicistat-boosted Atazanavir Compared to Ritonavir-boosted Atazanavir in Combination With Emtricitabine/Tenofovir Disoproxil Fumarate in HIV-1 Infected, Antiretroviral Treatment-Naive Adults
Condition: HIV-1 Infection
Intervention: COBI; RTV; ATV; FTC/TDF; COBI placebo; RTV placebo
Intervention description: Cobicistat (COBI) 150 mg tablet administered orally once daily; Ritonavir (RTV) 100 mg soft gelatin capsule administered orally once daily; Atazanavir (ATV) 300 mg capsule administered orally once daily; Emtricitabine (FTC) 200 mg/tenofovir disoproxil fumarate (TDF) 300 mg fixed-dose combination tablet administered orally once daily; Placebo to match COBI administered orally once daily; Placebo to match RTV administered orally once daily
Intervention MeSH terms: Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination; Atazanavir Sulfate; Cobicistat
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Enrollment: 85.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: HIV; HIV-1; Antiretroviral Treatment-Naive

Summary:

      The objective of this study is to evaluate the safety and efficacy of a regimen containing
      cobicistat-boosted atazanavir (ATV+COBI) plus emtricitabine/tenofovir disoproxil fumarate
      (Truvada®; FTC/TDF) versus ritonavir-boosted atazanavir (ATV+RTV) plus FTC/TDF in HIV-1
      infected, antiretroviral treatment-naive adults.

      Participants will be randomized in a 2:1 ratio. Randomization will be stratified by HIV-1 RNA
      level (≤ 100,000 copies/mL or > 100,000 copies/mL) at screening. After Week 48, participants
      will continue to take their blinded study drug and attend visits every 12 weeks until
      treatment assignments are unblinded, at which point all participants will return for an
      unblinding visit and be given the option to participate in an open-label rollover extension
      and receive ATV+COBI+FTC/TDF until COBI tablets become commercially available, or until
      Gilead Sciences elects to terminate the study.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Ability to understand and sign a written informed consent form

          -  Plasma HIV-1 RNA levels ≥ 5,000 copies/mL

          -  No prior use of any approved or experimental anti-HIV drug

          -  Normal ECG (or if abnormal, determined by the investigator to be not clinically
             significant)

          -  Adequate renal function (estimated glomerular filtration rate ≥ 80 mL/min according to
             the Cockcroft-Gault formula)

          -  Hepatic transaminases ≤ 2.5 × upper limit of normal

          -  Total bilirubin ≤ 1.5 mg/dL, or normal direct bilirubin

          -  Adequate hematologic function (absolute neutrophil count ≥ 1000/mm^3; platelets ≥
             50,000/mm^3; hemoglobin ≥ 8.5 g/dL)

          -  Cluster of differentiation 4 (CD4) cell count > 50 cells/µL

          -  Serum amylase ≤ 1.5 × ULN (subjects with serum amylase >1.5 × ULN remained eligible if
             serum lipase is ≤ 1.5 × ULN)

          -  Normal thyroid-stimulating hormone

          -  Negative serum pregnancy test (females of childbearing potential only)

          -  Males and females of childbearing potential must agree to utilize highly effective
             contraception methods from screening throughout the duration of study treatment and
             for 30 days following the last dose of study drugs

          -  Age ≥ 18 years

          -  Life expectancy ≥ 1 year

        Exclusion Criteria:

          -  New AIDS-defining condition diagnosed within the 30 days prior to screening

          -  Documented drug resistance to nucleoside or nucleotide reverse transcriptase
             inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs), or
             primary PI resistance mutation(s)

          -  Hepatitis B surface antigen positive

          -  Hepatitis C antibody positive

          -  Participants experiencing cirrhosis

          -  Participants experiencing ascites

          -  Participants experiencing encephalopathy

          -  Females who are breastfeeding

          -  Positive serum pregnancy test (female of childbearing potential)

          -  Vaccinated within 90 days of study dosing

          -  History or family history of Long QT Syndrome or have a family history of sudden
             cardiac death or unexplained death in an otherwise healthy individual under the age of
             30 years

          -  Presence or history of cardiovascular disease, cardiomyopathy, and/or cardiac
             conduction abnormalities

          -  Prolonged QTcF (QT interval corrected for heart rate using Fridericia's formula)
             interval at screening (eg, a prolongation of the QTcF interval of greater than 450
             msec for males and greater than 470 msec for females)

          -  PR interval greater than or equal to 200 msec or less than or equal to 120 msec on ECG
             at screening

          -  QRS greater than or equal to 120 msec on ECG at screening

          -  Implanted defibrillator or pacemaker

          -  Subjects receiving ongoing therapy with any disallowed medications

          -  Current alcohol or substance use judged to potentially interfere with subject study
             compliance

          -  History of or ongoing malignancy (including untreated carcinoma in-situ) other than
             cutaneous Kaposi's sarcoma, basal cell carcinoma, or resected, noninvasive cutaneous
             squamous carcinoma

          -  Active, serious infections (other than HIV-1 infection) requiring parenteral
             antibiotic or antifungal therapy within 30 days prior to baseline

          -  Participation in any other clinical trial without prior approval

          -  Medications contraindicated for use with ATV, RTV, FTC, or TDF

          -  Any known allergies to the excipients of ATV capsules, RTV capsules, COBI tablets or
             FTC/TDF tablets

          -  Any other clinical condition or prior therapy that would make the subject unsuitable
             for the study or unable to comply with the dosing requirements