Study to Evaluate Switching From Regimens Consisting of a Ritonavir-boosted Protease Inhibitor Plus Emtricitabine/Tenofovir Fixed-Dose Combination to the Elvitegravir/Cobicistat/Emtricitabine/Tenofovir DF Single-Tablet Regimen in Virologically Suppressed, HIV-1 Infected Patients
Condition: Acquired Immunodeficiency Syndrome; HIV Infections
MeSH terms: HIV Infections; Acquired Immunodeficiency Syndrome; Immunologic Deficiency Syndromes
Intervention: PI; RTV; FTC/TDF; Stribild
Intervention description: PI administered according to prescribing information; allowed PIs include atazanavir (ATV), darunavir (DRV), fosamprenavir (FPV), lopinavir (LPV), or saquinavir (SQV); RTV administered according to prescribing information FTC/TDF administered according to prescribing information; FTC/TDF (200/300 mg) administered according to prescribing information; Stribild (E/C/F/TDF) (150/150/200/300 mg) STR administered orally once daily with food
Intervention MeSH terms: Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 438.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: HIV-1; HIV; Treatment Experienced

Summary:

      This study will evaluate the non-inferiority of Stribild® (elvitegravir/cobicistat/
      emtricitabine/tenofovir disoproxil fumarate (E/C/F/TDF)) single-tablet regimen (STR) relative
      to regimens consisting of a protease inhibitor (PI) boosted with ritonavir (RTV) plus
      Truvada® (FTC/TDF) fixed-dose combination in maintaining HIV-1 RNA < 50 copies/mL at Week 48
      in virologically suppressed, HIV-1 infected adults. This study will also evaluate the safety,
      tolerability, and efficacy of the two regimens through 96 weeks of treatment.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Ability to understand and sign a written informed consent form

          -  Be on a stable antiretroviral regimen consisting of a ritonavir boosted PI plus
             FTC/TDF continuously for ≥ 6 consecutive months preceding the screening visit

          -  Be on the first or second antiretroviral drug regimen documented undetectable plasma
             HIV 1 RNA levels for ≥ 6 months preceding the screening visit

          -  No previous use of any approved or experimental integrase strand transfer inhibitor
             (INSTI) for any length of time

          -  Documented historical genotype prior to starting initial antiretroviral therapy
             showing no known resistance to TDF or FTC

          -  HIV RNA < 50 copies/mL at screening

          -  Normal ECG

          -  Hepatic transaminases ≤ 5 × the upper limit of the normal range (ULN)

          -  Total bilirubin ≤ 1.5 mg/dL, or normal direct bilirubin

          -  Adequate hematologic function

          -  Serum amylase ≤ 5 × ULN

          -  Estimated glomerular filtration rate ≥ 70 mL/min

          -  Females of childbearing potential must agree to utilize highly effective contraception
             methods, or be nonheterosexually active, practice sexual abstinence from screening
             throughout the duration of the study period and for 30 days following the last dose of
             study drug

          -  Female participants who utilize hormonal contraceptive as one of their birth control
             methods must have used the same method for at least three months prior to study dosing

          -  Male participants must agree to utilize a highly effective method of contraception
             during heterosexual intercourse from the screening visit, throughout the duration of
             the study and for 30 days following discontinuation of investigational medicinal
             product, or must be nonheterosexually active, or practice sexual abstinence

          -  Age ≥ 18 years

        Exclusion Criteria:

          -  A new AIDS-defining condition diagnosed within the 30 days prior to screening

          -  Females who are breastfeeding

          -  Positive serum pregnancy test (female of childbearing potential)

          -  Receiving drug treatment for hepatitis C, or participants who are anticipated to
             receive treatment for hepatitis C during the course of the study

          -  Experiencing decompensated cirrhosis

          -  Have an implanted defibrillator or pacemaker

          -  Current alcohol or substance abuse that would interfere with compliance

          -  A history of malignancy within the past 5 years or ongoing malignancy other than
             cutaneous Kaposi's sarcoma, basal cell carcinoma, or resected, noninvasive cutaneous
             squamous carcinoma

          -  Active, serious infections requiring parenteral antibiotic or antifungal therapy
             within 30 days prior to Baseline, except for intramuscular penicillin for the
             treatment of syphilis

          -  Have been treated with immunosuppressant therapies or chemotherapeutic agents within 3
             months of study screening, or expected to receive these agents or systemic steroids
             during the study

          -  Receiving ongoing therapy with any of the medications, including drugs not to be used
             with elvitegravir, cobicistat, FTC, or TDF; or those with any known allergies to the
             excipients of E/C/F/TDF tablets, or FTC/TDF tablets

          -  No anticipated need to initiate drugs during the study that are contraindicated

          -  Receiving other investigational drugs

          -  Participation in any other clinical trial

          -  Any other clinical condition or prior therapy that would make the participant
             unsuitable for the study or unable to comply with the dosing requirements