Switch to Maraviroc + Integrase Inhibitor
Condition: HIV
Intervention: Switch to Maraviroc + Raltegravir or Dolutegravir
Intervention description: Change HIV-infected patients on stable, suppressed ART regimens for at least 1 year to experimental regimen of Maraviroc + Raltegravir or Dolutegravir for 48 weeks
Intervention MeSH terms: Raltegravir Potassium; Dolutegravir; Maraviroc
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 7.0
Sex: All
Minimum age: 18 Years
Maximum age: 75 Years
Healthy volunteers: No
Keywords: HIV

Summary:

      This clinical study proposes to evaluate the combination of maraviroc with an integrase
      strand transfer inhibitor (either raltegravir or dolutegravir) in antiretroviral-experienced
      patients to document the efficacy, safety, and tolerability of this combination in order to
      provide clinicians with a treatment regimen that minimizes the risk of metabolic
      complications by avoidance of NRTI/NNRTIs and PIs. The development of an alternative ART
      regimen which lessens the risk of metabolic complications could improve long-term adherence
      and reduce the risk of certain co-morbidities associated with long-term ART use. If this new
      combination is found to be as efficacious as the standard regimen with enhanced tolerability
      and improved metabolic effects, there is great potential for altering the current practice of
      HIV medicine.
    

Eligibility criteria:

        Inclusion Criteria:

          -  HIV-1 infection

          -  Age between 18 and 75 years

          -  CD4 count nadir ≥ 250 cells/mm3

          -  HIV RNA ≤ 50 copies/ml for ≥ 12 months while taking any ART regimen

             o One virologic blip ≤ 400 copies/ml permissible within the 12 months

          -  CCR5 tropic virus as defined by:

               -  trofile/tropism testing if available, OR

               -  DNA trofile if no trofile/tropism test available and CD4 nadir 250-499 cells/mm3,
                  OR

               -  CD4 nadir ≥ 500 cells/mm3

        Exclusion Criteria:

          -  Age < 18 or > 75 years

          -  CD4 count nadir < 250 cells/mm3

          -  Dual/mixed or X4 tropic virus if tested prior to viral suppression or if performed by
             DNA trofile testing at any time

          -  Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >2.5 times the
             upper limits of normal

          -  Women who:

               -  are currently pregnant or breastfeeding

               -  are of child-bearing age and do not agree to remain abstinent or use (or have
                  their partner use) an acceptable method of birth control throughout the study.
                  Acceptable method of birth control is defined as intrauterine device (IUD),
                  diaphragm with spermicide, contraceptive sponge, condom, vasectomy.

          -  History of any malignancy except non-melanoma skin cancer

          -  Concomitant use of drugs known to impact or be impacted in terms of pharmacokinetics
             or drug-drug interactions with either raltegravir or maraviroc. This includes:

               -  Inducers of UGT1A1 (such as rifampin, phenytoin, phenobarbital rifabutin, St.
                  John's wort)

               -  CYP3A inhibitors (such as ketoconazole, itraconazole, clarithromycin, nefazodone,
                  and telithromycin)

               -  CYP3A inducers (such as rifampin, carbamazepine, phenobarbital and phenytoin)

          -  Subject requires or is anticipated to require any of the prohibited medications noted
             in the protocol

          -  Enrollment in an experimental protocol having received investigational agents
             (antiretroviral or non-antiretroviral) within 30 days of study enrollment

          -  Chronic active hepatitis B infection as defined by presence of HBsAg

          -  Subject has a history or current evidence of any condition, therapy, laboratory
             abnormality or other circumstance that might interfere with the patient's
             participation for the full duration of the study, such that it is not in the best
             interest of the patient to participate.

          -  Subject is unlikely to adhere to the study procedures, keep appointments, or is
             planning to relocate during the study.