Study to Evaluate Switching From Regimens Consisting of a Ritonavir-boosted Protease Inhibitor (PI) and Two Nucleoside Reverse Transcriptase Inhibitors (NRTIs) to a Fixed-dose Tablet Containing Emtricitabine/Rilpivirine/Tenofovir DF
Condition: HIV-1 Infection
Intervention: FTC/RPV/TDF; PI; RTV; NRTIs
Intervention description: Emtricitabine (FTC) 200 mg/rilpivirine (RPV) 25 mg/tenofovir disoproxil fumarate (tenofovir DF; TDF) 300 mg single-tablet regimen (STR) administered orally with a meal once daily (QD); Protease inhibitors (PIs) included amprenavir, atazanavir, darunavir, fosamprenavir, Kaletra (lopinavir/ritonavir, coformulated), ritonavir, and saquinavir. PIs were administered according to prescribing information.; Ritonavir (RTV) was administered according to prescribing information.; NRTIs included abacavir, emtricitabine, Combivir (lamivudine/zidovudine, coformulated), Epzicom (abacavir/lamivudine, coformulated), lamivudine, stavudine, tenofovir DF, Truvada® (emtricitabine/tenofovir DF, coformulated), and zidovudine. NRTIs were administered according to prescribing information.
Intervention MeSH terms: Emtricitabine, Rilpivirine, Tenofovir Drug Combination
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 482.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: HIV-1; HIV; Treatment Experienced

Summary:

      The purpose of this randomized, open-label, multicenter, active-controlled Phase 3b study is
      to evaluate the noninferiority of the emtricitabine/rilpivirine/tenofovir disoproxil fumarate
      (FTC/RPV/TDF) single-tablet regimen (STR; also referred to as fixed-dose regimen or
      fixed-dose tablet) relative to regimens consisting of a ritonavir-boosted protease inhibitor
      (PI+RTV) and two nucleoside reverse transcriptase inhibitors (NRTIs) in virologically
      suppressed, HIV-1 infected subjects. The FTC/RPV/TDF STR could offer an attractive treatment
      option to patients who wish to simplify dosing by reducing pill burden or to improve the
      tolerability of their treatment.

      Participants will be randomized into 2 groups, the FTC/RPV/TDF STR group, in which
      participants will switch treatment regimens at the start of the study, and the Stay on
      Baseline Regimen (SBR)/Delayed Switch group, in which participants will remain on their
      baseline regimen during the first 24 weeks of the study (designed to provide an initial
      active control), and may switch to the FTC/RPV/TDF STR at the Week 24 visit.

      After the 48-week study analysis period, participants may continue to receive the FTC/RPV/TDF
      STR per protocol before switching to a commercially available source.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Ability to understand and sign a written informed consent form

          -  Receiving antiretroviral therapy with a ritonavir-boosted PI and two NRTIs
             continuously for ≥ 6 months preceding the screening visit

          -  Plasma HIV-1 RNA concentrations (at least two measurements) at undetectable levels for
             ≥ 6 months prior to the screening visit and HIV-1 RNA < 50 copies/mL at the screening
             visit

          -  On their first or second antiretroviral drug regimen; if on their second regimen,
             HIV-1 RNA ≤ 50 copies/mL required at the time of the first change in antiretroviral
             drugs, and no HIV RNA > 50 copies/mL measured at two consecutive time points after
             first achieving HIV RNA < 50 copies/mL

          -  No previous use of any approved or experimental nonnucleoside reverse transcriptase
             inhibitor (NNRTI) drug for any length of time

          -  Have a genotype prior to starting initial antiretroviral therapy and no known
             resistance to any of the study agents

          -  Normal ECG

          -  Hepatic transaminases (AST and ALT) ≤ 5 x upper limit of normal (ULN)

          -  Total bilirubin ≤ 1.5 mg/dL, or normal direct bilirubin

          -  Adequate hematologic function (absolute neutrophil count ≥ 1,000/mm^3; platelets ≥
             50,000/mm^3; hemoglobin ≥ 8.5 g/dL)

          -  Serum amylase ≤ 5 x ULN (subjects with serum amylase > 5 x ULN eligible if serum
             lipase ≤ 5 x ULN)

          -  Adequate renal function (estimated glomerular filtration rate ≥ 70 mL/min according to
             the Cockcroft-Gault formula)

          -  Males and females of childbearing potential must agree to utilize highly effective
             contraception methods (two separate forms of contraception, one of which must have
             been an effective barrier method, or been nonheterosexually active, practice sexual
             abstinence, or have a vasectomized partner) from screening throughout the duration of
             the study period and for 30 days following the last dose of study drug.

          -  Age ≥ 18 years

          -  Life expectancy ≥ 1 year

        Exclusion Criteria:

          -  A new AIDS-defining condition diagnosed within 30 days prior to screening except
             cluster of differentiation 4 (CD4) cell count and/or percentage criteria

          -  Females who are breastfeeding

          -  Positive serum pregnancy test (female of childbearing potential)

          -  Proven or suspected acute hepatitis 30 days prior to study entry.

          -  Current alcohol or substance abuse judged by the Investigator to potentially interfere
             with subject compliance.

          -  History of malignancy within 5 years prior to study entry 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

          -  Anticipated need to initiate contraindicated drugs during the study, including drugs
             not to be used with FTC, TDF, RPV; or subjects with known allergies to the excipients
             of FTC/RPV/TDF STR tablets or Truvada® tablets

          -  All investigational drugs

          -  Medications and use of herbal/natural supplements excluded or to be used with caution
             while participating in the study, including those not to be taken with Viread®,
             Emtriva®, Truvada, and Rilpivirine.

          -  Participation in any other clinical trial without prior approval from the sponsor was
             prohibited while participating in this trial

          -  Treatment with immunosuppressant therapies or chemotherapeutic agents within 3 months
             of study screening, or expected to receive these agents or systemic steroids during
             the study

          -  History of liver disease, including Gilbert's Disease

          -  Any other clinical condition or prior therapy making the subject unsuitable for the
             study or unable to comply with the dosing requirements