A Study of Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (D/C/F/TAF) Evaluated as a Fixed Dose Combination Regimen in Participants Switching From an Integrase Inhibitor Who Have Experienced Rapid Weight Gain

Study Overview
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Brief Summary
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The purpose of this study is to assess the percent change in body weight when switching to darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) fixed-dose combination (FDC) (Immediate Switch Arm) compared to continuing the current integrase (INI) + tenofovir alafenamide/emtricitabine (TAF/FTC) antiretroviral (ARV) regimen (Delayed Switch Arm) in virologically-suppressed human immunodeficiency virus (HIV)-1 infected participants who have experienced rapid and significant body weight gain.

Official Title
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A Phase 4, Randomized, Active-Controlled, Open-label Study to Evaluate the Safety and Tolerability of Switching to Once-Daily Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (D/C/F/TAF) Fixed-dose Combination (FDC) Regimen in Virologically-suppressed Human Immunodeficiency Virus Type 1 (HIV-1) Infected Participants Experiencing Rapid Weight Gain With an INI + TAF/FTC ARV Regimen

Conditions
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HIV-1

Intervention / Treatment
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* Drug: D/C/F/TAF FDC
* Drug: TAF/FTC FDC
* Drug: INI Based Regimen


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Body Mass Index (BMI) of greater than or equal to (>=) 18 kilogram per meter square (kg/m^2) at time of starting an integrase (INI)-based regimen plus Tenofovir Alafenamide/Emtricitabine (TAF/FTC) antiretroviral (ARV) regimen Documented human immunodeficiency virus (HIV)-1 infection Currently being treated with a stable ARV regimen consisting of an INI combined with TAF/FTC for >=6 consecutive months preceding the screening visit and experienced a >=10 percent (%) increase in body weight within a 36-month time period prior to screening and while on the current INI + TAF/FTC ARV regimen Documented evidence of being virologically suppressed while on the current stable INI+TAF/FTC ARV regimen prior to screening At least one plasma HIV-1 RNA measurement less than (<) 50 copies/milliliter (mL) occurring between 12 and 2 months prior to the screening visit while on the stable INI+ TAF/FTC ARV regimen and have HIV-1 RNA <50 copies/ mL at the screening visit Exclusion Criteria: Known 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 Known allergies, hypersensitivity, or intolerance to D/C/F/TAF fixed-dose combination (FDC) tablet or its excipients Active hepatitis B (HBV) or hepatitis C virus (HCV) infection Uncontrolled diabetes that will require treatment with insulin during the study period Evidence of Child Pugh Class C based on clinical laboratory testing and clinical evaluation History of failure on darunavir (DRV) treatment or known documented history of >=1 DRV resistance-associated mutations (RAM) Screening hepatic transaminases >5x the upper limit of the normal range Screening creatinine based estimated glomerular filtration rate (eGFRcr) <30 ml/min according to the Cockcroft-Gault formula for creatinine clearance Participants initiating or discontinuing concomitant medications associated with significant changes in weight within the last 90 days

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: D/C/F/TAF FDC Arm (Immediate Switch)<br>Participants will be immediately switched to a regimen of darunavir 800 milligram (mg)/cobicistat 150 mg/emtricitabine 200 mg/tenofovir alafenamide 10 mg (D/C/F/TAF) fixed-dose combination (FDC) once daily for 48 weeks. | Drug: D/C/F/TAF FDC<br>* A FDC tablet containing darunavir 800 mg, cobicistat 150 mg, emtricitabine 200 mg, tenofovir alafenamide 10 mg will be administered once daily.<br>|
| Active Comparator: INI + TAF/FTC Arm (Delayed Switch)<br>Participants will continue to receive current baseline integrase (INI)-based regimen plus Tenofovir Alafenamide/Emtricitabine (TAF/FTC) antiretroviral (ARV) regimen for 24 weeks. After 24 weeks participants will switch to a regimen of D/C/F/TAF FDC once daily for an additional 24 weeks. | Drug: D/C/F/TAF FDC<br>* A FDC tablet containing darunavir 800 mg, cobicistat 150 mg, emtricitabine 200 mg, tenofovir alafenamide 10 mg will be administered once daily.<br>Drug: TAF/FTC FDC<br>* TAF/FTC ARV regimen will be administered once daily.<br>Drug: INI Based Regimen<br>* The integrase (INI) inhibitors (for example, bictegravir, dolutegravir, elvitegravir/cobicistat, and raltegravir) will be administered in combination with TAF/FTC, as appropriate. Regimen may consist of a single tablet regimen or a combination of two separate pills.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent Change from Baseline in Body Weight at Week 24 | Percent change from baseline in body weight at Week 24 will be reported. | Baseline and Week 24 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in Absolute Body Weight at Weeks 24 and 48 | Change from baseline in absolute body weight at Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Percentage of Participants with Percent Change in Body Weight Greater Than (>) 3 Percent (%) at Weeks 24 and 48 | Percentage of participants with % change in body weight >3% at Weeks 24 and 48 will be reported. | Weeks 24 and 48 | 
| Percentage of Participants with Percent Change in Body Weight >5% at Weeks 24 and 48 | Percentage of participants with % change in body weight >5% at Weeks 24 and 48 will be reported. | Weeks 24 and 48 | 
| Change from Baseline in Body Mass Index (BMI) at Weeks 24 and 48 | Change from baseline in BMI at Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Change from Baseline in Body Composition as Measured by Dual-energy X-ray Absorptiometry (DEXA) Scan at Weeks 24 and 48 | Change from baseline in body composition (absolute mass of fat, lean body mass and total mass) as measured by DEXA scan at Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Change from Baseline in Waist Circumference at Weeks 24 and 48 | Change from baseline in waist circumference at Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Change from Baseline in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) at Weeks 24 and 48 | Change from baseline in SBP and DBP from Baseline at Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Change from Baseline in Fasting Lipids at Weeks 24 and 48 | Change from baseline in fasting lipids at Weeks 24 and 48 will be reported. Fasting plasma lipids are measured to determine triglyceride or cholesterol concentrations. | Baseline, Weeks 24 and 48 | 
| Change from Baseline in Fasting Glucose at Weeks 24 and 48 | Change from baseline in fasting glucose at Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Change from Baseline in Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) at Weeks 24 and 48 | Change from baseline in HOMA-IR at Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Change from Baseline in Hemoglobin A1c (HbA1c) at Weeks 24 and 48 | Change from baseline in HbA1c at Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Change from Baseline in Leptin at Weeks 24 and 48 | Change from baseline in leptin at Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Change from Baseline in Adiponectin at Weeks 24 and 48 | Change from baseline in adiponectin at Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Change from Baseline in the Percentage of Participants with Advanced Fibrosis as Assessed by Non-alcoholic Fatty Liver Disease (NAFLD) Fibrosis Score at Weeks 24 and 48 | Change from baseline in the percentage of participants with advanced fibrosis according to the NAFLD fibrosis score at Weeks 24 and 48 will be reported. In participants with NAFLD Score less than (< ) -1.455, advanced liver fibrosis can be excluded with high accuracy and NAFLD Score greater than (>) 0.675, the presence of advanced liver fibrosis can be diagnosed with high accuracy. Scores between -1.455 and 0.675 are considered indeterminate. | Baseline, Weeks 24 and 48 | 
| Change from Baseline in the Percentage of Participants at High Risk of Nonalcoholic Fatty Liver Disease (NASH) According to the Hypertension, Age, Insulin, Resistance (HAIR) Score at Weeks 24 and 48 | Change from baseline in the percentage of participants at high risk of NASH according to the HAIR score at Weeks 24 and 48 will be reported. HAIR score ranges from 0-3 which is calculated by adding Hypertension = 1, ALT >40 IU=1, and insulin resistance (IR) index >5.0 = 1. A score of greater than or equal to (>=) 2 is high risk for NASH. | Baseline, Weeks 24 and 48 | 
| Percentage of Participants with a Dose-reduction or Complete Withdrawal of Anti-hypertensive, Anti-hyperglycemic, or Lipid Lowering Agents | Percentage of participants with a dose-reduction or complete withdrawal of anti-hypertensive, anti-hyperglycemic, or lipid lowering agents from baseline to Weeks 24 and 48 will be reported. | Baseline up to Weeks 24 and 48 | 
| Percentage of Participants Initiating an Anti-hypertensive, Anti-hyperglycemic, or Lipid Lowering Agent | Percentage of participants initiating an anti-hypertensive, anti-hyperglycemic, or lipid lowering agent from baseline to Weeks 24 and 48 will be reported. | Baseline up to Weeks 24 and 48 | 
| Percentage of Participants with any Grade Adverse Events (AEs) | Percentage of participants with any Grade AEs (related and not related) will be reported. | Up to 24 and 48 weeks | 
| Percentage of Participants with Grade 3 and Grade 4 AEs | Percentage of participants with Grade 3 and Grade 4 AEs (related and not related) will be reported where Grade 3: Severe and Grade 4: Potentially life-threatening. | Up to 24 and 48 weeks | 
| Percentage of Participants who Discontinued due to AEs | Percentage of participants who discontinued due to AEs will be reported. | Up to 24 and 48 weeks | 
| Percentage of Participants with Serious Adverse Events (SAEs) | Percentage of participants with SAEs (related and not related) through Week 24 and Week 48 will be reported. | Up to 24 and 48 weeks | 
| Change from Baseline in Biochemistry Tests | Change from baseline in biochemistry tests (such as sodium, potassium, chloride, bicarbonate, blood urea nitrogen, serum creatinine, glucose, aspartate aminotransferase, alanine aminotransferase, insulin, bilirubin [total, direct, indirect], alkaline phosphatase, calcium, calcium corrected for albumin, phosphate, albumin, total protein) through Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Change from Baseline in Hematology Tests | Change from baseline in hematology tests (hematocrit, hemoglobin, platelet count, red blood cell count, absolute neutrophil count, white blood cell count) through Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Change from Baseline in Urinalysis Tests | Change from baseline in urinalysis tests (specific gravity, pH, glucose, protein, blood ketones, bilirubin, urobilinogen, nitrite, leukocyte esterase) through Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Change from Baseline in Urine Chemistry Tests | If applicable, change from baseline in urine chemistry tests (urine creatinine, urine sodium, urine phosphate, urine glucose, urine albumin, urine protein, serum creatinine) through Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Percentage of Participants with Grade 3 and Grade 4 Laboratory Abnormalities | Percentage of participants with Grade 3 and Grade 4 laboratory abnormalities will be reported. | Up to 24 and 48 weeks | 
| Percentage of Participants with Confirmed Virologic Rebound | Percentage of participants with confirmed virologic rebound through Weeks 24 and 48 will be reported. Virologic rebound is defined as the 2 consecutive human immunodeficiency virus type-1 ribonucleic acid (HIV-1 RNA) values greater than or equal to (>=) 200 copies/milliliter (mL) at a scheduled or unscheduled visit after maintaining HIV-1 RNA less than (<) 50 copies/mL. | Up to Weeks 24 and 48 | 
| Percentage of Participants with Virologic Response (HIV-1 RNA<50 copies/mL) at Weeks 24 and 48 | Percentage of participants with virologic response (HIV-1 RNA <50 copies/mL), at Weeks 24 and 48 according to the Food Drug Administration (FDA) snapshot algorithm will be reported. | Weeks 24 and 48 | 
| Percentage of Participants with Virologic Failure (HIV-1 RNA ≥50 copies/mL) at Weeks 24 and 48 | Percentage participants with virologic failure (HIV-1 RNA >=50 copies/mL) at Weeks 24 and 48 according to the FDA snapshot algorithm will be reported. | Weeks 24 and 48 | 
| Percentage of Participants Having Virologic Response (HIV-1 RNA<200 copies/mL) at Weeks 24 and 48 | Percentage participants with virologic response (HIV-1 RNA < 200 copies/mL) at Weeks 24 and 48 according to the FDA snapshot algorithm will be reported. | Weeks 24 and 48 | 
| Percentage of Participants Having Virologic Failure (HIV-1 RNA ≥200 copies/mL) at Weeks 24 and 48 | Percentage participants having virologic failure, that is HIV-1 RNA >= 200 copies/mL, at Weeks 24 and 48 according to the FDA snapshot algorithm will be reported. | Weeks 24 and 48 | 
| Change from Baseline in Cluster of Differentiation-4 (CD4+) Cell Count at Weeks 24 and 48 | Change from baseline in CD4+ cell count at Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Percentage of Participants with Pre-baseline Protease (PR), Reverse Transcriptase (RT), and Integrase (INI) Resistance-Associated Mutation (RAMs) | Percentage of participants with pre-baseline PR, RT, and INI RAMs based on historical genotypes will be reported. | Baseline (Day 1) | 
| Percentage of Participant with Newly Identified Post-Baseline RAMS and Phenotypic Resistance Compared to Pre-baseline Resistance Tests | Percentage of participant with newly identified post-baseline RAMs and phenotypic resistance compared to pre-baseline resistance tests when available, upon meeting confirmed virologic rebound through Week 48. | Up to Week 48 | 
| Percentage of Participants with Genotypic and Phenotypic Antiretroviral (ARV) Resistance for Meeting HIV-1 RNA Rebound Criteria up to Weeks 24 and 48 | Percentage of participants with genotypic and phenotypic ARV resistance who are meeting HIV-1 RNA rebound criteria through Weeks 24 and 48 will be reported. | Up to Weeks 24 and 48 | 
| Change from Baseline in the Percentage of Participants who Have Bothersome Symptoms (Scores of 1, 2, 3 or 4) Across all Items of the HIV-Symptom Index (HIV-SI) at Weeks 24 and 48 | Change from baseline in the percentage of participants who have bothersome symptoms (scores of 1, 2, 3 or 4) across all items of the HIV-SI at Weeks 24 and 48 will be reported. The HIV-SI assesses 20 items which are evaluated on a scale of 0-4 where 0= I do not have this symptom to 4=It bothers me a lot'. Minimum HIV-SI score is 0 and maximum HIV-SI score is 80. | Baseline, Weeks 24 and 48 | 
| Change from Baseline in the Percentage of Participants who Have Any Symptoms (scores of 1, 2, 3 or 4) Across all Items of the HIV-Symptom Index (HIV-SI) at Weeks 24 and 48 | Change from baseline in the percentage of participants who have any symptoms (scores of 1, 2, 3 or 4) across all items of the HIV-SI at Weeks 24 and 48 will be reported. | Baseline, Weeks 24 and 48 | 
| Association Between Treatment Arm and Each Bothersome Symptom of the HIV-SI Adjusting for Baseline Variables at Week 24 | Association between treatment arm and each bothersome symptom of the HIV-SI adjusting for Baseline variables at Week 24 will be reported. | Week 24 | 
| Patient Global Impression of Change (PGIC) Scale | The PGIC is a global index that is used to rate the overall status of the participant related to the participant's overall condition. It is rated by the participant and is based on the single question, compared to before starting the study or compared to the Week 24 and Week 48 visits, my overall status is, where response choices include 1=very much improved, 2=much improved, 3=minimally improved, 4=no change, 5=minimally worse, 6=much worse, and 7=very much worse. | Weeks 24 and 48 | 
| Adherence Rate to Treatment at Weeks 4, 12 and 24 | Adherence rate to treatment will be assessed by participant self-report using 4-day recall at Weeks 4, 12, 24, 36 and 48. | Weeks 4, 12, 24, 36 and 48 |