Clinical trial NCT04295460: Triple vs. Double Therapy in naïves HIV-Infected Patients
Official title: Effectiveness of a Dual Therapy (Dolutegravir + Lamivudine) on Reduction of the Viral Reservoir, Immune Recovery and Immune Activation Compared With a Triple Therapy (Dolutegravir + Tenofovir Alafenamide/Emtricitabine) in Treatment-naïve HIV-Infected Patients
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: PHASE4
Conditions: HIV Infection
Lead sponsor: Hospitales Universitarios Virgen del Rocío
Sponsor class: OTHER
First posted: 2020-03-04
Enrollment: 70
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The objective of this study is to clarify whether if starting antiretroviral treatment based on dual therapy (DTG + 3TC) could provide less control of residual HIV replication and, therefore, a detriment on immune activation and inflammation compared to starting with triple therapy, and could worsen the patients' long-term prognosis. For this purpose, the investigator has designed a randomized clinical trial where will assess the immunological recovery (CD4+/CD8+), immune activation, proliferation, senescence and apoptosis in T lymphocytes CD4+ and CD8+ cells by flow cytometry, the immune activation of monocytes/ macrophages and plasma concentrations of various inflammatory mediators by ELISAS, and the thymic function, the cellular reservoir of HIV and the degree of HIV DNA transcription by digital dropped PCR.


Eligibility criteria: Inclusion Criteria:

* Treatment-naïve HIV-1-infected patients ≥ 18 years of age.
* Plasma HIV-1 RNA \>5000 and \<500.000 copies/ml.
* T lymphocyte CD4+ count in peripheral blood \>200/μl.
* Patients of childbearing age should consent to use a highly effective contraceptive method from 15 days before the time of inclusion of the study until 30 days after the end of it. It is considered a highly effective method:

  * Complete abstinence from penile-vaginal intercourse from 2 weeks prior to administration of Investigational Product, throughout the study, and for at least 2 weeks after discontinuation of all study medications;
  * Any intrauterine device with published data showing that the expected failure rate is \<1% per year (not all intrauterine devices meet this criterion)
  * Male partner sterilization confirmed prior to the female subject's entry into the study, and this male is the sole partner for that subject.
  * Approved hormonal contraception.
  * Any other method with published data showing that the expected failure rate is \<1% per year.
* Signed written informed consent prior to inclusion.

Exclusion Criteria:

* Acute HIV infection
* T lymphocyte CD4+ count in peripheral blood ≤ 200/µl
* Active opportunistic infection.
* Pregnancy at inclusion or during the follow-up
* Active hepatitis C and/or B virus co-infection.
* ALT ≥ 5 times the ULN, or ALT ≥ 3xULN and bilirubin ≥ 1.5xULN (with \>35% direct bilirubin).
* Unstable liver disease (as defined by the presence of ascites, encephalopathy, coagulopathy, hypoalbuminemia, esophageal or gastric varices, or persistent jaundice), cirrhosis, known biliary abnormalities (apart from hyperbilirubinemia or jaundice due to Gilbert's syndrome or asymptomatic gallstones).
* Subjects with severe hepatic impairment (Class C) as determined by Child-Pugh classification.
* Current or past disease that requires the use subsidiary of treatment with corticosteroids, immunomodulatory agents, interferon or chemotherapeutic agents.
* Any laboratory abnormality grade 3 or 4 according to the U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Division of AIDS (Annex 3)
* Concomitant use of drugs with potential major interactions with the prescribed drugs according to the respective full prescribing information.
* Estimated creatinine clearance \<50ml/min.
* History or presence of allergy to the study drugs or their components

Primary outcomes:
measure: proviral HIV-DNA
timeFrame: 48 and 96 weeks
Secondary outcomes:
measure: Immune Recovery
timeFrame: 48 and 96 weeks
measure: Immune Activation
timeFrame: 48 and 96 weeks
measure: Monocytes Activation
timeFrame: 48 and 96 weeks
measure: Immunosenescense
timeFrame: 48 and 96 weeks
measure: Inflammation
timeFrame: 48 and 96 weeks
measure: Viral Reservoir
timeFrame: 48 and 96 weeks
Other outcomes:
measure: Semen
timeFrame: 24 weeks
measure: GALT
timeFrame: 48 weeks
Locations:
city: Seville
country: Spain
facility: Hospital Universitario Virgen del Rocio
Study officials:
References: