HIV-1-infection
Conditions
Brief summary
Since 1996, HAART based on 3-drug regimens (3DR) in people living with HIV (PLHIV) has decreased mortality and today, PLHIV have a life expectancy close to that of the general population. In the last decade new drugs have improved tolerance and posology of these treatment. However PLHIV needs to continue the treatment and will likely remain on antiviral therapy for many years. In the recent period, active research is being sought with the aim of improving the dosage and reducing the amount of drugs necessary to maintain efficacy, to avoid the possible cumulative effects of long-term antiretroviral therapy (ART). Two-drug regimens (2DRs) have been investigated as a means for reducing the number of antiretroviral agents (ARVs) taken by individuals who need lifelong ART. Dovato® (Dolutegravir/lamivudine) has been evaluated in two phase III studies (GEMINI-1 and GEMINI-2) in treatment-naive adults achieving non inferiority according to the US Food and Drug Administration (FDA) Snapshot algorithm. These data led to the approval of the fixed-dose combination of dolutegravir/lamivudine as a once-daily, single-tablet 2DR by the FDA and the European Medicines Agency. Actual update to the US Department of Health and Human Services treatment guidelines for HIV-1 infection and European AIDS Clinical Society guidelines indicate Dovato ® as an initial treatment in HIV-naÏve patients. However there is no real- life cohort data. Our aim is to provide information related to effectiveness and tolerability/safety in naïve patients when used in routine clinical practice. It has been already published results from the phase III study in pretreatment adult patients. Our results in real life have encouraged us to conduct a multicenter cohort study in patients who have already started their first antiretroviral therapy with dolutegravir (DTG) + lamivudine (3TC), to verify efficacy and tolerance in real life. Our hypothesis is that the data will be similar to those reported in clinical trials.
Detailed description
Our primary objective of this study is to analyze the proportion of individuals (HIV naïve patients) who has initiated 3TC (300 mg p.o. q 24 h) plus DTG (50 mg p.o. q 24 h), and who achieve viral suppression (HIV-1 RNA ≤50 copies/mL) at weeks 48. Secondary objectives are: to analyze the proportion of individuals who achieve viral suppression (HIV-1 RNA ≤50 copies/mL) at weeks 24 and 96, to describe absolute values and changes from ART initiation in CD4+ cells count and CD4:CD8 ratio at 24, 48 and 96 weeks, Changes from ART initiation in creatinine clearance anda fasting lipids at weeks 24, 48 and 96, and the proportion of subjects who discontinue treatment and reasons for discontinuations
Interventions
The subjects started their antiretroviral treatment containing dolutegravir once a day.
The subjects started their antiretroviral treatment containing lamivudine once a day
Sponsors
Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Patient ≥ 18 years of age diagnosed with HIV. * Naïve antiretroviral treatment with dolutegravir/lamivudine initiated between July 2018 and March 2020. * Patients who agree to participate and sign the informed consent form of the study * Patients lost to follow up or died prior to the inclusion in the study (Ethics Committee agreement for exemption from obtaining informed consent in these cases).
Exclusion criteria
* Patient \< 18 years of age. * Patients who don't agree to participate and don't sign the informed consent. * Current pregnancy or breastfeeding. * No effective contraception for FRP women. * Evidence of DTG or 3TC resistance genotype\* * Hepatitis B (HBV) infection * Severe hepatic impairment or unstable liver disease * Moderate to severe renal impairment * AIDS defining illness
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of individuals who achieve viral suppression (HIV-1 RNA ≤50 copies/mL) at weeks 48 | 48 weeks | HIV-1 RNA ≤50 copies/mL at 48 weeks |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Absolute values and changes from ART initiation in CD4+ cells count at 24, 48 and 96 weeks | weeks 24, 48 and 96 | CD4 (cel/μL) at weeks 0, 24,48 and 96 |
| Absolute values and changes from ART initiation in CD4:CD8 ratio at 24, 48 and 96 | weeks 24, 48 and 96 | CD4/CD8 (ratio) at weeks 0, 24,48 and 96 |
| Proportion of individuals who achieve viral suppression (HIV-1 RNA ≤50 copies/mL) at weeks 24 and 96 | weeks 24 and 96 | HIV-1 RNA ≤50 copies/mL at 24 and 96 weeks |
| Changes from ART initiation in fasting lipids (total cholesterol, HDL cholesterol, LDL) cholesterol, triglycerides and ratio of total cholesterol to HDL cholesterol) at weeks 24, 48 and 96 | weeks 24, 48 and 96 | total cholesterol, HDL cholesterol, LDL (mg/dL) at weeks 0, 24, 48 and 96. |
| Proportion of subjects who discontinue treatment and reasons for discontinuations | weeks 48 and 96 | number of subjects who discontinue treatment and reasons for these discontinuations |
| Changes from ART initiation in creatinine clearance at weeks 24, 48 and 96. | weeks 24, 48 and 96 | creatinine clearance (mg/dL) at weeks 0, 24, 48 and 96. |
Countries
Spain
Outcome results
None listed