Study To Evaluate Emtricitabine/Tenofovir Alafenamide (F/TAF) in Human Immunodeficiency Virus 1 (HIV-1) Infected Children and Adolescents Virologically Suppressed on a 2- Nucleoside/Nucleotide Reverse Transcriptase Inhibitor (2-NRTI)-Containing Regimen

A Phase 2/3, Open-Label, Multi-Cohort Switch Study to Evaluate Emtricitabine/Tenofovir Alafenamide (F/TAF) in HIV-1 Infected Children and Adolescents Virologically Suppressed on a 2-NRTI-Containing Regimen

The primary objective of this study is to confirm the TAF dose and to evaluate the pharmacokinetics (PK) of TAF, safety, and tolerability of F/TAF in HIV-1 infected children and adolescents virologically suppressed (defined as having < 50 copies/mL of HIV-1 ribonucleic acid [RNA] for a period of at least 6 months) while on a stable NRTI containing regimen.

Study Overview

• Status: Active, not recruiting
• Conditions: HIV-1
• Intervention / Treatment: Drug: F/TAF; Drug: 3rd ARV agent; Drug: Boosted PIs

Detailed Description

Cohorts 2, 3, and 4 will be on a boosted protease inhibitor (PI) or any other 3rd antiretroviral (ARV) agent and will switch their current 2-NRTI-containing regimen to open-label F/TAF while continuing their boosted PI or 3rd agent through 48 weeks. A minimum of 10 participants each in Groups 1 and 2 of Cohort 2, and Cohorts 3 and 4, who are on boosted-atazanavir (ATV) as their 3rd ARV agent will be enrolled. Participants in Cohort 2, Group 1 receive boosted PI agents only. Cohorts 2, 3, and 4 will be enrolled by cohort into a two-part study (Parts A and B).

After completion of 48 weeks, all participants will be given the option to participate in an extension phase of the study. Gilead will provide F/TAF until a) The participant turns 18 years old and F/TAF is commercially available for use in adults in the country in which the participant is enrolled or b), F/TAF becomes commercially available for pediatric use in the country in which the participant is enrolled or c), Gilead Sciences elects to terminate development of F/TAF in the applicable country.

• Study Type: Interventional
• Enrollment (Actual): 41
• Phase: Phase 2; Phase 3

Contacts and Locations

Study Locations

• Panama
  • Panama City, Panama, 0816-00383
    • Hospital del Nino
• South Africa
  • Cape Town, South Africa, 7505
    • KIDCRU, Ward J8, Tygerberg Children's Hospital
  • Cape Town, South Africa, 7626
    • Be Part Yoluntu Centre
  • Coronationville
    • Johannesburg, Coronationville, South Africa, 2093
      • Rahima Moosa Mother and Child Hospital
• United States
  • California
    • Los Angeles, California, United States, 90095
      • University of California Los Angeles
  • Colorado
    • Aurora, Colorado, United States, 80045
      • Children's Hospital Colorado
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19134
      • St. Christopher's Hospital for Children
  • Washington
    • Seattle, Washington, United States, 98105-0371
      • Seattle Children's Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 month to 17 years (Child)
• Accepts Healthy Volunteers: No

Description

Key Inclusion Criteria:

• HIV-1 infected male and female adolescents and children aged 1 month to < 18 years at baseline/Day 1 (according to requirements of the enrolling cohort)
• Must be able to give written assent prior to any screening evaluations
• Parent or guardian able to give written informed consent prior to any screening evaluations and willing to comply with study requirements

• Body weight at screening as follows:

  • Cohort 1: ≥ 35 kg
  • Cohort 2, Group 1: ≥ 25 kg
  • Cohort 2, Group 2: 17 kg to < 25 kg
  • Cohort 3: to be updated per a protocol amendment
  • Cohort 4: to be updated per a protocol amendment
• Currently on a stable 2-NRTI containing regimen that includes a 3rd ARV agent for ≥ 6 consecutive months prior to screening
• Plasma HIV-1 RNA levels < 50 copies/mL for ≥ 6 consecutive months preceding the screening visit
• No opportunistic infection within 30 days of study entry (at baseline/Day 1)
• A negative serum β-human chorionic gonadotropin (HCG) pregnancy test is required for females of childbearing potential only

Key Exclusion Criteria:

• An acquired immunodeficiency syndrome (AIDS) - indicator condition with onset within 30 days prior to screening
• Life expectancy of < 2 years
• Active, serious infections (other than HIV-1 infection) requiring parenteral antibiotic or antifungal therapy within 30 days prior to baseline/Day 1
• Evidence of active pulmonary or extra-pulmonary tuberculosis disease within 3 months of the screening visit
• Active hepatitis C virus (HCV) infection defined as positive for HCV antibody and having detectable HCV RNA
• Positive hepatitis B surface antigen or other evidence of active hepatitis B virus (HBV) infection.
• Have any serious or active medical or psychiatric illness which, in the opinion of the Investigator, would interfere with treatment, assessment, or compliance with the protocol.
• Pregnant or lactating females
• Have history of significant drug sensitivity or drug allergy
• Have previously participated in an investigational trial involving administration of any investigational agent, other than tenofovir, within 30 days prior to the study dosing

NOTE: Other protocol defined Inclusion/ Exclusion criteria may apply.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

10

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: F/TAF+3rd ARV agent (Cohort 1); Participants between 12 to < 18 years of age and ≥ 35 kg in body weight will switch their current 2-NRTI containing regimen to F/TAF (200/25 mg for unboosted 3rd agent and 200/10 mg for boosted 3rd agent) while continuing on their 3rd ARV agent for 48 weeks.	Drug: F/TAF; F/TAF tablets administered orally once daily; Drug: 3rd ARV agent; A 3rd antiretroviral (ARV) agent of the participant's pre-existing regimen may include one of the following: boosted atazanavir (ATV), boosted lopinavir (LPV), boosted darunavir (DRV), unboosted efavirenz (EFV), unboosted nevirapine (NVP), unboosted raltegravir (RAL), or unboosted dolutegravir (DTG).
Experimental: F/TAF+3rd ARV agent (Cohort 2, Group 1, Part A); Participants between 6 to < 12 years of age and ≥ 25 kg in body weight must be on a boosted protease inhibitor (PI) as their 3rd ARV agent and will switch their current 2-NRTI regimen to F/TAF 200/25 mg while continuing on their boosted PI for 48 weeks.	Drug: F/TAF; F/TAF tablets administered orally once daily; Drug: Boosted PIs; Boosted PIs of the participant's pre-existing regimen may include one of the following: ATV, LPV, or DRV.
Experimental: F/TAF+3rd ARV agent (Cohort 2, Group 2, Part A); Participants between 2 to < 12 years of age and between 17 kg to < 25 kg in body weight must be on a boosted protocol specified 3rd ARV agent and will switch their current 2-NRTI containing regimen to F/TAF 120/15 mg while continuing their 3rd ARV agent for 48 weeks.	Drug: F/TAF; F/TAF tablets administered orally once daily; Drug: 3rd ARV agent; A 3rd antiretroviral (ARV) agent of the participant's pre-existing regimen may include one of the following: boosted atazanavir (ATV), boosted lopinavir (LPV), boosted darunavir (DRV), unboosted efavirenz (EFV), unboosted nevirapine (NVP), unboosted raltegravir (RAL), or unboosted dolutegravir (DTG).
Experimental: FTC/TAF+3rd ARV agent (Cohort 3, Part A); Participants between 2 to < 6 years of age will receive F/TAF plus a 3rd ARV agent through 48 weeks.	Drug: F/TAF; F/TAF tablets administered orally once daily; Drug: 3rd ARV agent; A 3rd antiretroviral (ARV) agent of the participant's pre-existing regimen may include one of the following: boosted atazanavir (ATV), boosted lopinavir (LPV), boosted darunavir (DRV), unboosted efavirenz (EFV), unboosted nevirapine (NVP), unboosted raltegravir (RAL), or unboosted dolutegravir (DTG).
Experimental: FTC/TAF+3rd ARV agent (Cohort 4, Part A); Participants between 1 month to < 2 years of age will receive F/TAF plus a 3rd ARV agent through 48 weeks.	Drug: F/TAF; F/TAF tablets administered orally once daily; Drug: 3rd ARV agent; A 3rd antiretroviral (ARV) agent of the participant's pre-existing regimen may include one of the following: boosted atazanavir (ATV), boosted lopinavir (LPV), boosted darunavir (DRV), unboosted efavirenz (EFV), unboosted nevirapine (NVP), unboosted raltegravir (RAL), or unboosted dolutegravir (DTG).
Experimental: F/TAF+3rd ARV agent (Cohort 2, Group 1, Part B); Screening will be initiated for Part B following confirmation of TAF dose in Part A. Approximately 10 additional total participants will be enrolled across all Part B cohorts and will receive F/TAF while continuing their 3rd ARV agent through 48 weeks.	Drug: F/TAF; F/TAF tablets administered orally once daily; Drug: 3rd ARV agent; A 3rd antiretroviral (ARV) agent of the participant's pre-existing regimen may include one of the following: boosted atazanavir (ATV), boosted lopinavir (LPV), boosted darunavir (DRV), unboosted efavirenz (EFV), unboosted nevirapine (NVP), unboosted raltegravir (RAL), or unboosted dolutegravir (DTG).
Experimental: F/TAF+3rd ARV agent (Cohort 2, Group 2, Part B); Screening will be initiated for Part B following confirmation of TAF dose in Part A. Approximately 10 additional total participants will be enrolled across all Part B cohorts and will receive F/TAF while continuing their 3rd ARV agent through 48 weeks.	Drug: F/TAF; F/TAF tablets administered orally once daily; Drug: 3rd ARV agent; A 3rd antiretroviral (ARV) agent of the participant's pre-existing regimen may include one of the following: boosted atazanavir (ATV), boosted lopinavir (LPV), boosted darunavir (DRV), unboosted efavirenz (EFV), unboosted nevirapine (NVP), unboosted raltegravir (RAL), or unboosted dolutegravir (DTG).
Experimental: FTC/TAF+3rd ARV agent (Cohort 3, Part B); Screening will be initiated for Part B following confirmation of TAF dose in Part A. Approximately 10 additional total participants will be enrolled across all Part B cohorts and will receive F/TAF while continuing their 3rd ARV agent through 48 weeks.	Drug: F/TAF; F/TAF tablets administered orally once daily; Drug: 3rd ARV agent; A 3rd antiretroviral (ARV) agent of the participant's pre-existing regimen may include one of the following: boosted atazanavir (ATV), boosted lopinavir (LPV), boosted darunavir (DRV), unboosted efavirenz (EFV), unboosted nevirapine (NVP), unboosted raltegravir (RAL), or unboosted dolutegravir (DTG).
Experimental: FTC/TAF+3rd ARV agent (Cohort 4, Part B); Screening will be initiated for Part B following confirmation of TAF dose in Part A. Approximately 10 additional total participants will be enrolled across all Part B cohorts and will receive F/TAF while continuing their 3rd ARV agent through 48 weeks.	Drug: F/TAF; F/TAF tablets administered orally once daily; Drug: 3rd ARV agent; A 3rd antiretroviral (ARV) agent of the participant's pre-existing regimen may include one of the following: boosted atazanavir (ATV), boosted lopinavir (LPV), boosted darunavir (DRV), unboosted efavirenz (EFV), unboosted nevirapine (NVP), unboosted raltegravir (RAL), or unboosted dolutegravir (DTG).
Experimental: FTC/TAF +3rd ARV agent (Extension Phase); After completion of 48 weeks, all participants will be given the option to participate in an extension phase of the study. Gilead will provide F/TAF until a) the participant turns 18 and F/TAF is commercially available for use in adults in the country in which the participant is enrolled or, b) F/TAF becomes commercially available for pediatric use in the country in which the participant is enrolled or, c) Gilead Sciences elects to terminate development of F/TAF in the applicable country.	Drug: F/TAF; F/TAF tablets administered orally once daily; Drug: 3rd ARV agent; A 3rd antiretroviral (ARV) agent of the participant's pre-existing regimen may include one of the following: boosted atazanavir (ATV), boosted lopinavir (LPV), boosted darunavir (DRV), unboosted efavirenz (EFV), unboosted nevirapine (NVP), unboosted raltegravir (RAL), or unboosted dolutegravir (DTG).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pharmacokinetic (PK) Parameter (Cohort 1): AUCtau of Tenofovir Alafenamide (TAF)	AUCtau is defined as concentration of drug over time (the area under the concentration versus time curve over the dosing interval).	Any time at Week 2 visit
PK Parameter (Cohort 2): AUCtau of TAF	AUCtau is defined as concentration of drug over time (the area under the concentration versus time curve over the dosing interval).	Any time at Week 2 or Week 4 visit, or within 7 days after the completion of Week 2 or Week 4 visits
Percentage of Participants Experiencing Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) Through Week 24	An AE is any untoward medical occurrence in a clinical study participant which does not necessarily have a causal relationship with the treatment. An AE can therefore be any unfavorable and/or unintended sign, symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. The TEAEs were defined as any AEs with an onset date of on or after the study drug start date and no later than 30 days after permanent discontinuation of study drug or any AEs leading to premature discontinuation of study drug.	Baseline through Week 24

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in CD4+ Cell Count at Week 24		Baseline, Week 24
Change From Baseline in CD4+ Cell Count at Week 48		Baseline, Week 48
Change From Baseline in CD4 Percentage at Week 24		Baseline, Week 24
Change From Baseline in CD4 Percentage at Week 48		Baseline, Week 48
PK Parameter (Cohort 1): Cmax of TAF, FTC, and TFV	Cmax is defined as the maximum concentration of drug.	Any time at Week 2 visit
PK Parameter (Cohort 2): Cmax of TAF, FTC, and TFV	Cmax is defined as the maximum concentration of drug.	Any time at Week 2 or Week 4 visit, or within 7 days after the completion of Week 2 or Week 4 visits
PK Parameter (Cohort 1): Clast of TAF	Clast is defined as the last observable concentration of drug.	Any time at Week 2 visit
PK Parameter (Cohort 2) : Clast of TAF	Clast is defined as the last observable concentration of drug.	Any time at Week 2 or Week 4 visit, or within 7 days after the completion of Week 2 or Week 4 visits
PK Parameter (Cohort 1): CL/F of TAF	CL/F is defined as the apparent oral clearance following administration of the drug.	Any time at Week 2 visit
PK Parameter (Cohort 2): CL/F of TAF	CL/F is defined as the apparent oral clearance following administration of the drug.	Any time at Week 2 or Week 4 visit, or within 7 days after the completion of Week 2 or Week 4 visits
PK Parameter (Cohort 1): Vz/F of TAF	Vz/F is defined as the apparent volume of distribution of the drug.	Any time at Week 2 visit
PK Parameter (Cohort 2): Vz/F of TAF	Vz/F is defined as the apparent volume of distribution of the drug.	Any time at Week 2 or Week 4 visit, or within 7 days after the completion of Week 2 or Week 4 visits
PK Parameter (Cohort 1): AUCtau of FTC and TFV	AUCtau is defined as concentration of drug over time (the area under the concentration versus time curve over the dosing interval).	Any time at Week 2 visit
PK Parameter (Cohort 2): AUCtau of FTC and TFV	AUCtau is defined as concentration of drug over time (the area under the concentration versus time curve over the dosing interval).	Any time at Week 2 or Week 4 visit, or within 7 days after the completion of Week 2 or Week 4 visits
PK Parameter (Cohort 1): Ctau of FTC and TFV	Ctau is defined as the observed drug concentration at the end of the dosing interval.	Any time at Week 2 visit
PK Parameter (Cohort 2): Ctau of FTC and TFV	Ctau is defined as the observed drug concentration at the end of the dosing interval.	Any time at Week 2 or Week 4 visit, or within 7 days after the completion of Week 2 or Week 4 visits
Percentage of Participants Experiencing TEAEs and SAEs Through Week 48	An AE is any untoward medical occurrence in a clinical study participant which does not necessarily have a causal relationship with the treatment. An AE can therefore be any unfavorable and/or unintended sign, symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. The TEAEs were defined as any AEs with an onset date of on or after the study drug start date and no later than 30 days after permanent discontinuation of study drug or any AEs leading to premature discontinuation of study drug.	Baseline through Week 48
Percentage of Participants With HIV-1 RNA < 50 Copies/mL at Week 24, as Defined by the United States Food and Drug Administration (US FDA)-Defined Snapshot Algorithm	The percentage of participants with HIV-1 RNA < 50 copies/mL at Week 24 was analyzed using the snapshot algorithm, which defined a participant's virologic response status using only the viral load at the predefined time point within an allowed window of time, along with study drug discontinuation status.	Week 24
Percentage of Participants With HIV-1 RNA < 50 Copies/mL at Week 48, as Defined by the US FDA-Defined Snapshot Algorithm	The percentage of participants with HIV-1 RNA < 50 copies/mL at Week 48 was analyzed using the snapshot algorithm, which defined a participant's virologic response status using only the viral load at the predefined time point within an allowed window of time, along with study drug discontinuation status.	Week 48
Percentage of Participants With Palatability of F/TAF Formulation	Palatability was reported based on the product taste of being normal or abnormal. Missing data were reported separately.	Week 2 (for Cohort 1), Week 2 and Week 4 (for Cohort 2)
Percentage of Participants With Acceptability of F/TAF Formulation	Acceptability was reported based on the the product size and shape. Missing data were reported separately.	Baseline up to Week 4

Collaborators and Investigators

• Sponsor: Gilead Sciences
• Investigators: Study Director: Gilead Study Director, Gilead Sciences

Publications and helpful links

Helpful Links

• Gilead Clinical Trials Website

Study record dates

Study Major Dates

• Study Start (Actual): January 20, 2015
• Primary Completion (Actual): November 4, 2019
• Study Completion (Estimated): December 1, 2024

Study Registration Dates

• First Submitted: November 4, 2014
• First Submitted That Met QC Criteria: November 4, 2014
• First Posted (Estimated): November 6, 2014

Study Record Updates

• Last Update Posted (Actual): November 27, 2023
• Last Update Submitted That Met QC Criteria: November 22, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Keywords: tenofovir; pediatric; children; adolescents; emtricitabine; TDF; FTC; antiretroviral
• Other Study ID Numbers: GS-US-311-1269; 2015-001339-19 (EudraCT Number)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No