- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04495348
Explorations Into the Mechanism for INSTI-associated Weight Gain: a Focus on Energy Balance
Weight gain following antiretroviral therapy (ART) initiation occurs with all modern regimens. Recent real-world reports suggest that integrase strand transfer inhibitor (INSTI)-based ART may be associated with excess weight gain compared to other regimens. Weight gain appears to occur regardless of baseline weight, and is most pronounced among women and minorities, often those at highest risk of obesity-associated comorbidities. INSTI- and TAF-based regimens are now preferred regimens for most persons according to the Department of Health and Human Services ART-Treatment Guidelines. As a result, there is an urgent need to understand the underlying mechanisms for this weight gain.
This study aims to understand the changes in energy balance that occur with changes in ART. Participants with HIV who have experienced >10% weight gain on INSTI (bictegravir or dolutegravir-based therapy) will be switched to doravirine for 12 weeks, and then back to their prior INSTI regimen, allowing for assessment of changes in metabolic parameters with drug withdrawal and reintroduction (with no change to NRTI-backbone). Twenty-four hour energy balance will be measured on both regimens during a 24-hour stay using a whole room indirect calorimetry, with a standardized diet. Ultimately, the investigator's goal is to understand the mechanisms of weight gain so that future interventions can most effectively mitigate ART-associated weight changes.
Study Overview
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
-
-
Colorado
-
Aurora, Colorado, United States, 80045
- University of Colorado Anschutz Medical Campus
-
-
Texas
-
Houston, Texas, United States, 77030
- UTHealth
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- Adults age >=18 years
- BMI of >=30.0 kg/m2
- >=10% weight gain within the first 2 years of switching to INSTI-based ART (bictegravir or dolutegravir-based regimens only), with weight gain that has continued or worsened (not decreased).
- At least one plasma HIV-1 RNA <50 copies/mL while on the current INSTI-based ART within 6 months of screening
- Willing to switch to doravirine and pay any associated co-pays that may not be covered by insurance.
- NRTI back-bone therapy with either TAF or TDF with 3TC or FTC and willing to continue these 2 agents
Exclusion Criteria:
- Use of an INSTI other than bictegravir or dolutegravir within the 1 year prior to entry
- Any plasma HIV-1 RNA >500 copies/mL within one year prior to entry
- Pregnant, breast-feeding, or intention to become pregnant during the study period.
- Participants using medications with a potential serious drug-drug interaction with doravirine that cannot be attenuated through dose change will also be excluded.
- Any plans to change diet or exercise regimen significantly within the study period.
NOTE: Significantly refers to intent to join a weight-loss program such as Weight Watchers, start a specific diet (such as ketogenic or very low carbohydrate).
- Use of human growth hormone, tesamorelin, supra-physiologic testosterone to achieve therapeutic blood levels, or any use of other anabolic steroids within 3 months prior to study entry or plans to start these on study.
NOTE: Chronic, stable hormone replacement therapy ≥3 months prior to entry in men with diagnosed hypogonadism or transgender person on masculinizing hormonal therapy is permitted.
- Use of estrogens or progesterones at supraphysiologic doses within 3 months prior to study entry.
NOTE: Stable doses used for contraception, post-menopausal hormone replacement or feminizing hormone therapy for transgender persons ≥3 months prior to entry is permitted.
- Use of prednisone (or equivalent steroid) within the prior 3 months, unless stable dosing ≤ 10mg
- Change or initiation of lipid- and/or glucose-lowering therapy in the 12 weeks prior to entry, or planned need for such therapy during the study period. Use of stable lipid- and/or glucose-lowering therapy during the study is allowed.
- Current serious illness requiring systemic treatment and/or hospitalization until participant completes therapy or is clinically stable as determined by the site investigator.
- Active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements.
- Intent to use any medication likely to cause significant changes in weight during the study period.
NOTE: A list of medications in this category will be provided.
- Prior bariatric surgery (e.g., lap band, gastric sleeve, or roux-en-y bypass surgery) or major gastric surgery or plans to undergo weight reduction surgery while on study.
- Screening laboratory values as follows:
ANC < 500 cells/mm3 Hemoglobin < 9 gm/dL Cr Cl < 30 mL/min (estimated by CKD-Epi equation) Fasting blood sugar <200
- Any chronic, end-stage organ disease that would impact metabolism, including end-stage liver or renal disease, cardiac cachexia, chronic obstructive pulmonary disease, or cancer
- Any condition that the study investigator believes would make the candidate unsuitable for participation.
- Severe claustrophobia that would limit ability of participant to remain in the whole room calorimeter
- Known resistance to any component of the study drugs, including detection of any of the following resistance mutations on prior HIV genotype test (genotype testing not required if not available): Doravirine resistance: V106A, V106I, V106T, V106M, Y188C, Y188H, Y188L, G190E, P225H, F227C, F227L, F227R, M230L, L234I Resistance to NRTIs: K65R, K65E, K65N, T69S (insertion complex), K70E, L74V, Y115F, Q151M, M184I, M184V.
- Active severe depression or anxiety, as evidenced by recent inpatient psychiatric admission (within the prior 6 months); PHQ-2 score of 6 (response of 'nearly every day' to 'do you have little interest or pleasure in doing things' or 'feeling down, depressed, or hopeless'; expressed suicidal ideations.
- Under the care of a provider for disordered eating (bulimia, anorexia, or other).
- Diabetes will be permitted if well-controlled with a Hb A1C of 7.5% of less in the prior 6 months and no use of insulin.
- Routine physical activity meeting or exceeding 150 minutes/week of moderate or vigorous activity, for at least 3 months prior to the study
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Open-label arm
Participants are switched to doravirine and then switched back to INSTI-based therapy.
|
Participants will be switched to doravirine and then switched back to INSTI-based therapy to determine the impact on energy balance.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in energy balance
Time Frame: 24 weeks
|
Change in total energy expenditure (kcal/day)
|
24 weeks
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Kristine Erlandson, MD, University of Colorado Denver, Anschutz Medical Campus
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 19-2960
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Weight Gain
-
Andalas UniversityNational Institute of Health Research and Development, Ministry of Health...CompletedBirth Weight | Pregnancy Weight GainIndonesia
-
Western University, CanadaIowa State UniversityCompletedBirth Weight | Excessive Weight Gain in Pregnancy With Baby Delivered | Excessive Weight Gain in Pregnancy, First TrimesterCanada
-
University of PittsburghThe Obesity Society; Weight Watchers InternationalCompletedObesity | Weight Gain, Maternal | Postpartum Weight RetentionUnited States
-
Medical University of South CarolinaNational Center for Research Resources (NCRR)Terminated
-
T.C. ORDU ÜNİVERSİTESİEge UniversityCompletedGestational Weight GainTurkey
-
University of HawaiiCompletedGestational Weight GainUnited States
-
Helena PiccininiNova Scotia Health AuthorityWithdrawnGestational Weight GainCanada
-
West China HospitalWest China Second University HospitalCompleted
-
Corcept TherapeuticsEli Lilly and CompanyCompletedWeight-Gain PreventionIndia
-
University of Colorado, DenverEunice Kennedy Shriver National Institute of Child Health and Human Development...Completed
Clinical Trials on Doravirine
-
University of North Carolina, Chapel HillMerck Sharp & Dohme LLCRecruitingHIV Infections | Pregnancy RelatedUnited States
-
Gamaleya Research Institute of Epidemiology and...MSD Pharmaceuticals LLCNot yet recruiting
-
Merck Sharp & Dohme LLCCompleted
-
Merck Sharp & Dohme LLCCompletedHuman Immunodeficiency Virus-1 (HIV-1)
-
Merck Sharp & Dohme LLCCompleted
-
Merck Sharp & Dohme LLCCompletedHIV-1 InfectionUnited States, Chile, France, United Kingdom
-
University of Roma La SapienzaRecruiting
-
Clinique du Quartier LatinMerck Frosst Canada Ltd.UnknownHIV InfectionsCanada, Martinique
-
Fundación FLS de Lucha Contra el Sida, las Enfermedades...Merck Sharp & Dohme LLCCompletedHIV-infected Participants With ESRD Undergoing Routine HemodialysisSpain
-
Chelsea and Westminster NHS Foundation TrustMerck Sharp & Dohme LLC; Imperial College London; University of LiverpoolCompletedHuman Immunodeficiency VirusUnited Kingdom