- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04665375
Can INSTI-associated Weight Gain be Halted or Reversed With a Switch to Doravirine/Lamivudine/Tenofovir DF? (DeLiTE)
Can the Weight Gain Associated With Use of Integrase Strand Inhibitors be Halted or Reversed With a Switch to Doravirine/Lamivudine/Tenofovir DF in Patients Living With HIV? (DeLiTE)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background and Importance: Lifelong antiretroviral treatment (ART) is recommended for all people living with HIV (PLWH) primarily with integrase strand inhibitor (INSTI)-based regimens. While weight gain following ART initiation was previously considered "return to health", recent studies have raised concerns of weight gain and increasing obesity in PLWH, most notably with INSTIs and possibly with tenofovir alafenamide (TAF), a preferred nucleoside backbone agent. The weight gain may be progressive and may increase cardiovascular risk. A critical unanswered question is whether weight gain and metabolic effects are permanent or reversible. This data is crucial to optimize ART therapy and health of PLWH.
Goal/Research Aims: No therapeutic alternatives are substantiated for ART-associated weight gain. Doravirine/lamivudine/tenofovir DF (DOR/3TC/TDF) is an attractive option to explore as it does not include an INSTI or TAF, is a well tolerated once daily single tablet, minimal drug interactions and has not been associated with significant weight gain to date. The investigators hypothesize that switching from an INSTI regimen to DOR/3TC/TDF will slow or reverse weight gain while maintaining viral suppression. Before embarking on a large randomized controlled study (RCT), the investigators propose this pilot study to determine the feasibility and acceptability and to obtain estimate measures of weight change to inform its design and sample size.
Methods: Open-label, exploratory pilot switch study. Patients who are virally suppressed on an INSTI regimen for >1 year, without ART resistance, and have experienced significant weight gain will be approached to switch to DOR/3TC/TDF for 48 weeks. Weight, adherence, viral load, CD4, and other relevant labs will be measured every 3 months. A DXA body scan and body image questionnaires will be completed at baseline and 12 months. The anticipated sample size is 25 with an aim to recruit 50% male, 50% female.
The primary objective is to determine what proportion of clinic patients meet eligibility criteria, agree to participate, and complete the study. The secondary objective is to estimate the distribution of various weight-related outcomes while on DOR/3TC/TDF compared to previous INSTI regimens. Exploratory outcomes will address metabolic changes and body image impact.
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
Ontario
-
Toronto, Ontario, Canada, M5G2C4
- University Health Network
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Documented HIV-1 infection by means of any one of the following:
Documentation of HIV diagnosis in the medical record by a licensed health care provider; OR HIV-1 RNA detection by a licensed HIV-1 RNA assay demonstrating >1000 RNA copies/mL; OR any licensed HIV screening antibody and/or HIV antibody/antigen combination assay confirmed by a second licensed HIV assay such as a HIV-1 Western blot confirmation or HIV rapid Multispot antibody differentiation assay.
- On an Integrase Strand Transfer Inhibitor (INSTI) based regimen for at least 1 year and less than 5 years prior to screening
- Significant weight gain since initiation of the INSTI-based regimen (>10% of baseline body weight)
- Viral load of <200 copies/mL for > 6 consecutive months prior to screening (single viral blips <200 copies/mL accepted if re-suppressed)
- Documentation of weight, glycemia, cholesterol, and blood pressure (BP) history within the last year.
- Signed Informed Consent Form (Appendix B) and willing to comply with the protocol.
- Using proper contraception if of child bearing age and potential.
Exclusion Criteria:
- Pregnancy or desire to become pregnant within the next year
- Failure to use adequate contraception during the study if of child-bearing potential.
- Any underlying documented ART resistance to doravirine, tenofovir disoproxil fumarate, or lamivudine
- Prior virologic failure
- Concomitant drugs that interact with doravirine
- Initiated on concomitant drugs known to cause weight gain within the last 6 months (i.e. antidepressants and antipsychotics)
- Concomitant drugs known to cause nephrotoxicity
- History of renal toxicity or renal events while on TDF therapy.
- Creatinine clearance (CrCL) < 50 mL/min
- Inability to read/understand English
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: NA
- Interventional Model: SINGLE_GROUP
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: DOR/3TC/TDF
100mg of doravirine (DOR), 300mg of lamivudine (3TC), and 300mg of tenofovir disoproxil fumarate (TDF)
|
switch antiretroviral regimen to doravirine/lamivudine/tenofovir disoproxil fumarate once daily for 1 year
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Identify number of active clinic patients who meet eligibility criteria, and of those approached, how many accepted enrollment and completed the study protocol.
Time Frame: 1 year
|
Feasibility (number eligible, enrolled and completed study)
|
1 year
|
Identify reasons for study ineligibility among clinic patients on INSTI-containing regimen who have experienced weight gain.
Time Frame: 1 year
|
Descriptive data.
Reasons for study ineligibility (i.e., not meeting inclusion criteria or presence of one or more exclusion criteria) will be recorded by the study coordinator.
|
1 year
|
Identify reasons for study refusal among clinic patients on INSTI-containing regimen who have experienced weight gain.
Time Frame: 1 year
|
Descriptive data.
Clinic patients who refuse to participate in the study will be asked an open-ended question by the study coordinator about main reason(s) for declining.
Responses will be grouped by the following categories: fear of side effects, distrust of researchers, general concerns about research design, interference in everyday life or changes in routine, and social discrimination.
These were main barriers to study participation identified in a meta-analysis by Mills et al. 2006 (PMID 16377532)
|
1 year
|
Identify factors associated with early study discontinuation.
Time Frame: 1 year
|
Factors will include age, gender, race, CD4 count, HIV viral load, prior enrollment in a study, history of injection drug use, and use of antidepressants.
These are variables which have previously been associated with early study discontinuation in a meta-analysis by Andersen et al (2007).
PMID 17395549.
|
1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
To determine the change in absolute weight from baseline to one year following the switch from the INSTI-containing regimen to DOR/TDF/3TC.
Time Frame: 1 year
|
Absolute weight (kg) - participants will be asked to remove heavy outer clothing, purses, footwear and heavy accessories or pocket contents.
|
1 year
|
To determine the change in relative weight change per year (i.e. weight trajectory) from baseline to one year following the switch from the INSTI-containing regimen to DOR/TDF/3TC.
Time Frame: 1 year
|
Change in weight trajectory (change in weight - baseline vs 1 year prior to baseline compared to change in weight - week 48 versus baseline) in kg
|
1 year
|
To determine the change in waist circumference (cm) from baseline to one year following the switch from the INSTI-containing regimen to DOR/TDF/3TC.
Time Frame: 1 year
|
Waist circumference to be measured using a landmark just above the uppermost lateral border of the right ilium (under the participant's clothing).
Measurement will be recorded to the nearest tenth of a centimeter at the end of the participant's normal expiration.
|
1 year
|
To determine the change in BMI category from baseline to one year following the switch from the INSTI-containing regimen to DOR/TDF/3TC.
Time Frame: 1 year
|
Change in BMI category: underweight (BMI<18.5),
normal weight (BMI 18.5-24.9),
overweight (BMI 25-29.9),
and obese (BMI 30 or more)
|
1 year
|
To determine the proportion of participants who maintain viral suppression (HIV RNA < 50 copies/ml) after a switch to DOR/TDF/3TC.
Time Frame: 1 year
|
HIV RNA<50 copies/mL using Abbott RealTime HIV-1 assay.
|
1 year
|
Number of patients with treatment-related adverse events as assessed by the US DHHS NIH/NIAID Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events, corrected version 2.1 (July 2017)
Time Frame: 1 year
|
Adverse event parameters graded according to severity: Grade 1 (mild), Grade 2 (moderate), Grade 3 (severe), Grade 4 (potentially life-threatening), Grade 5 (death).
|
1 year
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
To determine the impact from baseline to one year following the switch from the INSTI-containing regimen to DOR/TDF/3TC on DXA body scans.
Time Frame: 1 year
|
body composition (proportion of lean versus fat mass)
|
1 year
|
To determine the impact from baseline to one year following the switch from the INSTI-containing regimen to DOR/TDF/3TC on self-esteem related to body image as per the body image questionnaire B-WISE.
Time Frame: 1 year
|
Body weight, image and self-esteem (B-WISE) evaluation questionnaire includes 12 items, each scored as 1 (never), 2 (sometimes) or 3 (all the time); a higher total score is indicative of better adjustment.
ie., 12-20 = mild psychosocial impact, 21-28 = moderate psychosocial impact, 29-36 = severe psychosocial impact.
|
1 year
|
To determine the impact from baseline to one year following the switch from the INSTI-containing regimen to DOR/TDF/3TC on perceived changes in body size as per the FRAM body image questionnaire.
Time Frame: 1 year
|
The fat redistribution and metabolic change (FRAM) questionnaire includes 7 areas of the body that the participant is asked to indicate noticed changes in size over the past year.
Any changes are ranked from 1 (severely increased) to 6 (severely decreased).
A lower total score indicates greater perceived increases in body size.
|
1 year
|
To determine the impact from baseline to one year following the switch from the INSTI-containing regimen to DOR/TDF/3TC on fasting glucose values.
Time Frame: 1 year
|
fasting blood glucose (mmol/L), range 3.8-6.9.
|
1 year
|
To determine the impact from baseline to one year following the switch from the INSTI-containing regimen to DOR/TDF/3TC on insulin resistance (HOMA-IR).
Time Frame: 1 year
|
HOMA score: fasting plasma glucose (mmol/L) times fasting serum insulin (mU/L) divided by 22.5.
A score of <3 indicates normal insulin resistance, a score between 3 and -5 indicates moderate insulin resistance, and a score >5 indicates severe insulin resistance.
|
1 year
|
To determine the impact from baseline to one year following the switch from the INSTI-containing regimen to DOR/TDF/3TC on lipid values (standard lipid panel).
Time Frame: 1 year
|
Standard lipid panel includes total cholesterol, HDL, LDL, triglycerides (all mmol/L) and total cholesterol:HDL ratio
|
1 year
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Sharon Walmsley, University Health Network, Toronto
Publications and helpful links
General Publications
- Lakey W, Yang LY, Yancy W, Chow SC, Hicks C. Short communication: from wasting to obesity: initial antiretroviral therapy and weight gain in HIV-infected persons. AIDS Res Hum Retroviruses. 2013 Mar;29(3):435-40. doi: 10.1089/aid.2012.0234. Epub 2012 Nov 7.
- Kumar S, Samaras K. The Impact of Weight Gain During HIV Treatment on Risk of Pre-diabetes, Diabetes Mellitus, Cardiovascular Disease, and Mortality. Front Endocrinol (Lausanne). 2018 Nov 27;9:705. doi: 10.3389/fendo.2018.00705. eCollection 2018.
- Venter WDF, Moorhouse M, Sokhela S, Fairlie L, Mashabane N, Masenya M, Serenata C, Akpomiemie G, Qavi A, Chandiwana N, Norris S, Chersich M, Clayden P, Abrams E, Arulappan N, Vos A, McCann K, Simmons B, Hill A. Dolutegravir plus Two Different Prodrugs of Tenofovir to Treat HIV. N Engl J Med. 2019 Aug 29;381(9):803-815. doi: 10.1056/NEJMoa1902824. Epub 2019 Jul 24.
- Gomez M, Seybold U, Roider J, Harter G, Bogner JR. Correction to: A retrospective analysis of weight changes in HIV-positive patients switching from a tenofovir disoproxil fumarate (TDF)- to a tenofovir alafenamide fumarate (TAF)-containing treatment regimen in one German university hospital in 2015-2017. Infection. 2019 Feb;47(1):103-104. doi: 10.1007/s15010-018-1251-0.
- Reynes J, Trinh R, Pulido F, Soto-Malave R, Gathe J, Qaqish R, Tian M, Fredrick L, Podsadecki T, Norton M, Nilius A. Lopinavir/ritonavir combined with raltegravir or tenofovir/emtricitabine in antiretroviral-naive subjects: 96-week results of the PROGRESS study. AIDS Res Hum Retroviruses. 2013 Feb;29(2):256-65. doi: 10.1089/aid.2011.0275. Epub 2012 Aug 3.
- Rockstroh JK, Lennox JL, Dejesus E, Saag MS, Lazzarin A, Wan H, Walker ML, Xu X, Zhao J, Teppler H, Dinubile MJ, Rodgers AJ, Nguyen BY, Leavitt R, Sklar P; STARTMRK Investigators. Long-term treatment with raltegravir or efavirenz combined with tenofovir/emtricitabine for treatment-naive human immunodeficiency virus-1-infected patients: 156-week results from STARTMRK. Clin Infect Dis. 2011 Oct;53(8):807-16. doi: 10.1093/cid/cir510.
- McCann K, Moorhouse M, Sokhela S, Venter WD, Serenata C, Qavi A, et al. Changes in DXA-assessed body composition in TAF/FTC+DTG compared to TDF/FTC+DTG and TDF/FTC/EFV in the ADVANCE clinical trial. EACS, November 6-9, 2019, Basel, Switzerland.
- Bedimo R, Li X, Adams-Huet B, Lake J, Taylor B, Kim D, et al. Differential BMI changes following PI- and INSTI-based ART initiation by sex and race. Conference on Retroviruses and Opportunistic Infections; 2019 Mar 4-7; Seattle, Washington
- Rebeiro P, Jenkins C, Bian A, Lake J, Bourgi K, Horberg M, et al. The effect of initiating integrase inhibitor-based vs. non-nucleoside reverse transcriptase inhibitor-based antiretroviral therapy on progression to diabetes among North American persons in HIV care. IDWeek, October 2-6, 2019, Washington, DC. Abstract LB9.
- Schafer J, Sassa K, O'Connor J, Shimada A, Keith S, DeSimone J. BMI and ASCVD risk score changes in virologically suppressed patients with HIV switching from TDF to TAF containing ART. IDWeek, October 2-6, 2019, Washington, DC. Abstract 979
- Kerchberger AM, Sheth AN, Angert CD, Mehta CC, Summers NA, Ofotokun I, Gustafson D, Weiser SD, Sharma A, Adimora AA, French AL, Augenbraun M, Cocohoba J, Kassaye S, Bolivar H, Govindarajulu U, Konkle-Parker D, Golub ET, Lahiri CD. Weight Gain Associated With Integrase Stand Transfer Inhibitor Use in Women. Clin Infect Dis. 2020 Jul 27;71(3):593-600. doi: 10.1093/cid/ciz853.
- Johnson M, Kumar P, Molina JM, Rizzardini G, Cahn P, Bickel M, Mallolas J, Zhou Y, Morais C, Kumar S, Sklar P, Hanna GJ, Hwang C, Greaves W; DRIVE-SHIFT Study Group. Switching to Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate (DOR/3TC/TDF) Maintains HIV-1 Virologic Suppression Through 48 Weeks: Results of the DRIVE-SHIFT Trial. J Acquir Immune Defic Syndr. 2019 Aug 1;81(4):463-472. doi: 10.1097/QAI.0000000000002056.
- Hill A, Hughes SL, Gotham D, Pozniak AL. Tenofovir alafenamide versus tenofovir disoproxil fumarate: is there a true difference in efficacy and safety? J Virus Erad. 2018 Apr 1;4(2):72-79.
- Andersen JW, Fass R, van der Horst C. Factors associated with early study discontinuation in AACTG studies, DACS 200. Contemp Clin Trials. 2007 Sep;28(5):583-92. doi: 10.1016/j.cct.2007.02.002. Epub 2007 Feb 27.
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Department of Health and Human Services. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed [October 30, 2019].
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 20-5528
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.
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