- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05326971
The Effect Tenofovir Disoproxil Fumarate (TDF) and Tenofovir Alafenamide (TAF) on Small Intestine Gut Wall (TENENTOX)
The Effect of Tenofovir Disoproxil Fumarate (TDF) Versus Tenofovir Alafenamide (TAF) on Proximal Small Intestine - a Potential Mechanism to Explain Opposing Effects on Body Weight
Several studies among people living with HIV (PLWH) have shown more weight gain with tenofovir alafenamide (TAF) than with tenofovir disoproxil fumarate (TDF). This difference could be due to weight increasing effect of TAF and / or weight decreasing effect of TDF.
When TDF is ingested, it gets absorbed in the beginning of the small intestine. TDF is processed into free tenofovir (TFV) within the enterocytes, whereas TAF is not. The effect of TFV on enterocytes is not known, but in kidney tubular cells TFV seems to damage mitochondria and that seems lead to TDF-associated kidney toxicity.
In the present cross sectional study the investigators hypothesize that TDF but not TAF causes damage in the small intestine gut wall and that may lead to poorer absorption of nutrients and opposing effects on body weigh.
Twelve stable PLWH who have been treated with TDF for at least past 6 months and 12 PLWH who have similarly been treated with TAF for at least past 6 months will be recruited. The participants will have a gastroscopy done with biopsies taken from the small intestine. These biopsies will be examined for mitochondrial damage and other potential pathological findings. In addition, blood concentrations of several nutrients absorbed from the same part of the small intestine as TDF and blood concentrations of some markers of intestinal damage will be measured.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Integrase inhibitors (INSTI) and tenofovir alafenamide (TAF) have been associated with increased weight gain in several randomized studies among people living with HIV (PLWH). In most of these studies, the control group received tenofovir disoproxil (TDF) which raises the question whether the difference in weight change is due to weight increasing effect of INSTI/TAF or weight decreasing effect of TDF.
When ingested, TDF is prone to chemical and enzymatic hydrolysis by intestinal esterases once pH rises above 3. Therefore, it has a narrow time window to be absorbed as an intact prodrug from the proximal small intestine, also the site of absorption of considerable proportion of lipids, lipid-soluble vitamins, folates, calcium, phosphate, iron, and other micronutrients.
TDF is metabolized within enterocytes in a two-step process of ester group cleavage into free phosphonate tenofovir (TFV). Neither TDF nor the monoester intermediate are detected in systemic circulation, indicating complete presystemic metabolism. The consequences of free TFV within enterocytes are not known, but TFV is cytotoxic in renal tubular cells.
TAF is more resistant than TDF to enzymatic hydrolysis. Due to the smaller amount of ingested prodrug and based on PK studies, it is suggested that ingestion of TAF leads to much smaller - if any - intracellular concentration of TFV within enterocytes than that of TDF.
Mechanisms behind these clinical effects of TDF are not known. The investigators hypothesize these effects are mediated by reduced absorptive function of the proximal small intestine caused by intracellular accumulation of free TFV within enterocytes, a parallel mechanism to TFV-induced toxicity in proximal tubular cells.
This is a cross-sectional study comprising 24 adult PLW on stable antiretroviral therapy containing either TDF (n=12) or TAF (n=12) for at least the past six months. All participants will have a gastroduodenoscopy with biopsies from proximal and distal duodenum. Blood concentrations of nutrients absorbed from the proximal small intestine and related substances will be measured, as well as circulating markers of intestinal damage and function.
The primary objective is to compare pathology findings including mitochondrial studies in duodenal biopsies of PLWH receiving either TDF or TAF. The secondary objectives are to compare the effects of TDF versus TAF on absorption of selected nutrients absorbed from proximal duodenum and circulating markers of intestinal damage and function and microbiota.
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
Uusimaa
-
Helsinki, Uusimaa, Finland, 00290
- Infectious Disease Clinic, Helsinki University Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age ≥ 18 year;
- HIV-positive on a stable ART including either TDF or TAF for > 6 months
- HIV viral load < 200 copies for ≥ 6 months.
Exclusion Criteria:
- Known or suspected enteropathies (celiac disease, inflammatory bowel disease)
- Use of any of the following during the previous month: calcium, folic acid, iron, vitamin A, B, E supplements
- Pregnancy.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Tenofovir disoproxil TDF
Participants who have used TDF as part of their stable antiretroviral regimen for at least past six months.
|
Gastroscopy to evaluate the effect of long term exposure of TDF or TAF on enterocytes
|
Active Comparator: Tenofovir alafenamide (TAF)
Participants who have used TAF as part of their stable antiretroviral regimen for at least past six months.
|
Gastroscopy to evaluate the effect of long term exposure of TDF or TAF on enterocytes
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mitochondrial respiratory chain function in situ
Time Frame: Baseline
|
Cytochrome C Oxidase / Succinate Dehydrogenase (COX/SDH) activity analysis from cryosections
|
Baseline
|
Histopathology of duodenal biopsies
Time Frame: Baseline
|
Modified Marsh Classification
|
Baseline
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Fasting plasma lipid concentrations
Time Frame: Baseline
|
total, LDL and HDL cholesterol and triglycerides (all values in mmol/L)
|
Baseline
|
Fasting plasma calcium concentration (fP-Ca-ion)
Time Frame: Baseline
|
mmol/l
|
Baseline
|
Fasting serum folate concentration (fS-folate)
Time Frame: Baseline
|
nmol/l
|
Baseline
|
Fasting plasma iron concentration (fP-Fe)
Time Frame: Baseline
|
umol/l
|
Baseline
|
Fasting serum beta carotene concentration (fS-beta carotene)
Time Frame: Baseline
|
nmol/l
|
Baseline
|
Fasting blood thiamine concentration (fB-B1vit)
Time Frame: Baseline
|
nmol/l
|
Baseline
|
Fasting serum intestinal fatty acid binding protein (fS-IFABP2)
Time Frame: Baseline
|
ng/mL
|
Baseline
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Jussi Sutinen, Helsinki University Hospital Infectious Disease Clinic
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1/2022
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.
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