- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT02025868
Third Line Antiretroviral Treatment Optimization in Sub-Saharan Africa (THILAO)
Systematic "Adherence Intervention" Phase Before Switching to 3rd-line ART in Patients With 2nd-line ART Virologic Failure in Sub-Saharan Africa : a Phase 2b Non-randomized Study.
Thilao is a multi-country, phase 2b, non-randomized study, in Burkina Faso, Cote d'Ivoire, Mali and Senegal, West Africa.
HIV-1 adults with 2nd-line ART virologic failure (plasma HIV-1 RNA >1000 copies/ml) will be recruited and followed in two phases:
- First, a 12-week intentive adherence reinforcement phase, during which patients will continue 2nd-line ART, be seen repeatidly for counseling and educational training on adherence, and be offered the possibility of phone, SMS and home visit contacts with social workers;
Second, a 48-week phase, during which:
- Patients successfully resuppressed at the end of the first phase will continue 2nd-line ART and adherence reinforcement;
- Patients with persitent virologic failure will switch to a darunavir/r + raltegravir-based 3rd-line ART.
Genotype resistance tests will be performed retrospectively on frozen samples. The main outcome will be the percentage of patients with plasma HIV-1 viral RNA <50 copies/ml at 64 weeks.
Studieoversikt
Status
Forhold
Detaljert beskrivelse
Main objective
To estimate, in sub-Saharan African HIV-1 infected adults who failed a NNRTI-base first-line ART and then a PI-based second-line ART:
- The efficacy (and associated factors) at 12 weeks of an intensive 3-months adherence reinfrocement phase;
- In patients who successfully resuppress at 12 weeks: The percentage of patients still with continuing succesfull virologic supression on 2nd-line ART at 64 weeks (and factors associated to success) ;
- In patients with persistent failure at 12 weeks : The efficacy (and associated factors) at 64 weeks of a darunavir/r + raltegravir-based 3rd-line regimen.
Number of participants : 200
Main outcome :
- At 12 weeks : Proportion of patients with a plasma HIV-1 RNA <400 copies/ml and/or with a decrease in plasma HIV-1 RNA >2 log10 copies/ml between inclusion and 12 weeks;
- At 64 weeks : proportion of patients with a plasma HIV-1 RNA <50 copies/ml.
Inclusion criteria:
- Age >18 years
- Documented HIV-1 infection.
- History of failing a NNRTI-based 1st-line ART
- Current PI-based 2nd-line ART >6 months
- Plasma HIV-1 RNA >1000 copies/ml
- Signed informed consent
Studietype
Registrering (Faktiske)
Fase
- Fase 2
Kontakter og plasseringer
Studiesteder
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-
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Bobo-Dioulasso, Burkina Faso
- CHU Souro Sanou
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Ouagadougou, Burkina Faso
- CHU Yalgado Ouedraogo
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-
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-
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Abidjan, Elfenbenskysten
- Centre de Prise en Charge et de Formation (CePReF), Association ACONDA
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Abidjan, Elfenbenskysten
- Service des Maladies Infectieuses et Tropicales (SMIT)
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Bamako, Mali
- Centre d'Ecoute, de Soins, d'Animation et de Conseils (CESAC)
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Bamako, Mali
- CHU point G
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Dakar, Senegal
- CHU Fann
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Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Beskrivelse
Inclusion Criteria:
- Age >18 years
- Documented HIV-1 infection
- History of failing a NNRTI-based 1st-line ART
- Current PI-based 2nd-line ART >6 months
- Plasma HIV-1 RNA >1000 copies/ml
- Signed informed consent
Exclusion Criteria:
- HIV-2 infection
- Any Severe clinical event under exploration
- History of treatment including darunavir or raltegravir.
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: N/A
- Intervensjonsmodell: Enkeltgruppeoppdrag
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
---|---|
Eksperimentell: Adherence reinforcement before switch to 3rd-line ART
|
Directly observed treatment at home (family or relatives DOT); pillboxes; phone calls; SMS; home visits; adherence reinforcement sessions by trained health workers.
Second-line ART regimen : ongoing regimen at the time of inclusion will be continued. Third-line ART regimen : Darunavir/r + Raltegravir + 2 NRTIs (as chosen by the investigators) |
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Virologic efficacy of the adherence reinforcement intervention
Tidsramme: Week 12
|
Proportion of patients with plasma viral load <400 copies/ml at Week 12 and/or with a decrease in plasma viral load >2 log10 copies/ml between inclusion and Week 12
|
Week 12
|
Persistent virologic efficacy of the adherence reinforcement intervention
Tidsramme: Week 64
|
Proportion of patients with plasma viral load <50 copies/ ml at Week 64 among those who stayed on 2nd-line ART at Week 16
|
Week 64
|
Virologic efficacy of 3rd-line ART
Tidsramme: Week 64
|
Proportion of patients with HIV-1 plasma viral load <50 copies/ml at Week 64 among those with persistent failure at Week 12 who switched to 3rd-line ART
|
Week 64
|
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Immunological efficacy of the adherence reinforcement intervention
Tidsramme: Week 12
|
CD4 count evolution between inclusion and Week 12
|
Week 12
|
Immunological efficacy of 3rd-line ART
Tidsramme: Week 64
|
CD4 count evolution between Week12 and Week 64 among patients who switched to 3rd-line ART at Week 16
|
Week 64
|
Tolerance of 3rd-line ART drugs
Tidsramme: Week 64
|
Incidence of grade 3-4 adverse events (ANRS grading table) in patients on 3rd-line ART
|
Week 64
|
Adherence to 3rd-line ART
Tidsramme: Week 64
|
3rd-line Medication Possession Ratio between Week 16 and Week 64
|
Week 64
|
Resistance to 1st and 2nd-line antiretroviral drugs
Tidsramme: Week 12
|
Resistance mutations to antiretroviral drugs among patients with virological failure at Week 12
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Week 12
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Resistance to 1st, 2nd and 3rd-line antiretroviral drugs
Tidsramme: Week 64
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Resistance mutations to antiretroviral drugs among patients with virological failure at Week 64
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Week 64
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Plasma antiretroviral drugs concentration
Tidsramme: Week 12
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Plasma antiretroviral drugs concentration at Week 12
|
Week 12
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Plasma antiretroviral drugs concentration
Tidsramme: Week 64
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Plasma antiretroviral drugs concentration at Week 64
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Week 64
|
Samarbeidspartnere og etterforskere
Etterforskere
- Hovedetterforsker: Serge P. Eholié, MD, MSc, Pr, Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d'Ivoire
- Hovedetterforsker: Roland Landman, MD, Institut de Médecine et d'Epidémiologie Appliquée - Hôpital Bichat Claude Bernard, Paris, France
- Studiestol: Pierre-Marie Girard, MD, PhD, Infectious Diseases Department, University Hospital Saint Antoine, Paris, France
- Studieleder: Xavier Anglaret, MD, PhD, Inserm 897, University of Bordeaux, France
Publikasjoner og nyttige lenker
Hjelpsomme linker
Studierekorddatoer
Studer hoveddatoer
Studiestart
Primær fullføring (Faktiske)
Studiet fullført (Forventet)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Anslag)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Ytterligere relevante MeSH-vilkår
- RNA-virusinfeksjoner
- Virussykdommer
- Infeksjoner
- Blodbårne infeksjoner
- Smittsomme sykdommer
- Seksuelt overførbare sykdommer, virale
- Seksuelt overførbare sykdommer
- Lentivirus infeksjoner
- Retroviridae-infeksjoner
- Immunologiske mangelsyndromer
- Sykdommer i immunsystemet
- HIV-infeksjoner
- Molekylære mekanismer for farmakologisk virkning
- Anti-infeksjonsmidler
- Antivirale midler
- Enzymhemmere
- Anti-HIV-midler
- Proteasehemmere
- HIV-integrasehemmere
- Integrasehemmere
- HIV-proteasehemmere
- Virale proteasehemmere
- Raltegravir kalium
- Darunavir
- Antiretrovirale midler
Andre studie-ID-numre
- ANRS 12269 THILAO
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