Pan African Clinical Trials Registry

South African Medical Research Council, South African Cochrane Centre
PO Box 19070, Tygerberg, 7505, South Africa
Telephone: +27 21 938 0506 / +27 21 938 0834 Fax: +27 21 938 0836
Email: pactradmin@mrc.ac.za Website: pactr.samrc.ac.za
Trial no.: PACTR201409000836146 Date of Approval: 29/05/2014
Trial Status: Retrospective registration - This trial was registered after enrolment of the first participant
TRIAL DESCRIPTION
Public title Efficacy and Safety Study of Darunavir for the Treatment of HIV/AIDS
Official scientific title Monotherapy in Africa, New Evaluations of Therapy
Brief summary describing the background and objectives of the trial The aim of this pilot study is to assess the feasibility, efficacy and safety of Darunavir/ritonavir 800/100 mg once daily (DRV/r) monotherapy as a switch-maintenance strategy for patients receiving second-line ART at Yaoundé Central Hospital in Cameroon. HIV-infected adults receiving second-line antiretroviral therapy (ART) for ¿3 months with 2 nucleos(t)ide reverse transcriptase inhibitors (NRTIs) plus either lopinavir/ritonavir (LPV/r) or atazanavir/ritonavir (ATV/r) will undergo plasma HIV-1 RNA (¿viral¿) load testing. Those with a viral load below 50 copies/ml (<50 cps/ml) will undergo a repeat test ideally 4-6 weeks later (allowed up to 12 weeks); if the viral load is confirmed as <50 cps/ml the patient will be invited to join the randomised phase of the study. Patients (n=150) will be randomised 1:2 to either continue the current triple ART regimen (n=50) or switch to DRV/r monotherapy (n=100). The primary end-point will be viral load suppression <400 cps/ml at week 24; secondary end-points will be viral load suppression <50 cps/ml at week 12 and week 24, safety, tolerability, and emergence of protease inhibitor (PI) drug-resistance. Patients will continue observational follow-up depending on the treatment arm they are randomized to. After week 48, patients will return to local standard of care. Pharmacokinetics (PK) and pharmacogenomics sub-study to correlate plasma concentrations of DRV to outcomes, HIV-1 drug resistance testing sub study to detect mutants archived at the time of first-line ART failure and measuring HIV DNA load will be performed, as well as a cost-effectiveness analysis will test the hypothesis that savings can be achieved by switching to DRV/r monotherapy without affecting quality of care. The primary virological objective is to evaluate efficacy in terms of the percentage of subjects who have plasma HIV-1 RNA levels <400 cps/ml after 24 weeks of follow-up following a switch to DRV/r monotherapy versus continuing triple therapy containing
Type of trial RCT
Acronym (If the trial has an acronym then please provide) MANET
Disease(s) or condition(s) being studied Infections and Infestations
Sub-Disease(s) or condition(s) being studied HIV/AIDS
Purpose of the trial Treatment: Drugs
Anticipated trial start date 05/05/2014
Actual trial start date 12/05/2014
Anticipated date of last follow up 15/10/2015
Actual Last follow-up date
Anticipated target sample size (number of participants) 150
Actual target sample size (number of participants)
Recruitment status Not yet recruiting
Publication URL
Secondary Ids Issuing authority/Trial register
CUI_001 University of Liverpool
STUDY DESIGN
Intervention assignment Allocation to intervention If randomised, describe how the allocation sequence was generated Describe how the allocation sequence/code was concealed from the person allocating the participants to the intervention arms Masking If masking / blinding was used
Parallel: different groups receive different interventions at same time during study Randomised Simple randomisation using a randomised table created by a computer software program Sealed envelopes method Open-label(Masking Not Used)
INTERVENTIONS
Intervention type Intervention name Dose Duration Intervention description Group size Nature of control
Experimental Group Darunavir/ritonavir 800/100mg once daily monotherapy 48 weeks Darunavir (PREZISTA) is a film-coated, light orange, oval shaped tablet of 19.1mm debossed with "400MG" on one side and "TMC" on the other side. 100 Active-Treatment of Control Group
Control Group 2 (NRTIs) + either (LPV/r) or (ATV/r) as per national treatment guidelines 24 weeks Second Line ART for Cameroon 50 Active-Treatment of Control Group
ELIGIBILITY CRITERIA
List inclusion criteria List exclusion criteria Age Category Minimum age Maximum age Gender
1) Subjects with documented HIV-1 infection. 2) Male or female aged > 21 years old. 3) Subjects receiving ART with 2 NRTIs + LPV/r (or ATV/r) for at least 3 months at the time of Screening 1. 4) Nadir CD4 >100 cells/mm3 5) Plasma HIV-1 RNA <50 copies/ml at Screening 1 confirmed ideally 4-6 weeks later at Screening 2 (two results must be documented; a first result obtained up to 12 weeks earlier will be accepted). 6) Subjects can comply with the protocol requirements. In particular, subjects should be willing to be followed up at least until week 24 (discontinuation prior to week 24) and for the DRV/r arm up to week 48 (discontinuation after week 24) even if they discontinue randomized treatment. 7) Subjects who have voluntarily signed and dated the consent form. 1) Clinical or laboratory evidence of significantly decreased hepatic function or decompensation, irrespective of liver enzyme levels (liver insufficiency). 2) Co-infection with hepatitis B (HBsAg positive). 3) Grade 3 or 4 laboratory abnormality as defined by DAIDS, including haemoglobin ¿8mg/dL; platelets ¿50 000/mm3; estimated creatinine clearance ¿60mL/ minute, AST; ALT and alkaline phosphatase >3 times the upper limit of normal; and total bilirubin >2.5 times the upper limit of normal; with the following exceptions unless clinical assessment foresees an immediate health risk to the subject: ¿ Pre-existing diabetes or asymptomatic glucose grade 3 or 4 elevations. ¿ Asymptomatic triglyceride or cholesterol elevations of grade 3 or 4. 4) Presence of any currently active AIDS defining illness (Category C conditions according to the CDC Classification System for HIV Infection 1993) with the following exceptions: ¿ Stable cutaneous Kaposi¿s Sarcoma (i.e., no internal organ involvement other than oral lesions) that is unlikely to require any form of systemic therapy during the study. ¿ Wasting syndrome due to HIV infection. Note: An AIDS defining illness that is not clinically stabilized for at least 30 days will be considered as currently active. 5) Pregnant or breastfeeding women. 6) Active substance abuse, including alcohol or recreational drugs. 7) Any clinically significant disease (e.g., tuberculosis, cardiac dysfunction, pancreatitis, acute viral infections) or life threatening disease in the previous 14 days, or findings during screening of medical history or physical examination that, in the investigator¿s opinion, would compromise the subject¿s safety or outcome of the study. 8) Any medical or psychiatric condition which, in the opinion of the investigator, could compromise the subject's safety or adherence to the trial protocol. 9) Previously demonstrated clinically allergy or hypersensitivity to any of the excipients of the investigational medication (DRV). Note: DRV is a sulfonamide. Subjects who have previously experienced a sulfonamide allergy will be allowed to enter the trial. To date, no potential for cross sensitivity between drugs in the sulfonamide class and DRV has been identified in subjects participating in phase II trials. 10) Participation in any other clinical trials that involve administration of antiretrovirals or other drugs within the last 4 weeks and during the participation in this trial. 21 Year(s) 70 Year(s) Both
ETHICS APPROVAL
Has the study received appropriate ethics committee approval Date the study will be submitted for approval Date of approval Name of the ethics committee
Yes 25/07/2013 Cameroon National Ethics Committee
Ethics Committee Address
Street address City Postal code Country
Ministry of Public Health Yaounde P.O. Box 1937 Cameroon
Has the study received appropriate ethics committee approval Date the study will be submitted for approval Date of approval Name of the ethics committee
Yes Research Ethics Sub-Committee for Physical Intervention (RESPI)
Ethics Committee Address
Street address City Postal code Country
University of Liverpool, Brownlow Hill Liverpool L69 3GL United Kingdom
OUTCOMES
Type of outcome Outcome Timepoint(s) at which outcome measured
Primary Outcome HIV-1 RNA viral load suppression <400 cps/ml Week 24
Secondary Outcome 1) HIV-1 RNA viral load suppression <50 cps/ml 1) HIV-1 RNA viral load suppression <50 cps/ml at week 12 and week 24, 2) safety, 3) tolerability, 4) and emergence of protease inhibitor (PI) drug-resistance at enrolment
RECRUITMENT CENTRES
Name of recruitment centre Street address City Postal code Country
Yaounde Central Hospital Rue Henri Dunant Yaounde B.P. 5777 Cameroon
FUNDING SOURCES
Name of source Street address City Postal code Country
Janssen Pharmaceutica NV Turnhoutseweg 30 Beerse 2340 Belgium
University of Liverpool 2 Brownlow Street Liverpool L69 3GL United Kingdom
Chantal Biya International Reference Centre for Prevention and Management of HIV/AIDS (CIRCB) Melen Road Yaounde B.P. 3077 Cameroon
SPONSORS
Sponsor level Name Street address City Postal code Country Nature of sponsor
Primary Sponsor University of Liverpool 3 Brownlow Street Liverpool L69 3GL United Kingdom University
COLLABORATORS
Name Street address City Postal code Country
Anna Maria Geretti University of Liverpool, 3 Brownlow Street Liverpool L69 3GL United Kingdom
Charles Kouanfack Yaounde Central Hospital, Rue Henri Dunant Yaounde B.P. 5777 Cameroon
Judith Torimiro Melen Road Yaounde B.P. 3077 Cameroon
Andrew Hill University of Liverpool, 3 Brownlow Street Liverpool L69 3GL United Kingdom
CONTACT PEOPLE
Role Name Email Phone Street address
Principal Investigator Anna Maria Geretti a.m.geretti@liverpool.ac.uk 44(0)1517064381 3 Brownlow Street
City Postal code Country Position/Affiliation
Liverpool L69 3GL United Kingdom Honorary Consultant/ University of Liverpool
Role Name Email Phone Street address
Principal Investigator Anna Maria Geretti a.m.geretti@liverpool.ac.uk 44(0)1517959625 3 Brownlow Street
City Postal code Country Position/Affiliation
Liverpool L69 3GL United Kingdom Honorary Consultant/ University of Liverpool
Role Name Email Phone Street address
Public Enquiries Anna Maria Geretti a.m.geretti@liverpool.ac.uk +44 151 7959625 3 Bronlow Street
City Postal code Country Position/Affiliation
Liverpool L69 3GL United Kingdom Honorary Consultant, University Liverpool
Role Name Email Phone Street address
Scientific Enquiries Anna Maria Geretti a.m.geretti@livverpool.ac.uk 44(0)1517064381 3 Brownlow Street
City Postal code Country Position/Affiliation
Liverpool L69 3GL United Kingdom Honorary Consultant/ University of Liverpool
Role Name Email Phone Street address
Scientific Enquiries Anna Maria Geretti a.m.geretti@livverpool.ac.uk 44(0)1517959625 3 Brownlow Street
City Postal code Country Position/Affiliation
Liverpool L69 3GL United Kingdom Honorary Consultant/ University of Liverpool
REPORTING
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