A phase IV randomised, open-label pilot study to evaluate switching from protease-inhibitor based regimen to Bictegravir/Emtricitabine/Tenofovir Alafenamide single tablet regimen in Integrase inhibitor-naïve, virologically suppressed HIV-1 infected adults harbouring drug resistance mutations (PIBIK study): study protocol for a randomised trial.



Iwuji, Collins C, Churchill, Duncan, Bremner, Stephen, Perry, Nicky, To, Ye, Lambert, Debbie, Bruce, Chloe, Waters, Laura, Orkin, Chloe and Geretti, Anna Maria ORCID: 0000-0002-3670-6588
(2020) A phase IV randomised, open-label pilot study to evaluate switching from protease-inhibitor based regimen to Bictegravir/Emtricitabine/Tenofovir Alafenamide single tablet regimen in Integrase inhibitor-naïve, virologically suppressed HIV-1 infected adults harbouring drug resistance mutations (PIBIK study): study protocol for a randomised trial. BMC infectious diseases, 20 (1). p. 524.

Access the full-text of this item by clicking on the Open Access link.

Abstract

BACKGROUND:Currently recommended boosted protease-inhibitor (bPI) regimens may be associated with increased risk of cardiovascular or chronic kidney diseases; in addition, boosted regimens are particularly associated with drug-drug interactions. Since both cardiovascular and renal disease, and polypharmacy, are common in ageing people with HIV, there is a need for alternative efficacious regimens. bPI-based regimens are often the treatment of choice for individuals with pre-treatment or treatment-acquired resistance but it is plausible that carefully selected HIV-positive individuals with drug resistance, who are virologically suppressed on their current bPI regimen, could maintain virological efficacy when switched to bictegravir, emtricitabine and tenofovir alafenamide (B/F/TAF) fixed dose combination (FDC). METHODS/DESIGN:A phase IV, investigator-initiated, multicentre, open label pilot, randomised two-arm study to assess the safety and efficacy of switching from bPI regimen to B/F/TAF single tablet regimen in integrase inhibitor-naïve, virologically suppressed adults with HIV-1 infection harbouring drug resistance mutations. Eligible individuals will either continue on their bPI regimen or switch to B/F/TAF FDC. After 24 weeks, all participants in the bPI arm will be switched to B/F/TAF and followed for a further 24 weeks and all participants will be followed for 48 weeks. The primary efficacy endpoint is the proportion of participants with HIV-1 RNA < 50 copies/mL at week 24 using pure virologic response whilst the secondary efficacy endpoint is the proportion of participants with HIV-1 RNA < 50 copies/mL at Week 48. Other secondary outcome measures include between arm comparisons of drug resistance at virological failure, safety and tolerability and patient-reported outcome measures. DISCUSSION:We aim to provide preliminary evidence of the efficacy of switching to B/F/TAF in patients with virological suppression on a bPI-based regimen who harbour select drug resistance mutations. TRIAL REGISTRATION:ISRCTN 44453201 , registered 19 June 2019 and EudraCT 2018-004732-30.

Item Type: Article
Uncontrolled Keywords: HIV, antiretroviral drugs, drug resistance, protease inhibitor, B/F/TAF, integrase inhibitor, pilot, phase IV randomised trial
Depositing User: Symplectic Admin
Date Deposited: 18 Aug 2020 08:29
Last Modified: 18 Jan 2023 23:37
DOI: 10.1186/s12879-020-05240-y
Open Access URL: https://doi.org/10.1186/s12879-020-05240-y
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3097977