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| ID | Type | Description | Link |
|---|---|---|---|
| 2017-000040-17 | EudraCT Number |
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| Name | Class |
|---|---|
| Institut de Médecine et d'Epidémiologie Appliquée - Fondation Internationale Léon M'Ba | OTHER |
| Institut National de la Santé Et de la Recherche Médicale, France | OTHER_GOV |
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The trial is an open-label, multicenter, prospective, randomized trial in 2 parallel groups, evaluating at W48, the non-inferiority of antiretroviral treatment taken 4 consecutive days a week versus continuous therapy, in HIV infected patients with controlled viral load for at least 12 months and stable antiretroviral treatment since 4 months.
Open-label, multicenter, prospective, randomized trial in 2 parallel groups, evaluating at W48, the non-inferiority of antiretroviral treatment taken 4 consecutive days a week versus continuous therapy, in HIV infected patients with controlled viral load for at least 12 months and stable antiretroviral treatment since 4 months. The non-inferiority margin (delta) is 5%. The randomization will be stratified according to the family of the third antiretroviral agent (II, PI, and NNRTI). A minimum of 200 patients will be included in the integrase inhibitor strata to provide a sufficient power to assess the efficacy of strategy in this population.
At W48, all patients with virological success in the continuous therapy group will switch to the 4/7 days therapy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 4 days / 7 | Experimental | Patients included in this arm will take their ARV treatment 4 consecutive days per week during 98 weeks |
|
| 7 days / 7 | Active Comparator | Patients included in this arm will continue their ARV therapy 7 days per weeks during 48 weeks and after W48, they will take their ARV treatment 4 days per week until W98 |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Treatment discontinuation | Drug | • Receiving tritherapy. Allowed treatment drugs are :
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| Measure | Description | Time Frame |
|---|---|---|
| Proportion of patients with therapeutic success at Week 48. | To evaluate after 48 weeks the therapeutic success of a weekly strategy of 4 consecutive days on treatment followed by 3 days off treatment, defined by :
| Week 48 |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of patients with therapeutic success at Week 96 | To evaluate after 96 weeks the therapeutic success of a weekly strategy of 4 consecutive days on treatment followed by 3 days off treatment, defined by :
|
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Inclusion Criteria:
Allowed treatment drugs are :
1. nucleoside analogs : tenofovir (TDF ou TAF), emtricitabine, abacavir, lamivudine 2. protease inhibitors : lopinavir/r, darunavir/r ou atazanavir/r 3. Non nucleoside reverse transcriptase inhibitors : efavirenz, rilpivirine ou etravirine 4. integrase inhibitors : dolutegravir, elvitegravir/cobicistat ou raltegravir
Viruses susceptible to all antiretroviral drugs present in the ongoing tritherapy (AC11-ANRS algorithm).
Viral load (VL) < 50 cp/mL in the past year, with at least 3 VL measurements including screening; only one episode of viral blip < 200 copies/mL is authorized in the last year
CD4 T cells > 250/mm3 at the screening visit
Estimated glomerular filtration rate > 60 mL/min (Chronic Kidney Disease - Epidemiology Collaboration method)
Transaminases : aspartate aminotransférase et alanine aminotransférase < 3N
Haemoglobin > 10 g/dL
Platelets > 100 000/mm3
For women of childbearing age, negative pregnancy test at screening; agree to use mechanical contraception during the study
Social security system coverage
Informed consent form signed by patient and investigator
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Pierre De Truchis, MD | Hôpital Raymond Poincaré | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHU Pointe-à-Pitre | Pointe à Pitre | Guadeloupe | 97159 | France | ||
| Hôpital La Meynard Zobda Quitman |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35120640 | Result | Landman R, de Truchis P, Assoumou L, Lambert S, Bellet J, Amat K, Lefebvre B, Allavena C, Katlama C, Yazdanpanah Y, Molina JM, Petrov-Sanchez V, Gibowski S, Alvarez JC, Leibowitch J, Capeau J, Fellahi S, Duracinsky M, Morand-Joubert L, Costagliola D, Alvarez JC, Girard PM; ANRS 170 QUATUOR study group. A 4-days-on and 3-days-off maintenance treatment strategy for adults with HIV-1 (ANRS 170 QUATUOR): a randomised, open-label, multicentre, parallel, non-inferiority trial. Lancet HIV. 2022 Feb;9(2):e79-e90. doi: 10.1016/S2352-3018(21)00300-3. |
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Open-label, randomized trial in 2 parallel groups
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| Week 96 |
| Virological success | The HIV-1 viral load at week 48 must be inferior to 50 copies/mL | Week 48 and Week 96 |
| Number of virological " blips " | viral load > 50 copies/mL followed by a control value ≤ 50 cp/mL | between Week 0 and Week 48, and between Week 0 and Week 96 |
| Percentage of patients with a viral load signal detected | (subgroup of patients tested with Roche-Taqman, threshold<20 copies/mL) | between Week 0 and Week 48 and Week 0 and Week 96 |
| Proportion of patients with acquisition of drugs resistance mutations in case of virological failure detected by Sanger and by next generation sequencing | Week 4, Week 12, Week 24, Week 36, Week 48, Week 60, Week 72, Week 84, Week 96 (if it's necessary) |
| Frequency of minority resistant variants archived in DNA at Week 0 and their impact on virological failure (2 consecutive VL> 50 copies / mL) and on the acquisition of drugs resistance mutations | Week 0 |
| Evolution of ultra sensitive viral load and total DNA in the peripheral blood mononuclear cells at Week 0, Week 24, Week 48 and Week 96; evolution of viral genotypic sequence between Week 0, Week 48 and Week 96 (subgroup of 120 patients) | Immuno-viro-pharmacological sub-study of 120 patients | between Week 0, Week 48 and Week 96 |
| Description of the factors associated with virological rebound (viral load >50 cp/mL). | (viral load >50 cp/mL). | Week 4, Week 12, Week 24, Week 36, Week 48, Week 60, Week 72, Week 84, Week 96 (if it's necessary) |
| Evolution of T cluster of differentiation 4 and cluster of differentiation 8 cells count, and T cluster of differentiation 4 /cluster of differentiation 8 ratio | Measurement of T cluster of differentiation 4 cell count, T cluster of differentiation 8 cell count, and T cluster of differentiation 4 /T cluster of differentiation 8 ratio | from Week-4 to Week 48 and Week 96 |
| Evolution of fasting metabolic parameters | Measurement of total cholesterol total, LDL-C, HDL-C, Triglycerides and glycemia | until Week 48 and Week 96 |
| Evolution of inflammation and immune activation parameters | Measurement of sCD14, sCD163, IP-10, C-reactive protein, interleukin-6 et D-dimerus, soluble TNF receptor 1, soluble TNF receptor 2 Immuno-viro-Pharmacological Sub-study in 120 patients | from Week 0 to Week 24 and Week 48 |
| HIV RNA viral load in semen | Sperm sub-study (120 patients) | Week 0, Week 24 and Week 48 |
| Residual plasmatic concentrations of the third antiretroviral agent | Measurement of the third antiretroviral agent plasmatic concentration (protease inhibitors or non-nucleoside reverse transcriptase inhibitors or integrase inhibitors) | Week 0, Week 4, Week 12, Week 24, Week 36, Week 48, Week 60, Week 72, Week 84 and Week 96 |
| Residual plasmatic concentrations of tenofovir (TDF or TAF) | Measurement of tenofovir plasmatic concentration | Week 0, Week 4, Week 12, Week 24, Week 36, Week 48, Week 60, Week 72, Week 84 and Week 96 |
| Residual intracellular concentrations of the third antiretroviral agents | Immuno-viro-Pharmacological sub-study (120 patients) Measurement of the third antiretroviral agent intracellular concentration (protease inhibitors or non-nucleoside reverse transcriptase inhibitors or integrase inhibitors) | Week 0, Week 24 and Week 48 |
| Treatment adherence | Evaluation by a self-reported questionnaire | Week 0, Week 12, Week 24, Week 36, Week 48, Week 72,and Week 96 |
| Patient Quality of life | Evaluation by a self-reported questionnaire | Week-4, Week 0, Week 48 and Week 96 |
| Patient satisfaction | Evaluation by a self-reported questionnaire | Week 0, Week 12, Week 48 and Week 96 |
| Pharmaco-economic aspects of the strategy | Assessment and comparison of cost essay between each arm. | Between Week 0 and Week 98 |
| Median time to virologic failure | Measure the delay between week 0 and the date of different virologic failure | Between week 0 and 98 |
| Frequency of grade 3 or more adverse events, adverse effects, drug-modifying adverse events, drug-related adverse events and serious adverse events (SAE) | according to the sponsor's grading scale | Between Week 0 and Week 98 |
| Fort-de-France |
| Martinique |
| 97261 |
| France |
| Centre hospitalier Victor Dupouy | Argenteuil | 95100 | France |
| Hôpital Henri Duffaut | Avignon | 84000 | France |
| CHRU Jean Minjoz | Besançon | 25030 | France |
| Avicenne | Bobigny | 93000 | France |
| Jean Verdier | Bondy | 93143 | France |
| Hôpital Saint-André | Bordeaux | 33075 | France |
| Hôpital Pellegrin | Bordeaux | 33076 | France |
| Hôpital Ambroise Paré | Boulogne-Billancourt | 92104 | France |
| Hôpital de la Côte de Nacre | Caen | 14033 | France |
| Hôpital Louis Pasteur | Chartres | 28630 | France |
| Antoine Beclère | Clamart | 92140 | France |
| Hôpital Gabriel Montpied | Clermont-Ferrand | 63003 | France |
| Centre hospitalier sud francilien | Corbeil-Essonnes | 91106 | France |
| CHI de Créteil | Créteil | 94010 | France |
| Hôpital Henri Mondor | Créteil | 94010 | France |
| Hôpital du Bocage | Dijon | 21079 | France |
| Hôpital Raymond Poincaré | Garches | 92380 | France |
| Hôpital Michallon | Grenoble | 38043 | France |
| CHD de la Roche Sur Yon | La Roche-sur-Yon | 85295 | France |
| Bicêtre | Le Kremlin-Bicêtre | 94275 | France |
| Centre Hospitalier du Mans | Le Mans | 72037 | France |
| Institut hospitalier franco-britannique | Levallois-Perret | 92309 | France |
| Hôpital Dupuytren | Limoges | 87042 | France |
| Hôpital de la Croix Rousse | Lyon | 69000 | France |
| Hôpital Edouard Herriot | Lyon | 69437 | France |
| Hôpital Sainte Marguerite | Marseille | 13274 | France |
| Hôpital Européen | Marseille | 13331 | France |
| Hôpital Gui de Chauliac | Montpellier | 34295 | France |
| Hôpital Emile Müller | Mulhouse | France |
| Hôpital de l'Hôtel Dieu | Nantes | 44093 | France |
| Hôpital de l'Archet | Nice | 06202 | France |
| Hôpital Carémeau | Nîmes | 30029 | France |
| Hôpital de La Source | Orléans | 45100 | France |
| Hôpital Saint-Antoine | Paris | 75012 | France |
| Hôpital Necker | Paris | 75015 | France |
| Hôpital Bichat | Paris | 75018 | France |
| Hôpital de l'Hôtel Dieu | Paris | 75181 | France |
| Hôtel-Dieu | Paris | 75181 | France |
| Hôpital Saint-Louis | Paris | 75475 | France |
| Lariboisière | Paris | 75475 | France |
| Hôpital Pitié-Salpêtrière | Paris | 75651 | France |
| Hôpital Européen Georges Pompidou | Paris | 75908 | France |
| Tenon | Paris | 75970 | France |
| Centre Hospitalier de Perpignan | Perpignan | 66046 | France |
| Centre Hospitalier René Dubos | Pontoise | 95301 | France |
| Centre hospitalier Annecy Genevois | Pringy | 74374 | France |
| Hôpital Robert Debré | Reims | 51100 | France |
| Hôpital Pontchaillou | Rennes | 35033 | France |
| Centre Hospitalier de Saint-Brieuc | Saint-Brieuc | 22000 | France |
| Hôpital Delafontaine | Saint-Denis | 93205 | France |
| Hôpital Nord | Saint-Etienne | 42055 | France |
| Centre Hospitalier Général de Saint Nazaire | Saint-Nazaire | 44600 | France |
| Hôpital Civil | Strasbourg | 67091 | France |
| Hôpital Foch | Suresnes | 92151 | France |
| Hôpital La Grave | Toulouse | 31059 | France |
| Hôpital Purpan | Toulouse | 31059 | France |
| Hôpital Gustave Dron | Tourcoing | 59208 | France |
| Hôpital Bretonneau | Tours | 37044 | France |
| Hôpital de Brabois | Vandœuvre-lès-Nancy | 54511 | France |
| Hôpital André Mignot | Versailles | 78157 | France |
| Centre Hospitalier Intercommunal | Villeneuve-Saint-Georges | 94195 | France |
| ID | Term |
|---|---|
| D015658 | HIV Infections |
| ID | Term |
|---|---|
| D000086982 | Blood-Borne Infections |
| D003141 | Communicable Diseases |
| D007239 | Infections |
| D015229 | Sexually Transmitted Diseases, Viral |
| D012749 | Sexually Transmitted Diseases |
| D016180 | Lentivirus Infections |
| D012192 | Retroviridae Infections |
| D012327 | RNA Virus Infections |
| D014777 | Virus Diseases |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D007153 | Immunologic Deficiency Syndromes |
| D007154 | Immune System Diseases |
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