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The objective of this study is to clarify whether if starting antiretroviral treatment based on dual therapy (DTG + 3TC) could provide less control of residual HIV replication and, therefore, a detriment on immune activation and inflammation compared to starting with triple therapy, and could worsen the patients' long-term prognosis. For this purpose, the investigator has designed a randomized clinical trial where will assess the immunological recovery (CD4+/CD8+), immune activation, proliferation, senescence and apoptosis in T lymphocytes CD4+ and CD8+ cells by flow cytometry, the immune activation of monocytes/ macrophages and plasma concentrations of various inflammatory mediators by ELISAS, and the thymic function, the cellular reservoir of HIV and the degree of HIV DNA transcription by digital dropped PCR.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Dual Therapy | Experimental | Dolutegravir plus lamivudine |
|
| Triple Therapy | Active Comparator | Dolutegravir plus TAF/FTC |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Randomize | Drug | Randomize to naive-treatment HIV-infected patients to receive dual o triple therapy as initial antiretroviral treatment |
|
| Measure | Description | Time Frame |
|---|---|---|
| proviral HIV-DNA | Mean changes in proviral HIV-DNA in PBMCs after 48 and 96 weeks of treatment | 48 and 96 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Immune Recovery | Mean changes immune recovery assessed by CD4+/CD8+ T cell ratio. | 48 and 96 weeks |
| Immune Activation | Mean changes immune activation assessed by the expression of HLA-DR and CD38 in both of CD4+ and CD8+ T cells. |
| Measure | Description | Time Frame |
|---|---|---|
| Semen | Mean changes of HIV-RNA seminal plasma viral load | 24 weeks |
| GALT | Mean changes of viral reservoir assessed as proviral HIV-DNA and HIV-RNA in GALT |
Inclusion Criteria:
Treatment-naïve HIV-1-infected patients ≥ 18 years of age.
Plasma HIV-1 RNA >5000 and <500.000 copies/ml.
T lymphocyte CD4+ count in peripheral blood >200/μl.
Patients of childbearing age should consent to use a highly effective contraceptive method from 15 days before the time of inclusion of the study until 30 days after the end of it. It is considered a highly effective method:
Signed written informed consent prior to inclusion.
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital Universitario Virgen del Rocio | Recruiting | Seville | 41013 | Spain |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37545387 | Derived | Saborido-Alconchel A, Serna-Gallego A, Lopez-Cortes LE, Trujillo-Rodriguez M, Praena-Fernandez JM, Dominguez-Macias M, Lozano C, Munoz-Muela E, Espinosa N, Roca-Oporto C, Sotomayor C, Herrero M, Gutierrez-Valencia A, Lopez-Cortes LF. Decay kinetics of HIV-1-RNA in seminal plasma with dolutegravir/lamivudine versus dolutegravir plus emtricitabine/tenofovir alafenamide in treatment-naive people living with HIV. J Antimicrob Chemother. 2023 Sep 5;78(9):2354-2360. doi: 10.1093/jac/dkad245. |
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| ID | Term |
|---|---|
| D015658 | HIV Infections |
| ID | Term |
|---|---|
| D000086982 | Blood-Borne Infections |
| D003141 | Communicable Diseases |
| D007239 | Infections |
| D015229 | Sexually Transmitted Diseases, Viral |
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|
| 48 and 96 weeks |
| Monocytes Activation | Mean changes monocytes activation (plasma sCD14 and sCD163). | 48 and 96 weeks |
| Immunosenescense | Mean changes expression of markers for recent thymic emigrants (CD31), proliferation (Ki67), dysfunction (PD-1), senescence (CD57), and apoptosis (annexin A) in both CD4+ and CD8+ T cells. | 48 and 96 weeks |
| Inflammation | Mean changes concentration of pro-inflammatory soluble mediator in plasma: TNF-α, IL-1β, IL-6, IP-10, IFN- γ, MIP-1α, MIP-1β, hsPCR y D-dímers. | 48 and 96 weeks |
| Viral Reservoir | Mean changes viral reservoir size, evaluated by proviral HIV-DNA and HIV-RNA in peripheral blood mononuclear cells (PBMC) and CD4+ T cells isolate. | 48 and 96 weeks |
| 48 weeks |
| 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 |