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The main objective of this study is to evaluate at 96 weeks the safety with respect to hepatitis B control of 2 treatment reduction strategies for patients with previously controlled HIV-HBV co-infection on continuous triple therapy
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Arm 1 | No Intervention | - Arm 1 (reference arm): Continuation of continuous (7 days/week) triple antiviral therapy including TDF or TAF | |
| Arm 2 (T4): | Experimental | - Arm 2 (T4): Relief from previous triple antiviral therapy (containing TDF or TAF) on 4 out of 7 consecutive days |
|
| Arm 3 (B7) | Experimental | Switch from prior triple antiviral therapy (containing TDF or TAF) to continuous dual therapy without TDF or TAF but including 3TC in combination with Dolutegravir (DTG) or ritonavir-boosted Darunavir (rDVR |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TDF - 245mg or TAF -25mg associated to 3TC - 300mg or FTC - 200mg and a NNRTI or PI/r or INSTI | Drug | The study will include patients under current daily antiretroviral tritherapy not modified for ≥ 12 months must including tenofovir disoproxil fumarate (TDF) 245mg or tenofovir alafenamide fumarate (TAF -25mg) associated to lamivudine (3TC - 300mg) or emtricitabine (FTC - 200mg) and a NNRTI or PI/r or INSTI to choose from
|
| Measure | Description | Time Frame |
|---|---|---|
| The proportion of participants with HBV virological failure at 96 weeks. | HBV virologoical failure is defined by 2 successive varial load ≥ 10UI/ml | 96 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| • HBV virological success rate at 48 weeks | HBV virological success is defined by a viral load ≤10 UI/ml | at Week 48 |
| • HIV virological success rate at 48 and 96 weeks | HIV virological success is defined by a viral load ≤ 50 cp/ml |
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Inclusion Criteria:
HIV-1-HBV co-infection (positive HIV-1 serology associated with 2 positive HBsAg serologies within more than 6 months);
Age ≥ 18 years
Fibroscan less than 6 months < 9kPa
Current daily antiretroviral tritherapy not modified for ≥ 12 months must including tenofovir disoproxil fumarate (TDF) 245mg or tenofovir alafenamide fumarate (TAF -25mg) associated to lamivudine (3TC - 300mg) or emtricitabine (FTC - 200mg) and a NNRTI or PI/r or INSTI to choose from
Absence of documented HBV and HIV genotypic resistance compromising virologic control of any of the maintenance strategies. Patients with no genotypic history may be included);
HIV CV < 50cp/ml for ≥ 2 years (only 1 annual blip allowed if HIV CV < 200cp/ml and previous and subsequent viral loads are undetectable);
HBV CV < 10 IU/ml for ≥ 2 years (only 1 annual blip allowed if HBV CV < 200IU/ml and if previous and subsequent viral loads are undetectable);
Have ≥ 3 available measurements of HIV CV < 50cp/ml and HBV CV < 10 IU/mL over the past 24 months (including that of pre-inclusion);
CD4 lymphocytes > 250/mm3 at pre-inclusion;
ALT < 3N at pre-inclusion;
For women of childbearing potential, negative pregnancy test and commitment to use effective contraception throughout the trial;
Person affiliated with or benefiting from a social security system;
Free, informed, written consent, signed by the person and the investigator at the latest on the day of inclusion and before any examination carried out as part of the study (article L1122-1-1 of the Public Health Code)
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Fatoumata COULIBALY | Contact | 0144236110 | +33 | fatoumata.coulibaly@anrs.fr |
| Karine Amat | Contact | +33 | karine.amat@fondation-imea.org |
| Name | Affiliation | Role |
|---|---|---|
| Julie Bottero | Bicetre Hospital | Principal Investigator |
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Interventional, sequential, Phase IIA equivalent, multicenter, open-label, randomized, non-comparative study evaluating, for 96 weeks, the safety in terms of HBV virological control of 2 antiviral therapy relief strategies, in HIV-1 and HBV co-infected patients with prolonged virological success (undetectable HIV-1 and HBV viral loads for ≥ 2 years) and on unmodified antiviral therapy for ≥ 1 year.
Participants will be randomized 1:2:2 into 3 parallel arms:
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| Dual therapy with 3TC in combination with DTG or ritonavir-boosted Darunavir (rDVR) | Drug | dual therapy without TDF or TAF but including 3TC in combination with Dolutegravir (DTG) or ritonavir-boosted Darunavir (rDVR |
|
| At week 48 and week 96 |
| • Time to virological failure (rebound HBV and/or HIV viral load) | between Week 0 and Week96 |
| • The rate of participants with at least one HBV viral load blip until W48 and until W96 | a blip is defined by a HBV viral load >10UI/mL followed by a control value ≤ 10UIml | At week 48 and week 96 |
| • Selection of HBV resistance mutations at the time of virological failure | between Week 0 and Week 96 |
| • Incidence of grade 3 or higher adverse events of grade 3 or higher, incidence of adverse events and incidence of strategy discontinuation of the strategy at W48 and W96 | At week 48 and week 96 |
| • Evolution of CD4 from W0 to W48 and W96 | Week 0 to Week 48 and week 96 |
| • Evolution of total cholesterol from W0 to W48 and W96 | from Week 0 to Week 48 and Week 96 |
| • Evaluation of the adherence by self-reported questionnaire | without analysis scale | at Week 0, Week 12, Week 24, Week 48, Week 72 and Week 96 |
| • Evaluation of quality of life using the Pro-Qol self-questionnaire | without analysis scale | at Week 0, Week 12, Week 24, Week 48, Week 72 and Week 96 |
| Evolution of CD8 T lymphocytes from W0 to W48 and W96 | Week 0 to Week 48 and week 96 |
| Evolution of the CD4/CD8 ratio from W0 to W48 and W96 | Week 0 to Week 48 and week 96 |
| Evolution of LDL-c from W0 to W48 and W96 | from Week 0 to Week 48 and Week 96 |
| Evolution of HDL-c from W0 to W48 and W96 | from Week 0 to Week 48 and Week 96 |
| Evolution of triglycerides from W0 to W48 and W96 | from Week 0 to Week 48 and Week 96 |
| Evolution of fasting blood sugar from W0 to W48 and W96 | from Week 0 to Week 48 and Week 96 |
| HBV virological success rate at 96 weeks between arms | HBV virological success is defined by a viral load ≤10 UI/ml | at Week 96 |
| 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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| ID | Term |
|---|---|
| C075889 | Racivir |
| C562325 | dolutegravir |
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