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OsteoporosisPhase 4BEINGNCT02815566

Bone Health in Aging HIV Infected Women

A Phase 4 study testing tenofovir-alafenamide-emtricitabine and tenofovir-emtricitabine in people with Osteoporosis and HIV, run by University Health Network, Toronto at 7 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Design: Open-label randomised multicenter international strategic trial of older women on combination antiretroviral therapy (cART) containing tenofovir-emtricitabine (TDF/FTC) with HIV RNA suppression for > 6 months to : 1. Read more about this study

Who is it for?
Ages 40 to 60 years, women only
Conditions the study is for
Osteoporosis, HIV, Menopause
What is being tested?
tenofovir-alafenamide-emtricitabine and tenofovir-emtricitabine
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
34 participants
Where
7 sitesin 2 countries
Study dates
12 Sep 2017to 25 Feb 2021
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 to 60 years
  • Women only
  • No healthy volunteers
  • Adult

Who may be able to join

  • Biological female aged 40-60
  • Documented HIV-1 infection
  • Peri-menopausal ( as documented by history).
  • Signed Informed Consent Form and willing to comply with the protocol.
  • Receiving a cART regimen containing a ritonavir boosted PI (darunavir, atazanavir, lopinavir,) or an NNRTI (efavirenz, nevirapine or rilpivirine) or an integrase inhibitor (dolutegravir or raltegravir or elvitegravir) in combination with TDF-FTC for > 24 weeks.
  • Stable viral suppression (plasma HIV-RNA<50 copies/mL for > 24 weeks). Single viral blip <500/ml allowed if re-suppresses.
  • If of childbearing potential, is using effective birth control methods and is willing to continue during the trial.
  • Women will be assessed for vitamin D and calcium dietary intake; if inadequate for age, supplements will be recommended.

Who cannot join

  • HIV-2
  • High 10-year fracture risk at baseline ( > 20%) based on country specific FRAX
  • Current treatment with active bone medications- bisphosphonates, denosumab, calcitonin, raloxifene, teriparatide, strontium
  • Current use of systemic steroids ( inhaled steroids permitted) or chemotherapeutic agents
  • Acute viral hepatitis
  • Chronic hepatitis C with liver transaminases >5 x ULN or expected to require treatment for hepatitis C during the trial period.
Show all 12Show fewer
  • Any investigational ARV within 30 days.
  • Dialysis or renal insufficiency (creatinine clearance < 50ml/min)
  • History of decompensated liver disease (AST or ALT≥5x the upper limit of normal (ULN) or ALT ≥ 3 x ULN and bilirubin ≥ 1.5 x ULN with > 35% direct bilirubin), or the presence of ascites, encephalopathy, coagulopathy, hypoalbuminemia, esophageal or gastric varices.
  • Pregnant or breastfeeding
  • Screening blood result with any grade 3/4 toxicity according to Division of AIDS (DAIDS) grading scale, except: asymptomatic grade 3 amylase, creatinine phosphokinase, or lipid elevation.
  • Any condition (including illicit drug use or alcohol abuse) or lab results which, in the investigator's opinion, interfere with assessments or completion of the trial.

Trial locations and contacts

7 sites in 2 countries.

7 sites in 2 countries

Canada5 sites
  • Hamilton Health Sciences

    Hamilton, Ontario, L8S 1A4

  • McGill University Health Centre

    Montreal, Quebec, H4A 3J1

  • CHU de Québec-Université Laval

    Québec, Quebec, G1V 4G2

  • University Health Network

    Toronto, Ontario, M5G 2C4

  • Vancouver ID Research and Care Centre

    Vancouver, British Columbia, V6Z 2C7

Other trials in Canada

Italy2 sites
  • Ospedale San Raffaele

    Milan, 20127

  • Università degli Studi di Modena e Reggio Emilia

    Modena, 41124

Other trials in Italy

About this study

Official title: Bone Health in Aging HIV Infected Women: Improvement or Prevention of Changes in Bone Mineral Density by Switching Antiretroviral Agents. Is There an Optimal Time to Intervene?

Design: Open-label randomised multicenter international strategic trial of older women on combination antiretroviral therapy (cART) containing tenofovir-emtricitabine (TDF/FTC) with HIV RNA suppression for > 6 months to : 1. Immediate switch of TDF/FTC to tenofovir alafenamide-emtricitabine (TAF/FTC) while continuing the third antiretroviral agent.; 2. Delayed switch; with switch of TDF/FTC to TAF/FTC at 48 weeks while continuing the third agent. Follow up of all subjects to 96 weeks.

Subject Population: The anticipated sample size is 128 HIV infected women aged 45-55 years (peri or early post menopause). .

Read more

Primary endpoint: Percentage change from baseline bone mineral density (BMD) at the lumbar spine at weeks 48 and 96.

Secondary Endpoints: BMD change at hip, trabecular bone score, estimated bone strength by high resolution peripheral quantitative computerized tomography (HR-pQCT), muscle quality, geriatric assessment; biomarkers of bone, immune activation and inflammation; HIV viral suppression; safety, lipid and renal function, cardiovascular risk scores at weeks 48 and 96.

Expected Outcomes: To determine if a switch from TDF/FTC to TAF?FTC improves BMD to a degree correlating with a decreased risk of fragility fracture in aging HIV infected women. Secondary outcomes will assess bone strength using new imaging modalities, timing of switch, and renal health. This data will be used by health policy makers and providers to determine the proper use of TAF/FTC in the aging HIV population.

Read the detailed description

A Randomized controlled clinical trial (RCT) of immediate vs delayed switch from TDF/FTC to TAF/FTC to define the impact of switching ARV on BMD in different stages of the aging trajectory in HIV infected women. Included is a geriatric assessment based on the conceptualization of health transition across menopause.

Study Hypothesis: The primary hypothesis is that switching from TDF/FTC will improve BMD to a degree that correlates with a lower fracture risk in aging HIV+ women. We will further explore our theory that the impact is greater in those in the early stages of menopause and in those who also receive a protease inhibitor (PI) as the third antiretroviral agent (ARV).

Primary objectives: To determine if: 1. Switching HIV+ women on TDF/FTC to TAF/FTC increases BMD at the spine at 48 weeks relative to those who continue TDF/FTC 2. To determine if any observed improvements continue or stabilize in the year after switch.

Hypothesis generating objectives: To determine if the effect of switching from TDF/FTC to TAF/FTC on BMD varies by stage of menopause and by third ARV.

Study design: This study is double blind placebo controlled randomised, 1:1, multicentre strategic trial. Patients will be randomised to immediate vs delayed switch, with randomization allocation arranged to minimize differences between treatment group with respect to stage of menopause (peri- menopause vs early post menopause) and site. Study population: HIV positive women who are in the peri-menopausal period or those within 10 years post menopause to capture those with greatest risk of BMD loss. As menopause typically occurs earlier in HIV + women we include those aged 45-55 years. They must be on a cART regimen containing TDF/FTC with HIV RNA <50 c/ml for at least 6 months.

Intervention:

  1. Immediate switch of TDF/FTC to TAF/FTC while maintaining the third ARV agent.
  2. Delayed switch of TDF/FTC to TAF/FTC at 48 weeks while maintaining the third ARV agent.

Randomization: A computer-generated randomization list will be prepared prior to study onset by a statistician unassociated with the study. Randomization will be stratified by study centre.

Primary endpoint: Comparison of the immediate vs delayed group in the % change from baseline in BMD at the lumbar spine at week 48 and 96.

Secondary endpoints: Will compare changes between the immediate and delayed group from data collected at screening or baseline and weeks 48 and 96.

  • change from baseline in BMD at hip Changes in Bone architecture as determined by Trabecular bone scan (TBS) and HRpQCT (high resolution peripheral quantitative computerized tomography) (Toronto site) Changes in 10 year fracture risk determined by country specific FRAX® (fracture risk assessment) calculator
  • with HIV-1 RNA <50 c/ml Change from baseline in geriatric functional measures: frailty, performance and balance Change from baseline in muscle quality: Sarcopenia - grip strength measured by a Dynamometer Change from baseline in lipid values and Framingham cardiovascular risk scores Changes in renal tubular and glomerular function: GFR (glomerular filtration rate), Creatinine, urine albumin /creatinine and protein/creatinine, glucosuria Safety (clinical and laboratory adverse events) Changes in biomarkers of inflammation, coagulation and bone metabolism Tolerability (EuroQoL questionnaire)
Being tested
tenofovir-alafenamide-emtricitabine, tenofovir-emtricitabine
Keywords
kidney, antiretroviral agent, tenofovir, osteoporosis, women
Medical subject headings
Osteoporosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • tenofovir-alafenamide-emtricitabineDrug

    Also called Descovy

    comparison of tenofovir-emtricitabine and tenofovir-alafenamide-emtricitabine on bone mineral density

  • tenofovir-emtricitabineDrug

    Also called Truvada

    comparison of tenofovir-emtricitabine and tenofovir-alafenamide-emtricitabine on bone mineral density

Study groups in NCT02815566
Study groupRoleWhat they receive
Immediate switchExperimentalOpen label tenofovir-alafenamide (25/10mg)-emtricitabine (200mg) tablet once daily by mouth for 96 weeks
Receives: Drug: tenofovir-alafenamide-emtricitabine
delayed switchActive comparatorOpen-label tenofovir (300mg)-emtricitabine (200mg) tablet once daily by mouth for 48 weeks followed by open label tenofovir-alafenamide (25/10mg)-emtricitabine (200mg) tablet once daily by mouth for an additional 48 weeks
Receives: Drug: tenofovir-emtricitabine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percent Change in Bone Mineral Density From Baseline at the Lumbar Spine

    The outcome measures presented are descriptive as enrollment in the clinical trial did not reach the target number of subjects needed to achieve target power and was insufficient to produce statistically reliable results. There are limited results at the week 48 timepoint due to the COVID pandemic.

    Measured: Baseline, 48 weeks and 96 weeks

Secondary outcomes (1)
  1. % Change in Bone Mineral Density From Baseline at the Femoral Neck

    The outcome measures presented are descriptive as enrollment in the clinical trial did not reach the target number of subjects needed to achieve target power and was insufficient to produce statistically reliable results. There are limited results at the week 48 timepoint due to the COVID pandemic.

    Measured: Baseline, 48 weeks and 96 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Jun 2016 (estimated)
  2. Study start12 Sep 2017
  3. Primary completion25 Feb 2021
  4. Study completion25 Feb 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
34 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02815566
Sponsor's protocol ID
16-5543
Other IDs
IN-CA-311-3963
Acronym
BEING
Status last verified
Dec 2024
First submitted
22 Jun 2016
Last updated
19 Dec 2024
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes: Information on viral load, toxicity and bone scans will be available to treating physicians

Publications

  • Walmsley S, Clarke R, Lee T, Singer J, Cheung AM, Smaill F, De Pokomandy A, Trottier S, Messina E, Guaraldi G. BEING: Bone Health in Aging Women with HIV: Impact of Switching Antiretroviral Therapy on Bone Mineral Density During the Perimenopausal Period. AIDS Res Hum Retroviruses. 2023 Apr;39(4):204-210. doi: 10.1089/AID.2022.0106. Epub 2023 Jan 20.

    PubMed 36511389

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing tenofovir-alafenamide-emtricitabine and tenofovir-emtricitabine in people with Osteoporosis and HIV, run by University Health Network, Toronto at 7 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 19 Dec 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 7 sites in Canada, Italy. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 19 Jan 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percent Change in Bone Mineral Density From Baseline at the Lumbar Spine (time frame: Baseline, 48 weeks and 96 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02815566, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Dec 2024.

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