A prospective randomized trial on abacavir/ lamivudine plus darunavir/ritonavir or raltegravir in HIV-positive drug-naïve patients with CD4<200 cells/uL (the PRADAR study)

Background Very few data are available on treatment in HIV Late presenter population that still repre- sents a clinical challenge. Methods Prospective, multicenter, randomized open-label, 2 arm, phase-3 trial comparing the 48- week virological response of two different regimens: abacavir/lamivudine + darunavir/r vs abacavir/lamivudine + raltegravir in antiretroviral naive with CD4+ counts < 200/mm3 and a viral load (VL)<500,000 copies/mL. The primary Endpoint was the proportion of patients with undetectable viremia (VL<50 copies/mL) after 48 weeks. The planned sample size for this trial was 350 patients. Results In 3 years, 53 patients were screened and 46 enrolled: 22 randomized to raltegravir and 24 to darunavir/r; 7 patients were excluded, 4 because of a VL >500,000 copies/mL and 3 for HLAB5701 positivity. The snapshot analysis at 48 weeks showed a virologic success of 77.3% in raltegravir and 66.7% in darunavir/r. Time to starting treatment was 34.5 days in PLOS ONE | https://doi.org/10.1371/journal.pone.0222650 September 27, 2019 1 / 11 Abacavir/lamivudine plus darunavir/ritonavir or raltegravir in HIV+ drug-naïve patients with CD4<200 cells Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Funding: Funding for this study was provided by ViiV Healthcare, the authors are solely responsible for final content and interpretation. Supported in part by a research grant from Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp. Supported in part by a research grant by Janssen. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Janssen. Competing interests: We received unrestricted financial support for the study from the Companies: ViiV Healthcare, Merck Sharp and Dohme Corp and Janssen, but this does not alter our adherence to PLOS ONE policies on sharing data and materials. raltegravir and 53 days in darunavir/r. At the as treated analysis, the median CD4 counts at 48 weeks was 297 cells/μL in raltegravir and 239 cells/μL in darunavir/r. No difference in total cholesterol, while triglycerides were higher in the darunavir/r arm. No statistical analy- ses were performed due to the low number of patients enrolled. Conclusions Late presenter patients are frequent but very difficult to enroll in clinical trials, especially in western countries. These regimens and the conditions of many patients could not allow the test and treat strategy. The rate of virologic success was higher than 65% in both arms with a median CD4 cell count >200/μL at week 48.