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1. Nucleoside/nucleotide reverse transcriptase inhibitor sparing regimen with once daily integrase inhibitor plus boosted darunavir is non-inferior to standard of care in virologically-suppressed children and adolescents living with HIV – Week 48 results of the randomised SMILE Penta-17-ANRS 152 clinical trialResearch in context

Author

Alexandra Compagnucci, Man K. Chan, Yacine Saïdi, Tim R. Cressey, Alasdair Bamford, Yoann Riault, Alexandra Coelho, Aoife Nolan, Suwalai Chalermpantmetagul, Gabija Morkunaite, Pauline Amuge, Victor Musiime, Avy Violari, Mark Cotton, Adeodata R. Kekitiinwa, Elizabeth Kaudha, Marisa Groenewald, Afaaf A. Liberty, Suparat Kanjanavanit, Alla Volokha, Rosa Bologna, Noris Pavia Ruz, Luis Prieto Tato, Paolo Paioni, Laura Marques, Véronique Reliquet, Tim Niehues, Steven B. Welch, Deborah Ford, Carlo Giaquinto, Diana M. Gibb, Abdel Babiker, Jose Tomas Ramos Amador, A. Compagnucci, Y. Saidi, Y. Riault, A. Coelho, C. Kouakam, L. Picault, M. Ndiaye, L. Meyer, C. Cagnot, S. Circosta, L. Léger, S. Simanic, A. Arulananthan, D.M. Gibb, A. Babiker, M. Chan, D. Ford, F. Hudson, L. Harper, A. Bamford, A. Nolan, K. Widuch, S. Townsend, N. Van-Looy, L. Gao, E. Little, A. Turkova, S. Fabiane, J. Calvert, J. Blackstone, K. Scott, J. Inshaw, A. Nunn, A. Nardone, D. Bilardi, T.R. Cressey, S. Chalermpantmetagul, W. Khamduang, G. Jourdain, N. Ngo Giang Huong, D. Chinwong, C. Saenjum, R. Peongjakta, P. Sukrakanchana, L. Laomanit, A. Kaewbundit, J. Khamkon, K. Than-in-at, C. Meeboon, W. Sripaoraya, N. Krueduangkam, N. Kruenual, W. Khamjakkaew, S. Klinprung, C. Giaquinto, G. Morkunaite, D. Hirt, L. Prieto Tato, T. Niehues, D. Plonné, C. Morén, T. Noguera, M.A. Muñoz Fernández, R. Bologna, S. Arazi, A.G. Fedullo, M. Taicz, E. Vicentini, M. Moragas, A. Mangano, M. Dell’Orso, M. Gatto, V. Reliquet, A. Soria, E. Paredes, N. Chereau, M. Tching Sin, L. Flet, A. Rodallec, C. Hemon, N. Elenga, M.D. Terrine, N. Blaise, S. Augustin, P. Mespoulhe, H. Pouchain, N. Pavia-Ruz, R. Muñoz- Hernández, A. Neri-Macias, M.D. Jarillo-Quijada, C. Espinosa-Sotero, L. Marques, C. Teixeira, A. Fernandes, R. Nunes, H. Nascimento, J. Tuna, A. Padrao, I. Ferraz, A.C. Mendes, C. Correira, H. Pinheiro, A.C. Matos, A.C. Sampaio, A. Oliveira, A. Caldeira, M. Tavares, A. Reis Melo, C. Castro, C. Faria, C. Prucha, R. Ribeiro, F. Monteiro, M.F. Candeias, T. Silva Milhiero, E. Gomes Neves, R. Corte-Real, M. Morgado, D. Mendes, M. Cardão, A. Violari, N. Ramsagar, A. Liberty, M. Nyati, L. Maseko, M. Khunene, S. Mkhize, Z. Essack, N. Akoojee, U. Singh, Y. Fourie, S. Govender, A. Vadee, R. Lakha, J. Erasmus, A. Mamiane, T. Daniel, P. Bhana, N. Maduna, M. Cotton, M. Groenewald, G. Slade, J. Coetzee, L. Ganger, S. Weldon, M. Wessels, L. Hoorn, S. Pieterse, C. Makola, K. Smith, M. Isaacs, A. Cweya, S. Fry, S. Barnabas, M. Theunissen, N. Nduna, M. Smuts, P. Rojo Conejo, C. Epalza, M. Fernández, M.J. Mellado Peña, T. Sainz Costa, L. Escosa García, P. Gomez Salcedo, C. Fortuny Guasch, T. Noguera Julian, C. Estepa, M. Cubells, E. Sans, E. Bruno, L. Prieto, P. Mendez García, A. Murciano Cabeza, M. Coto, R. Torrent, M. Torres Arauz, M. Navarro Gómez, A. Mur, S. Guillén Martin, M. Moreno, J.T. Ramos Amador, I. Garcia, C. Kalhert, T. Wachinger, B. Wohlwend, S. Hafner, G. Dollenmaier, P. Paioni, R. Signorell, J. Boni, A. Duppenthaler, B. Mann, C. Saegesser, M. Barbani, C. Ngampiyaskul, P. Greetanukroh, P. Khannak, P. Tearsansern, W. Chamjamrat, N. Chanto, T. Thapwai, K. Thungkham, P. Puangmalai, C. Ruklao, P. Ounchanum, S. Khusuwan, S. Denjanta, Y. Thaweesombat, J. Thewsoongnoen, K. Kaewmamueng, P. Kamboua, S. Pongprapass, W. Srisuk, A. Kongponoi, J. Limplertjareanwanich, S. Kanjanavanit, C. Saewtrakool, P. Yingyong, D. Chutima, R. Junkaew, T. Chankun, U. Srirompotong, P. Sudsaard, K. Kongsuk, T. Petpranee, S. Srirojana, D. Donngernl, A. Kamkoonmongkol, N. Na Kalasin, P. Phunkhum, A.R. Kekitiinwa, P. Amuge, D. Bbuye, J. Nalubwama, S. Namanda, M. Nsibuka Kisekka, A. Kirabira, L. Lawrence, G. Agaba, G. Ahimbisibwe, A. Nalugo, F. Namuli, R. Kadhuba, R. Namuddu, I. Nabwire, L. Kiyimba, A. Baita, J. Tikabibamu, L. Nakandi, G.P. Kisitu, N. Nabukeera Barung, C.M. Kityo, V. Musiime, E. Kaudha, A. Nanduudu, E. Mujyambere, S.P. Labeja Ocitti, J. Ategeka, E. Nambi, R. Nazzinda, D. Rutebarika, R. Basiimwa, R. Mbabazi, P. Kyobutungi, M. Nabalamba, A. Nakalyango, J. Tumusiime, S. Nakabuye, J. Mwebaza, S. Oruk, J. Namusanje, A. Musiime, L. Mugarura, M. Ojok, J. Kitabalwa, C. Katemba, M. Nannungi, E. Bagirigomwa, D. Odoch, E. Rubanga, D. Mulima, E.L. Babu, D. Baliruno, C. Inyakuwal, E.D. Williams, A. Mulindwa, A. Uyungrwoth, I. Raus, O. Mostovenko, T. Stepchenkova, A. Volokha, N. Primak, J. Kenny, A. Callaghan, M. Ahmad, S. Vergnano, M. Ross, F. Manyi, D. Nayagam, S. Hawkins, C. Ball, E. Hamlyn, C. Gilmour, S. Gilmour-White, S. Doshi, E. Fuller, A. Adebayo, K. Tupper, E. Nsirim, S. Welch, J. Daglish, L. Thrasyvoulou, E. Irvine, K. Gandhi, Y. Vaughn-Gordon, and N. Sibanda

Subjects
HIV, Children, Adolescents, Randomised, Paediatrics, Dual therapy, Medicine (General), R5-920
Abstract

Summary: Background: Integrase inhibitor (INSTI) with boosted darunavir (DRV/r), a regimen with a high-resistance barrier, avoiding NRTI toxicities, might be a switching option in children living with HIV (CLWHIV). Methods: SMILE is a randomised non-inferiority trial evaluating safety and antiviral efficacy of once-daily INSTI + DRV/r vs. continuing on current standard-of-care (SOC) triple ART (2NRTI + boosted PI/NNRTI) in virologically-suppressed CLWHIV aged 6–18 years. The primary outcome is the proportion with confirmed HIV-RNA ≥50 copies/mL by week 48, estimated by Kaplan–Meier method. Non-inferiority margin was 10%. Registration number for SMILE are: ISRCTN11193709, NCT #: NCT02383108. Findings: Between 10th June 2016 and 30th August 2019, 318 participants were enrolled from Africa 53%, Europe 24%, Thailand 15% and Latin America 8%, 158 INSTI + DRV/r [153 Dolutegravir (DTG); 5 Elvitegravir (EVG)], 160 SOC. Median (range) age was 14.7 years (7.6–18.0); CD4 count 782 cells/mm3 (227–1647); 61% female. Median follow-up was 64.3 weeks with no loss to follow-up. By 48 weeks, 8 INSTI + DRV/r vs. 12 SOC had confirmed HIV-RNA ≥50 copies/mL; difference (INSTI + DRV/r-SOC) −2.5% (95% CI: −7.6, 2.5%), showing non-inferiority. No major PI or INSTI resistance mutations were observed. There were no differences in safety between arms. By week 48, difference (INSTI + DRV/r-SOC) in mean CD4 count change from baseline was −48.3 cells/mm3 (95% CI: −93.4, −3.2; p = 0.036). Difference (INSTI + DRV/r-SOC) in mean HDL change from baseline was −4.1 mg/dL (95% CI: −6.7, −1.4; p = 0.003). Weight and Body Mass Index (BMI) increased more in INSTI + DRV/r than SOC [difference: 1.97 kg (95% CI: 1.1, 2.9; p

Published
2023
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2. The cost-effectiveness of prophylaxis strategies for individuals with advanced HIV starting treatment in Africa

Author

Walker, SM, Cox, E, Revill, P, Musiime, V, Bwakura‐Dangarembizi, M, Mallewa, J, Cheruiyot, P, Maitland, K, Ford, N, Gibb, DM, Walker, AS, Soares, M, Mugyenyi, P, Kityo, C, Wavamunno, P, Nambi, E, Ocitti, P, Ndigendawani, M, Kabahenda, S, Kemigisa, M, Acen, J, Olebo, D, Mpamize, G, Amone, A, Okweny, D, Mbonye, A, Nambaziira, F, Rweyora, A, Kangah, M, Kabaswahili, V, Abach, J, Abongomera, G, Omongin, J, Aciro, I, Philliam, A, Arach, B, Ocung, E, Amone, G, Miles, P, Adong, C, Tumsuiime, C, Kidega, P, Otto, B, Apio, F, Baleeta, K, Mukuye, A, Abwola, M, Ssennono, F, Baliruno, D, Tuhirwe, S, Namisi, R, Kigongo, F, Kikyonkyo, D, Mushahara, F, Tusiime, J, Musiime, A, Nankya, A, Atwongyeire, D, Sirikye, S, Mula, S, Noowe, N, Lugemwa, A, Kasozi, M, Mwebe, S, Atwine, L, Senkindu, T, Natuhurira, T, Katemba, C, Ninsiima, E, Acaku, M, Kyomuhangi, J, Ankunda, R, Tukwasibwe, D, Ayesiga, L, Hakim, J, Nathoo, K, Reid, A, Chidziva, E, Mhute, T, Tinago, GC, Bhiri, J, Mudzingwa, S, Phiri, M, Steamer, J, Nhema, R, Warambwa, C, Musoro, G, Mutsai, S, Nemasango, B, Moyo, C, Chitongo, S, Rashirai, K, Vhembo, S, Mlambo, B, Nkomani, S, Ndemera, B, Willard, M, Berejena, C, Musodza, Y, Matiza, P, Mudenge, B, Guti, V, Etyang, A, Agutu, C, Berkley, J, Njuguna, P, Mwaringa, S, Etyang, T, Awuondo, K, Wale, S, Shangala, J, Kithunga, J, Mwarumba, S, Said Maitha, S, Mutai, R, Lozi Lewa, M, Mwambingu, G, Mwanzu, A, Kalama, C, Latham, H, Shikuku, J, Fondo, A, Njogu, A, Khadenge, C, Mwakisha, B, Siika, A, Wools‐Kaloustian, K, Nyandiko, W, Sudoi, A, Wachira, S, Meli, B, Karoney, M, Nzioka, A, Tanui, M, Mokaya, M, Ekiru, W, Mboya, C, Mwimali, D, Mengich, C, Choge, J, Injera, W, Njenga, K, Cherutich, S, Anyango Orido, M, Omondi Lwande, G, Rutto, P, Mudogo, A, Kutto, I, Shali, A, Jaika, L, Jerotich, H, Pierre, M, Kaunda, S, Van Oosterhout, J, O'Hare, B, Heydermann, R, Gonzalez, C, Dzabala, N, Kelly, C, Denis, B, Selemani, G, Nyondo Mipando, L, Chirwa, E, Banda, P, Mvula, L, Msuku, H, Ziwoya, M, Manda, Y, Nicholas, S, Masesa, C, Mwalukomo, T, Makhaza, L, Sheha, I, Bwanali, J, Limbuni, M, Gibb, D, Thomason, M, Pett, S, Szubert, A, Griffiths, A, Wilkes, H, Rajapakse, C, Spyer, M, Prendergast, A, Klein, N, Rauchenberger, M, Van Looy, N, Little, E, Fairbrother, K, Cowan, F, Seeley, J, Bernays, S, Kawuma, R, Mupambireyi, Z, Kyomuhendo, F, Nakalanzi, S, Peshu, J, Ndaa, S, Chabuka, J, Mkandawire, N, Matandika, L, Kapuya, C, Weller, I, Malianga, E, Mwansambo, C, Miiro, F, Elyanu, P, Bukusi, E, Katabira, E, Mugurungi, O, Peto, T, Musoke, P, Matenga, J, Phiri, S, Lyall, H, Johnston, V, Fitzgerald, F, Post, F, Ssali, F, Arenas‐Pinto, A, Turkova, A, Bamford, A, Academic Medical Center, and DiFDMRCWellcome Trust

Subjects
Male, Antifungal Agents, Cost effectiveness, Cost-Benefit Analysis, Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, Cohort Studies, 0302 clinical medicine, late‐presenters, fluconazole, Advanced disease, Global health, 030212 general & internal medicine, Child, Research Articles, health care economics and organizations, education.field_of_study, cost‐effectiveness, 3. Good health, Infectious Diseases, Child, Preschool, Female, Quality-Adjusted Life Years, prophylaxis, 0305 other medical science, Post-Exposure Prophylaxis, medicine.drug, Research Article, Adult, medicine.medical_specialty, Tuberculosis, Antigens, Fungal, Adolescent, Cryptococcal antigen, Anti-HIV Agents, Population, late-presenters, 1117 Public Health and Health Services, 03 medical and health sciences, medicine, Humans, education, cost-effectiveness, 030505 public health, AIDS-Related Opportunistic Infections, business.industry, Public Health, Environmental and Occupational Health, HIV, 1103 Clinical Sciences, medicine.disease, CD4 Lymphocyte Count, Cryptococcus, Emergency medicine, Africa, business, Fluconazole, 1199 Other Medical and Health Sciences
Abstract

Introduction: Many HIV-positive individuals in Africa have advanced disease when initiating antiretroviral therapy (ART) so have high risks of opportunistic infections and death. The REALITY trial found that an enhanced-prophylaxis package including fluconazole reduced mortality by 27% in individuals starting ART with CD4

Published
2020

3. Late Presentation with HIV in Africa: Phenotypes, Risk, and Risk Stratification in the REALITY Trial

Author

Siika, A, McCabe, L, Bwakura-Dangarembizi, M, Kityo, C, Mallewa, J, Berkley, J, Maitland, K, Griffiths, A, Baleeta, K, Mudzingwa, S, Abach, J, Nathoo, K, Thomason, MJ, Prendergast, AJ, Walker, AS, Gibb, DM, Mugyenyi, P, Musiime, V, Wavamunno, P, Nambi, E, Ocitti, P, Ndigendawani, M, Kemigisa, M, Acen, J, Olebo, D, Mpamize, G, Amone, A, Okweny, D, Mbonye, A, Nambaziira, F, Rweyora, A, Kangah, M, Kabaswahili, V, Abongomera, G, Omongin, J, Aciro, I, Philliam, A, Arach, B, Ocung, E, Amone, G, Miles, P, Adong, C, Tumsuiime, C, Kidega, P, Otto, B, Apio, F, Mukuye, A, Abwola, M, Ssennono, F, Baliruno, D, Tuhirwe, S, Namisi, R, Kigongo, F, Kikyonkyo, D, Mushahara, F, Tusiime, J, Musiime, A, Nankya, A, Atwongyeire, D, Sirikye, S, Mula, S, Noowe, N, Lugemwa, A, Kasozi, M, Mwebe, S, Atwine, L, Senkindu, T, Natuhurira, T, Katemba, C, Ninsiima, E, Acaku, M, Kyomuhangi, J, Ankunda, R, Tukwasibwe, D, Ayesiga, L, Hakim, J, Reid, A, Chidziva, E, Mhute, T, Tinago, GC, Bhiri, J, Phiri, M, Steamer, J, Nhema, R, Warambwa, C, Musoro, G, Mutsai, S, Nemasango, B, Moyo, C, Chitongo, S, Rashirai, K, Vhembo, S, Mlambo, B, Global Health, Graduate School, APH - Personalized Medicine, APH - Quality of Care, AII - Infectious diseases, University of St Andrews. School of Medicine, University of St Andrews. Infection and Global Health Division, and DiFDMRCWellcome Trust

Subjects
0301 basic medicine, Male, Human immunodeficiency virus (HIV), HIV Infections, R Medicine (General), medicine.disease_cause, Late presentation, 0302 clinical medicine, Risk Factors, Antiretroviral Therapy, Highly Active, Health care, 030212 general & internal medicine, Child, health care economics and organizations, immunosuppression, Age Factors, 11 Medical And Health Sciences, 3. Good health, Phenotype, Infectious Diseases, Child, Preschool, Risk stratification, Female, Adult, Microbiology (medical), Adolescent, Anti-HIV Agents, 030106 microbiology, NDAS, Library science, Microbiology, Risk Assessment, 03 medical and health sciences, Immunocompromised Host, SDG 3 - Good Health and Well-being, medicine, Humans, Advanced HIV Disease, Mortality, Africa South of the Sahara, AIDS-Related Opportunistic Infections, business.industry, HIV, 06 Biological Sciences, Supplementary food, Antiretroviral therapy, mortality, R1, CD4 Lymphocyte Count, Clinical trials unit, Africa, Self care, business, Immunosuppression
Abstract

REALITY was funded by the Joint Global Health Trials Scheme (JGHTS) of the UK Department for International Development, the Wellcome Trust, and Medical Research Council (MRC) (grant number G1100693). Additional funding support was provided by the PENTA Foundation and core support to the MRC Clinical Trials Unit at University College London (grant numbers MC_UU_12023/23 and MC_UU_12023/26). Cipla Ltd, Gilead Sciences, ViiV Healthcare/GlaxoSmithKline, and Merck Sharp & Dohme donated drugs for REALITY, and ready-to-use supplementary food was purchased from Valid International. A. J. P. is funded by the Wellcome Trust (grant number 108065/Z/15/Z). J. A. B. is funded by the JGHTS (grant number MR/M007367/1). The Malawi-Liverpool–Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine (grant number 101113/Z/13/Z) and the Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi (grant number 203077/Z/16/Z) are supported by strategic awards from the Wellcome Trust, United Kingdom. Permission to publish was granted by the Director of KEMRI. This supplement was supported by funds from the Bill & Melinda Gates Foundation. Background. Severely immunocompromised human immunodefciency virus (HIV)-infected individuals have high mortality shortly afer starting antiretroviral therapy (ART). We investigated predictors of early mortality and "late presenter" phenotypes. Methods. Te Reduction of EArly MortaLITY (REALITY) trial enrolled ART-naive adults and children =5 years of age with CD4 counts .1). Results. Among 1711 included participants, 203 (12%) died. Mortality was independently higher with older age; lower CD4 count, albumin, hemoglobin, and grip strength; presence of World Health Organization stage 3/4 weight loss, fever, or vomiting; and problems with mobility or self-care at baseline (all P

Published
2018

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