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CompletedNCT04738812DATURAUpdated Dec 22, 2025

Determination of Adequate Tuberculosis Regimen in Patients Hospitalized With HIV-associated Severe Immune Suppression

A Phase 3 interventional study of Intensified TB treatment (initial phase) and WHO standard TB treatment (initial phase) in Tuberculosis, HIV-1-infection and Immuno-Deficiency, sponsored by ANRS, Emerging Infectious Diseases. Completed at 6 sites in 6 countries. Open to participants aged 15 Years and older. Per ClinicalTrials.gov, last updated 2025-12-22.

Sponsored by ANRS, Emerging Infectious Diseases · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
1,330
Allocation
Randomized
Ages
15 Years and older
Sex
All
01

Study summary

DATURA trial is a phase III, multicenter, two-arm, open-label, randomized superiority trial to compare the efficacy and the safety of an intensified tuberculosis (TB) regimen versus standard TB treatment in HIV-infected adults and adolescents hospitalized for TB with CD4 ≤ 100 cells/μL over 48 weeks:

  • Intensified TB treatment regimen: increased doses of rifampicin and isoniazid together with standard-dose of pyrazinamide and ethambutol for 8 weeks in addition to prednisone for 6 weeks and albendazole for 3 days
  • WHO standard TB treatment regimen.

The continuation phase of TB treatment will be identical in the two arms: 4 months of rifampicin and isoniazid at standard doses.

Read the detailed description

Settings: 5 African (Cameroon, Guinea, Uganda, Zambia, Mozambique) and 1 South-East Asian (Cambodia) countries.

Sample size : 1330 patients (665 in each arm). Follow-up : 48 weeks after entry in the trial (TB treatment initiation).

All participants will initiate antiretroviral therapy (ART) 2 weeks after starting TB treatment. In each country, the chosen ART regimen will be the same in both arms. According to the first-line regimen recommended in each country, the ART combination will be TDF/3TC/EFV 600 mg, or TDF/3TC + double-dose DTG.

The primary objective is to estimate the impact of an intensified initial phase of TB treatment on mortality at 48 weeks among HIV-infected adults and adolescents hospitalized for TB with CD4 ≤ 100 cells/μL in comparison with standard TB treatment.

The secondary objectives are to estimate the impact of an intensified initial phase of TB treatment, in comparison with the standard TB regimen, on:

  • Mortality at weeks 8 and 24
  • Adverse events, including

    • All grade 3 and 4 events
    • Selected grade 2 events of interest
    • Drug-related adverse events
    • AIDS-defining illnesses
    • Paradoxical TB-associated immune reconstitution inflammatory syndrome (IRIS)
  • TB treatment success
  • TB recurrence
  • ART response in terms of virological success and immunological response
  • Adherence to TB treatment and ART
  • Peak plasma concentrations of rifampicin and isoniazid (and its N-acetyl-metabolite) at day 3, day 7 and week 2
  • Plasma concentrations of efavirenz and dolutegravir at week 4 (i.e. 2 weeks after the onset of ART).

A pharmacokinetic sub-study of rifampicin and isoniazid will be carried out in 72 voluntary patients (6 patients/arm/country) at the second week of the main study.

02

Conditions studied

  • Tuberculosis
  • HIV-1-infection
  • Immuno-Deficiency

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Keywords

  • Tuberculosis
  • HIV-1
  • Mortality
  • Immuno-deficiency
  • Isoniazid
  • Rifampicin
03

Who can participate

Ages eligible
15 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Patient (and legally designed representative of minor patient) able to correctly understand the trial and to sign the informed consent
  • Aged ≥ 15 years
  • Confirmed HIV-1 infection as documented at any time prior to trial entry per national HIV testing procedures
  • CD4 count ≤ 100 cells/μL
  • Hospitalized for a newly diagnosed TB, defined by:

    • Any positive Xpert® MTB/RIF specimen (sputum, urine, pus, other),
    • Or a positive urine lipoarabinomannan (LAM) test,
    • Or an abnormal chest X-ray compatible with active TB

Exclusion criteria

EXCLUSION CRITERA

  • Initiation of TB drugs for more than 7 days
  • History of TB treatment during the last 6 months
  • Central neurological symptoms, including but not restrictive to TB meningitis
  • Suspected TB pericarditis
  • Documented Mycobacterium tuberculosis strain resistant to rifampicin using rapid molecular testing (Xpert® MTB/RIF)
  • Any concomitant medication or known hypersensitivity contraindicating any component of the TB treatment
  • HIV-2 co-infection
  • Current treatment with ART containing protease inhibitors
  • Any contraindication to efavirenz and dolutegravir
  • Severe associated diseases requiring corticosteroids or for which corticosteroids are contra-indicated
  • Impaired hepatic function with ALT (SGPT) > 5 times the upper limit of normal (ULN) value
  • Creatinine clearance \< 30 mL/min/1.73m2 (according to either the MDRD or the CKD-EPI formula)
  • Pregnancy or breastfeeding
04

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
1,330 participants (actual)

Study arms

  • Experimental
    Intensified TB treatment

    * Increased doses of rifampicin (R) to 35±5 mg/kg daily and isoniazid (H) 10±2 mg/kg daily together with standard-dose of pyrazinamide (Z) 20-30 mg/kg daily + ethambutol (E) 15-20 mg/kg daily for 8 weeks (initial phase of TB treatment). * Prednisone 40 to 80 mg once a day (OD) according to weight bands for 2 weeks, followed by 20 to 40 mg OD according to weight bands for 2 weeks, then 10 to 20 mg OD according to weight bands for the last 2 weeks (total duration: 6 weeks). Because of the corticosteroid treatment, albendazole 400 mg OD will be given to participants for 3 days. * Continuation phase: 16 weeks of RH.

    Drug: Intensified TB treatment (initial phase)

  • Active comparator
    WHO standard TB treatment

    * Standard-dose of R 8-12 mg/kg daily + H 4-6 mg/kg daily + Z 20-30 mg/kg daily + E 15-20 mg/kg daily for 8 weeks. * Continuation phase: 16 weeks of RH.

    Drug: WHO standard TB treatment (initial phase)

Interventions

  • DrugIntensified TB treatment (initial phase)

    8 weeks of RHEZ with high dose of rifampicin (R) and isoniazid (H). Fixed dose combination (FDC) of RHZE with the addition of FDC of RH and single caps of R. 6 weeks of prednisone with tapering doses. 3 days of albendazole 400 mg.

  • DrugWHO standard TB treatment (initial phase)

    8 weeks of RHEZ with FDC.

05

What researchers measure

Primary outcomes

  1. Rate of all causes death

    Number of deaths between the inclusion visit and week 48, divided by the total person-years of follow-up until week 48

    Time frame: Up to 48 weeks

Secondary outcomes

  1. Rate of all causes death

    Death for any cause at week 8 will be calculated as the number of deaths between the inclusion visit and week 24, divided by the total person-years of follow-up during the same period

    Time frame: Up to 8 weeks

  2. Rate of all causes death

    Death for any cause at week 24 will be calculated as the number of deaths between the inclusion visit and week 24, divided by the total person-years of follow-up during the same period

    Time frame: Up to 24 weeks

  3. Rate of adverse events

    Number of serious adverse events, all grade 3-4 adverse events (using the DAIDS tables), and any grade 2 adverse events of interest (e.g., hepatotoxicity, rash, peripheral neuropathy, thrombocytopenia, neuropsychiatric disorders), between the inclusion visit and week 48, divided by the total person-years of follow-up during that period

    Time frame: Up to 48 weeks

  4. Rate of AIDS-defining illnesses

    Number of AIDS-defining illnesses according to the WHO clinical staging table

    Time frame: Up to 48 weeks

  5. Rate of paradoxical TB-associated IRIS

    Number of paradoxical TB-associated IRIS according to the definition of the international network for the study of HIV-associated (INSHI) consensus case definition

    Time frame: Up to 14 weeks

  6. Rate of TB treatment success

    The percentage of patients with TB success will be calculated as the number of patients who are cured or who have completed TB treatment, as defined by WHO, divided by the total number of randomized patients

    Time frame: Up to 24 weeks

  7. Rate of TB recurrence

    The number of patients with TB recurrence divided by the total number of randomized patients with TB treatment success at week 24

    Time frame: Up to 48 weeks

  8. Rate of virological success

    The percentage will be calculated as the number of patients with HIV RNA \<50 copies/mL divided by the total number of randomized patients.

    Time frame: Week 24

  9. Rate of virological success

    The percentage will be calculated as the number of patients with HIV RNA \<50 copies/mL divided by the total number of randomized patients.

    Time frame: Week 48

  10. Adherence to TB and ART treatment

    The proportion of days with perfect adherence divided by the total number of days of treatment

    Time frame: up to 24 weeks

  11. Immunological response

    The mean CD4 cell count gain (with 95% confidence interval) will be calculated as the difference of CD4 cell count between pre-inclusion and week 48

    Time frame: Up to 48 weeks

  12. Plasma concentrations of rifampicin and isoniazid

    Determined 2 hours after the TB drugs intake at day 3, day 7 and week 2 in a subset of 20 patients per arm per country

    Time frame: Up to 2 weeks

  13. Plasma concentrations of efavirenz and dolutegravir

    Determined 12 hours after the drugs intake at week 4 (i.e. 2 weeks after the onset of ART) in a subset of 60 patients per arm for efavirenz and 60 patients per arm for dolutegravir

    Time frame: Week 4

06

Study locations

6 sites
  • National Center for HIV/AIDS, Dermatology and STD (NCHADS)
    Phnom Penh, Cambodia
  • Jamot Hospital
    Yaoundé, Cameroon
  • Ignace Deen Hospital
    Conakry, Guinea
  • MACHAVA Hospital
    Maputo, Mozambique
  • Mbarara Regional Referral hospital
    Mbarara, Uganda
  • University Teaching Hospital
    Lusaka, Zambia
07

References and documents

Individual participant data

Plan to share: Yes — All coded IPD will be available upon researchers request.

Supporting information: Study protocol, Sap, Icf

No publications or documents are linked to this record.

08

Registry details

Key details

Study ID
NCT04738812
Lead sponsor
ANRS, Emerging Infectious Diseases
Collaborators
European Union, European and Developing Countries Clinical Trials Partnership (EDCTP)
Responsible party
Sponsor
First posted
Feb 4, 2021
Start date
Apr 21, 2022
Primary completion
Nov 12, 2025
Completion
Nov 12, 2025
Last update
Dec 22, 2025

Study contacts

BLANC François-Xavier, MD, PhD
principal investigator · University Hospital of Nantes, France
LAUREILLARD Didier, MD
principal investigator · University Hospital of Nimes, France

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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