Evaluating the Safety of Immediate Versus Deferred Isoniazid Preventive Therapy Among HIV-Infected Pregnant Women

This study is not yet open for participant recruitment. (see Contacts and Locations)
Verified July 2014 by National Institute of Allergy and Infectious Diseases (NIAID)
Sponsor:
Information provided by (Responsible Party):
National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier:
NCT01494038
First received: December 14, 2011
Last updated: July 7, 2014
Last verified: July 2014
  Purpose

Tuberculosis (TB) is a leading cause of death among HIV-infected persons in low-income settings and can be a serious complication for HIV-infected pregnant women and their infants. Isoniazid (INH) preventive therapy (IPT) is effective for HIV-infected adults, but the safety of IPT in pregnant women is unknown. This study will evaluate the safety of IPT among HIV-infected pregnant women.


Condition Intervention Phase
HIV Infections
Tuberculosis
Drug: Isoniazid (INH)
Drug: Placebo for isoniazid (INH)
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver)
Primary Purpose: Prevention
Official Title: A Phase IV Randomized Double-Blind Placebo-Controlled Trial to Evaluate the Safety of Immediate (Antepartum-Initiated) Versus Deferred (Postpartum-Initiated) Isoniazid Preventive Therapy Among HIV-Infected Women in High Tuberculosis (TB) Incidence Settings

Resource links provided by NLM:


Further study details as provided by National Institute of Allergy and Infectious Diseases (NIAID):

Primary Outcome Measures:
  • Grade 3 or higher adverse events (AEs) [ Time Frame: Measured through Week 48 postpartum ] [ Designated as safety issue: Yes ]
    Grade 3 or higher AEs possibly, probably, or definitely associated with INH/placebo for INH or permanent discontinuation of INH/placebo for INH due to an adverse reaction in women after randomization


Secondary Outcome Measures:
  • Fetal death [ Time Frame: Measured through Week 48 after birth ] [ Designated as safety issue: Yes ]
  • Fetus small for gestational age [ Time Frame: Measured through Week 48 after birth ] [ Designated as safety issue: Yes ]
  • Premature birth of infant (less than 37 weeks gestation) [ Time Frame: Measured through Week 48 after birth ] [ Designated as safety issue: Yes ]
  • Low birth weight of infant [ Time Frame: Measured through Week 48 after birth ] [ Designated as safety issue: Yes ]
  • Congenital anomalies of infant [ Time Frame: Measured through Week 48 after birth ] [ Designated as safety issue: Yes ]
  • Grade 3 or higher clinical or laboratory AEs for fetus/infant [ Time Frame: Measured through Week 48 after birth ] [ Designated as safety issue: Yes ]
  • HIV infection of infant [ Time Frame: Measured through Week 48 after birth ] [ Designated as safety issue: No ]
  • Maternal TB [ Time Frame: Measured through Week 48 postpartum ] [ Designated as safety issue: No ]
  • Infant TB [ Time Frame: Measured through Week 48 after birth ] [ Designated as safety issue: No ]
  • Death of infant [ Time Frame: Measured through Week 48 after birth ] [ Designated as safety issue: Yes ]
  • Death of mother [ Time Frame: Measured through Week 48 postpartum ] [ Designated as safety issue: Yes ]
  • Resistance to INH in isolates of Mycobacterium tuberculosis from mothers who develop culture-confirmed TB [ Time Frame: Measured through Week 48 postpartum ] [ Designated as safety issue: No ]
  • Resistance to INH in isolates of Mycobacterium tuberculosis from infants who develop culture-confirmed TB [ Time Frame: Measured through Week 48 after birth ] [ Designated as safety issue: No ]
  • Intensive pharmacokinetic (PK) outcomes [ Time Frame: Measured through Week 16 postpartum ] [ Designated as safety issue: No ]
  • Interferon-gamma release assay (IGRA) result in women [ Time Frame: Measured through Week 44 postpartum ] [ Designated as safety issue: No ]
  • IGRA result in infants [ Time Frame: Measured through Week 44 after birth ] [ Designated as safety issue: No ]
  • Tuberculin skin test (TST) in women [ Time Frame: Measured through Week 44 postpartum ] [ Designated as safety issue: No ]
  • TST for infants [ Time Frame: Measured through Week 44 after birth ] [ Designated as safety issue: No ]
  • Adherence to INH/placebo for INH among women as assessed by self-report and pill count [ Time Frame: Measured throughout Week 48 postpartum ] [ Designated as safety issue: No ]
  • Occurrence of hepatotoxicity [ Time Frame: Measured throughout Week 48 postpartum ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 950
Study Start Date: April 2014
Estimated Primary Completion Date: February 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm A (Immediate INH Treatment)
Women in Arm A will receive immediate, or antepartum-initiated, INH treatment. Women will receive INH at study entry through Week 28, then will switch to placebo for INH treatment through Week 40 postpartum.
Drug: Isoniazid (INH)
300-mg tablet once daily by mouth, either from entry through Week 28 antepartum (Arm A) or from Week 12 postpartum through Week 40 postpartum (Arm B)
Drug: Placebo for isoniazid (INH)
Placebo tablet once daily by mouth, either from Week 28 visit through Week 40 postpartum (Arm A) or from entry until Week 12 postpartum visit (Arm B)
Experimental: Arm B (Deferred INH Treatment)
Women in Arm B will receive deferred, or postpartum-initiated, INH treatment. Women will receive placebo for INH at study entry through Week 12 postpartum, then will switch to INH through Week 40 postpartum.
Drug: Isoniazid (INH)
300-mg tablet once daily by mouth, either from entry through Week 28 antepartum (Arm A) or from Week 12 postpartum through Week 40 postpartum (Arm B)
Drug: Placebo for isoniazid (INH)
Placebo tablet once daily by mouth, either from Week 28 visit through Week 40 postpartum (Arm A) or from entry until Week 12 postpartum visit (Arm B)

Detailed Description:

TB disease is the most common HIV-related opportunistic infection and is a leading cause of death among HIV-infected persons in low-income settings. When TB occurs during or soon after pregnancy, it can cause complications for the mother as well as infant TB or death. Infant TB is very difficult to diagnose, and up to half of infant TB cases are caused by maternal TB. It has been shown that treatment for active TB is safe and effective during pregnancy and that IPT is safe and effective in preventing TB infection in HIV-infected adults. However, the safety of IPT in HIV-infected pregnant women is not known, especially in regard to its combination with highly active retroviral therapy (HAART). This study will evaluate the safety of immediate (antepartum, or before delivery) versus deferred (postpartum, or after delivery) IPT among HIV-infected pregnant women in high TB incidence settings.

HIV-infected pregnant women will be randomly assigned to one of two arms. Arm A (immediate/antepartum INH) will receive oral INH once daily from study entry through Week 28 antepartum. At Week 28 antepartum, Arm A will receive oral placebo once daily until Week 40 postpartum. Arm B (deferred/postpartum INH group) will receive oral placebo once daily from study entry to Week 12 postpartum. At Week 12 postpartum, Arm B will receive oral INH once daily through Week 40 postpartum. Women in both arms will receive oral prenatal multivitamins and pyridoxine (vitamin B6) once daily from study entry through Week 40 postpartum.

Study visits for women will occur at screening, entry, every 4 weeks until labor and delivery, at labor and delivery, and every 4 weeks after delivery until 48 weeks postpartum. Visits will consist of giving a medical history and undergoing a physical exam and blood collection; all visits through the delivery visit will also include an obstetrical exam. Presence of HIV infection will be documented at screening and a tuberculin skin test (TST) will be administered at the delivery visit and at the Week 44 postpartum visit. Some postpartum visits will include a urine pregnancy test. Study visits for infants will occur at birth and every 4 weeks until 44 weeks after birth. These visits will include a medical history, physical exam, and blood collection. Plasma collected from women and infants during this study will be stored for future studies.

  Eligibility

Ages Eligible for Study:   13 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Documented HIV-1 infection, defined as positive results from two samples collected at different time points. The same method may be used at both time points. All samples tested must be whole blood, serum, or plasma. More information on this criterion can be found in the protocol.
  • Documented HIV treatment, according to World Health Organization (WHO) guidelines, for prevention of mother-to-child transmission (PMTCT) and standard of care for HIV infection
  • Pregnant females age 18 years or older
  • Pregnant females younger than age 18 but at least age 13 who are able and willing to provide signed informed consent under local law or pregnant females unable to consent under local law whose parents/legal guardians provide consent or "minimum age of consent according to locally applicable laws or regulations"
  • Pregnancy gestational age confirmed by best available method at site to be 14 weeks or greater through 34 weeks, 6 days
  • Weight greater than or equal to 35 kg at screening
  • The following laboratory values obtained within 30 days prior to study entry:

    • Absolute neutrophil count (ANC) greater than or equal to 750 cells/mm^3
    • Hemoglobin greater than or equal to 7.5 g/dL
    • Platelet count greater than or equal to 50,000/mm^3
    • Aspartate aminotransferase (AST)/serum glutamic oxaloacetic transaminase (SGOT), alkaline phosphatase (ALT)/serum glutamic pyruvic transaminase (SGPT), and total bilirubin less than or equal to 1.25 times the upper limit of normal (ULN)
  • Intent to remain in current geographical area of residence for the duration of the study

Exclusion Criteria:

  • Any woman with a positive TB symptom screen per WHO guidelines, including any one or more of the following: any cough, fever, self-reported weight loss, or night sweats. Note: If a potential subject is found to be negative for TB upon further testing, the subject may be rescreened for the study.
  • Any positive acid-fast bacillus (AFB) smear or culture from any site within the past 12 weeks, chest radiograph (x-ray) with findings suggestive of active TB, or clinician suspects active TB
  • Known exposure to AFB smear-positive active TB case within past 12 weeks prior to study entry
  • Reported INH exposure (more than 30 days) in the past year prior to study entry
  • Receipt of any TB or atypical mycobacteria therapy for more than 30 days in the past year
  • Evidence of acute hepatitis, such as jaundice, dark urine (not concentrated urine), and/or acholic stools sustained for more than 3 days within 90 days prior to entry. More information on this criterion can be found in the protocol.
  • Grade 1 or higher peripheral neuropathy. More information on this criterion can be found in the protocol.
  • History of acute systemic adverse reaction or allergy to INH
  • Known current heavy alcohol use (more than 2 drinks per week) or alcohol exposure that, in the investigator's opinion, would compromise participation and the outcome of this study
  • Presence of new AIDS-defining opportunistic infection that has been treated less than 30 days prior to study entry
  • Receipt of an investigational agent or chemotherapy for active malignancy within 30 days prior to study entry
  • Any clinically significant diseases (other than HIV infection) or clinically significant findings during the screening medical history or physical examination that, in the investigator's opinion, would compromise participation and the outcome of this study
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01494038

Locations
Botswana
Gaborone CRS Not yet recruiting
Gaborone, Botswana
Contact: Tebogo Kakhu    267-3931353    tkakhu@bhp.org.bw   
Molepolole CRS Not yet recruiting
Gaborone, Botswana
Contact: Ayotunde Omoz-Oarhe, MDCM    267-3910388    aomozooarhe@bhp.org.bw   
South Africa
Soweto IMPAACT CRS Not yet recruiting
Johannesburg, Gauteng, South Africa, 1864
Contact: Nasreen Abrahams    27-11-9899700    abrahamsn@phru.co.za   
Zimbabwe
Seke North CRS Not yet recruiting
Chitungwiza, Zimbabwe
Contact: Suzen Maonera, M.Sc., B.Sc., R.N.    263-772-268521    suzen@uz-ucsf.co.zw   
St Mary's CRS Not yet recruiting
Chitungwiza, Zimbabwe
Contact: Emmie Marote, R.N., B.A.    263-772-268519    emarote@uz-ucsf.co.zw   
Sponsors and Collaborators
Investigators
Study Chair: Amita Gupta, MD, MHS Johns Hopkins University
  More Information

Publications:
Responsible Party: National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier: NCT01494038     History of Changes
Other Study ID Numbers: P1078, 10732, IMPAACT P1078
Study First Received: December 14, 2011
Last Updated: July 7, 2014
Health Authority: United States: Food and Drug Administration

Additional relevant MeSH terms:
Tuberculosis
HIV Infections
Acquired Immunodeficiency Syndrome
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Slow Virus Diseases
Mycobacterium Infections
Actinomycetales Infections
Gram-Positive Bacterial Infections
Bacterial Infections
Isoniazid
Fatty Acid Synthesis Inhibitors
Hypolipidemic Agents
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Antitubercular Agents
Anti-Bacterial Agents
Anti-Infective Agents
Therapeutic Uses
Lipid Regulating Agents

ClinicalTrials.gov processed this record on July 29, 2014