Interactions Between HIV and Malaria in African Children (TCC)

This study has been completed.
Sponsor:
Collaborators:
Makerere University
The AIDS Support Organization
Information provided by (Responsible Party):
University of California, San Francisco
ClinicalTrials.gov Identifier:
NCT00527800
First received: September 10, 2007
Last updated: October 9, 2013
Last verified: October 2013

September 10, 2007
October 9, 2013
August 2007
March 2013   (final data collection date for primary outcome measure)
  • Incidence of clinical episodes of malaria [ Time Frame: over entire course of follow-up ] [ Designated as safety issue: No ]
  • Risk of treatment failure at Day 28 defined as any early treatment failure or late clinical/parasitological failure adjusted and unadjusted by genotyping to distinguish recrudescence (treatment failure due to drug resistance) and new infections [ Time Frame: 28 days following each malaria treatment ] [ Designated as safety issue: No ]
  • Incidence of clinical episodes of malaria
  • Risk of treatment failure at Day 28 defined as any early treatment failure or late clinical/parasitological failure adjusted and unadjusted by genotyping to distinguish recrudescence (treatment failure due to drug resistance) and new infections.
Complete list of historical versions of study NCT00527800 on ClinicalTrials.gov Archive Site
  • Prevalence of mutations known to confer resistance to antifolate drugs in pretreatment samples from patients diagnosed with malaria [ Time Frame: each time episode of malaria is diagnosed ] [ Designated as safety issue: No ]
  • Risk of adverse events [ Time Frame: 28 days following each malaria treatment ] [ Designated as safety issue: Yes ]
  • Prevalence of mutations known to confer resistance to antifolate drugs in pretreatment samples from patients diagnosed with malaria
  • Risk of adverse events
Not Provided
Not Provided
 
Interactions Between HIV and Malaria in African Children
Interactions Between HIV and Malaria in African Children

This is a prospective cohort study where HIV-infected and uninfected children will be enrolled between 6 weeks and 9 months of age and followed to the age of 21 months. All HIV-infected children will be given trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis as of 6 weeks of age. HIV-uninfected children born to HIV-infected mothers will be given TMP/SMX prophylaxis for the duration of breastfeeding and then randomized to the continuation of TMP/SMX or discontinuation of TMP/SMX prophylaxis. HIV-uninfected children born to HIV-uninfected mothers will not be given TMP/SMX prophylaxis. Study participants will be followed for all of their health care needs in a designated study clinic. All mother-child pairs will receive a basic care package including insecticide-treated bednets (ITNs) at enrollment. All HIV-infected mothers and children will receive antiretroviral therapy if eligible according to standardized World Health Organization (WHO) criteria. Study participants 4 months of age or older and at least 5 kg will be randomized to treatment with artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DP) at the time of their first diagnosis of uncomplicated malaria. Study participants will receive the same antimalarial treatment regimen for all future episodes of uncomplicated malaria. Study participants less than 4 months of age or less than 5 kg diagnosed with malaria and all episodes of complicated malaria will be treated with quinine in accordance with local guidelines.

The investigators will test the hypotheses that:

  1. TMP/SMX prophylaxis is highly effective in preventing malaria in both HIV-infected and HIV-uninfected children
  2. The use of TMP/SMX prophylaxis is associated with an increased risk of infection with malaria parasites containing antifolate resistance-conferring mutations.
  3. The use of antiretroviral (ARV) drugs is associated with a decreased incidence of malaria.
  4. The efficacy, safety, and tolerability of AL and DP for the treatment of uncomplicated malaria differ.

    In 2008, we received approval and funding to extend the trial until 2012. We are now following all children through 5 years of age. First randomization to continue or discontinue TMP/SMX prophylaxis in our HIV-exposed population occurs 6-8 weeks after cessation of breastfeeding when HIV status can be confirmed as negative by DNA PCR. A second randomization occurs at 2 years of age in our HIV-exposed participants. At that point all HIV-exposed children who were originally randomized to continue TMP/SMX prophylaxis are again randomized to either immediately discontinue TMP/SMX prophylaxis or continue prophylaxis until age 4 years. All children will be off TMP/SMX between 4 and 5 years of age.

    We have also added an additional hypothesis to test during the study extension:

  5. Prolonged TMP/SMX prophylaxis will result in an increased incidence of malaria in children in the year immediately following cessation of prophylaxis compared to children who have not used prophylaxis for over a year and those who have never been on prophylaxis.
Not Provided
Interventional
Phase 3
Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Factorial Assignment
Masking: Open Label
Primary Purpose: Treatment
  • Malaria
  • HIV Infections
  • Drug: Dihydroartemisinin-piperaquine
    Once daily for 3 days, given in fixed dose tablets (40 mg dihydroartemisinin + 320 mg piperaquine) according to weight-based guidelines
  • Drug: Artemether-lumefantrine
    Dosed twice daily for 3 days, given in fixed dose tablets (20 mg artemether + 120 mg lumefantrine) according to weight-based guidelines
  • Drug: Trimethoprim-sulfamethoxazole
    Once daily dosing according to weight based guidelines
  • Experimental: 1
    Treatment for episodes of uncomplicated malaria
    Intervention: Drug: Dihydroartemisinin-piperaquine
  • Active Comparator: 2
    Treatment for uncomplicated malaria
    Intervention: Drug: Artemether-lumefantrine
  • Experimental: A
    Prevention of malaria in HIV uninfected, exposed children
    Intervention: Drug: Trimethoprim-sulfamethoxazole
  • No Intervention: B
    Prevention of malaria in HIV uninfected, exposed children

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
351
March 2013
March 2013   (final data collection date for primary outcome measure)

Inclusion Criteria:

  1. Age 6 weeks to 9 months
  2. Documented HIV-1 status of mother and child
  3. Agreement to come to the study clinic for any febrile episode or other illness
  4. Agreement to avoid medications administered outside the study protocol
  5. Guardian age 18 years or older (no age limit for parents)
  6. Parent or guardian willing to provide informed consent
  7. Residence within a 30 km radius of the study clinic

Exclusion Criteria:

  1. HIV-exposed infants who have already stopped receiving TMP/SMX as a result of having stopped breastfeeding and having been tested HIV-negative before screening
  2. Intention to move more than 30 km from the study clinic during the follow-up period
  3. History of allergy or sensitivity to AL or DP or TMP/SMX
  4. Active medical problem requiring in-patient evaluation at the time of screening
Both
6 Weeks to 9 Months
Yes
Contact information is only displayed when the study is recruiting subjects
Uganda
 
NCT00527800
CDC- PEPFAR CoAg#U62P024421
No
University of California, San Francisco
University of California, San Francisco
  • Centers for Disease Control and Prevention
  • Makerere University
  • The AIDS Support Organization
Principal Investigator: Grant Dorsey, MD, PhD University of California, San Francisco
University of California, San Francisco
October 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP