Trial to Evaluate PRO 2000/5 Gels for the Prevention of Vaginally Acquired HIV Infection

This study has been completed.
Sponsor:
Collaborators:
Medical Research Council
Department for International Development, United Kingdom
Information provided by (Responsible Party):
Endo Pharmaceuticals
ClinicalTrials.gov Identifier:
NCT00262106
First received: December 5, 2005
Last updated: September 5, 2012
Last verified: September 2012
  Purpose

The objective of the study is to determine the efficacy and safety of 0.5% and 2% PRO 2000/5 gels compared to placebo in preventing vaginally acquired HIV infection.


Condition Intervention Phase
HIV Infections
Gonorrhea
Chlamydial Infections
Genital Herpes
Drug: PRO 2000/5
Drug: Placebo
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Prevention
Official Title: An International Multi-centre, Randomised, Double-blind, Placebo-controlled Trial to Evaluate the Efficacy and Safety of 0.5% and 2% PRO 2000/5 Gels for the Prevention of Vaginally Acquired HIV Infection

Resource links provided by NLM:


Further study details as provided by Endo Pharmaceuticals:

Primary Outcome Measures:
  • Acquisition of HIV infection before or at the 12 month time point, confirmed in a central laboratory, in participants confirmed to be HIV negative at enrollment [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]
  • Grade 3 (severe) or 4 (life-threatening) clinical or laboratory adverse event confirmed on examination or repeat testing, respectively [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Acquisition of HIV infection before or at the 6, 9, or beyond 12 month time points, confirmed in a central laboratory, in participants confirmed to be HIV negative at enrollment [ Time Frame: 6, 9 and 12 months ] [ Designated as safety issue: Yes ]
  • HSV-2 incidence rates by the 9 month time point in participants uninfected at enrollment. Although prevalence rates are high, 75% - 85% in some sites, data from feasibility studies indicate that incidence rates are also likely to be high [ Time Frame: 9 months ] [ Designated as safety issue: Yes ]
  • HSV-2 incidence rates by the 12 month time point in participants uninfected at enrolment. Although prevalence rates are high, 75% - 85% in some sites, data from feasibility studies indicate that incidence rates are also likely to be high [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]
  • Cross-sectional prevalence of Neisseria gonorrhoeae at 24 weeks, determined by a positive nucleic acid amplification assay [ Time Frame: 24 weeks/6 months ] [ Designated as safety issue: Yes ]
  • Cross-sectional prevalence of Chlamydia trachomatis at 24 weeks, determined by a positive nucleic acid amplification assay [ Time Frame: 24 wks/6 months ] [ Designated as safety issue: Yes ]

Enrollment: 9404
Study Start Date: October 2005
Study Completion Date: September 2009
Primary Completion Date: August 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Placebo Comparator: Placebo
placebo
Drug: Placebo
Placebo
Other Name: placebo
Active Comparator: PRO 2000/5 Gel 0.5%
PRO 2000/5 Gel 0.5%
Drug: PRO 2000/5
Gel

Detailed Description:

The HIV pandemic continues with an estimated 13,000 new infections each day, the vast majority of which are acquired through heterosexual intercourse. Although consistent and correct use of condoms by men remains the most effective form of protection from heterosexually acquired HIV, women are not always able to negotiate condom use. An effective prophylactic vaccine remains a key objective, but development is slow because of virus variability and difficulty in determining the immunological correlates of protection. Vaginal microbicides are being developed in response to the urgent need for an HIV prevention method that women can control. Licensed spermicides containing nonoxynol-9 (N-9), which has potent anti-HIV activity in vitro, were the first products to be investigated as potential microbicides. However, the association of N-9 and other products belonging to this class (surfactants) with genital epithelial disruption, histologically determined genital inflammation, and reduction in populations of vaginal lactobacilli led to concerns that their use could enhance the risk of HIV transmission. Early Phase 3 studies of N-9 products yielded conflicting results, but more recently, a multicenter randomized placebo-controlled trial of a low dose N-9 formulation demonstrated an increased incidence of HIV infection in the N-9 group compared to placebo. These findings have intensified efforts to develop agents with a more favorable toxicity profile. At least four of these have entered trials to assess effectiveness in preventing vaginally acquired HIV infection: Buffer Gel, Carraguard, cellulose sulfate and PRO 2000/5 Gel. Protocol MDP 301 describes a randomized placebo-controlled trial design to explore the safety and efficacy of two concentrations of PRO 2000/5 Gel.

Participant recruitment and follow-up is complete. Between October 2005 and August 2008, 9404 eligible, sexually active, HIV-uninfected women were enrolled at six or more sites in Africa. Up until February 2008, participants were randomly assigned to 0.5% or 2% PRO 2000/5 Gel treatment arms or a placebo gel arm. Following a recommendation by the Independent Data Monitoring Committee that the 2% PRO2000/5 Gel treatment arm should not continue as there was no more than a small chance of demonstrating benefit, participants enrolled after February 13, 2008 were randomly assigned to the 0.5% PRO 2000/5 gel treatment arm or placebo arm. Participants were instructed to apply a single dose of study gel 1 hour or less before every act of vaginal intercourse using a single-use pre-filled applicator. Participants also receive risk-reduction counseling and condoms, and STD testing. Most study participants were followed for 12 months. A cohort of sero-discordant couples enrolled in Uganda was followed for up to 24 months.

The primary efficacy outcome measure is acquisition of HIV infection at the 12 month time point. Secondary outcomes include measures of HIV infection at the 6, 9 and more than 12 month time points, infection by HSV-2, Neisseria gonorrhoeae, Chlamydia trachomatis, and adverse events.

  Eligibility

Ages Eligible for Study:   16 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Women aged 16 years and above at enrolment in Masaka and Mwanza, or aged 18 years and above at enrolment in the South African and Zambian sites
  • Likely to be sexually active at entry and during follow-up
  • Willing to undergo HIV testing at screening and approximately 12 weekly intervals, and additionally, if required, to determine HIV status
  • HIV negative at screening according to the local HIV testing algorithm
  • Willing to receive the HIV result before randomization
  • Willing to use study gel as instructed
  • Willing to undergo regular speculum examinations and genital infection screens
  • Willing to have regular urine pregnancy tests
  • Willing to receive health education about condoms
  • Willing and able to give informed consent

Exclusion Criteria:

  • Unable or unwilling to provide a reliable method of contact for the field team
  • Likely to move permanently out of the area within the next year
  • Likely to have sex more than 14 times a week on a regular basis during the course of follow-up
  • Using spermicides regularly
  • Pregnant or within 6 weeks postpartum at enrollment
  • Has Grade 3 clinical or laboratory abnormalities which are considered by the clinician or the Trial Management Group to make enrollment inadvisable
  • Requires referral for assessment of a clinically suspicious cervical lesion
  • Treatment to the cervix, or to the womb through the cervix, within 30 days of enrolment
  • Known latex allergy
  • Participating, or has participated within 30 days of enrolment, in a clinical trial of an unlicensed product, microbicide, barrier method, or any other intervention likely to impact on the outcome of this trial
  • Considered unlikely to be able to comply with the protocol
  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: NCT00262106

Locations
South Africa
Reproductive Health and HIV Research Unit, Chris Hani Baragwanath Hospital
Bertsham, South Africa, 2013
Africa Centre for Health and Population Studies
Mtubatuba, South Africa, 3935
HIV Prevention Research Unit, Medical Research Council
Westville, South Africa, 3630
Tanzania
AMREF Lake Zone Programme
Mwanza, Tanzania
Uganda
MRC Programme on AIDS in Uganda, Uganda Virus Research Institute
Entebbe, Uganda
Zambia
MDP Zambia, Nakambala Sugar Estate
Mazabuka, Zambia
Sponsors and Collaborators
Endo Pharmaceuticals
Medical Research Council
Department for International Development, United Kingdom
Investigators
Principal Investigator: Sheena McCormack, MBBS, MSc, FRCP MRC Clinical Trials Unit
  More Information

Additional Information:
Publications:
Responsible Party: Endo Pharmaceuticals
ClinicalTrials.gov Identifier: NCT00262106     History of Changes
Other Study ID Numbers: MDP301, ISRCTN64716212
Study First Received: December 5, 2005
Last Updated: September 5, 2012
Health Authority: United States: Food and Drug Administration

Keywords provided by Endo Pharmaceuticals:
Administration, intravaginal
Anti-infective agents
Double blind method
Drug evaluation
Female
Gels
HIV infections/prevention and control
Microbicide
Naphthalenesulfonates/administration and dosage
Polymers/administration and dosage
Sexual behavior
Vaginal creams, foams and jellies
HIV Seronegativity
Genital Herpes Infections

Additional relevant MeSH terms:
Acquired Immunodeficiency Syndrome
Chlamydia Infections
Communicable Diseases
Herpes Genitalis
HIV Infections
Infection
Bacterial Infections
Chlamydiaceae Infections
DNA Virus Infections
Genital Diseases, Female
Genital Diseases, Male
Gram-Negative Bacterial Infections
Herpes Simplex
Herpesviridae Infections
Immune System Diseases
Immunologic Deficiency Syndromes
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Sexually Transmitted Diseases
Sexually Transmitted Diseases, Bacterial
Sexually Transmitted Diseases, Viral
Slow Virus Diseases
Virus Diseases

ClinicalTrials.gov processed this record on October 30, 2014