Trizivir Vs. Kaletra and Combivir for the Prevention of Mother-to-Child Transmission of HIV

This study has been completed.
Sponsor:
Collaborator:
Harvard School of Public Health
Information provided by (Responsible Party):
National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier:
NCT00270296
First received: December 22, 2005
Last updated: November 7, 2012
Last verified: November 2012
  Purpose

Anti-HIV drug regimens have dramatically improved the rates of prevention of mother-to-child transmission (MTCT) of HIV in developed countries. However, little is known of the effectiveness of such regimens in developing countries, such as Botswana. This study will determine whether Trizivir (TZV), a single pill containing abacavir sulfate, lamivudine, and zidovudine (ABC/3TC/ZDV), or lopinavir/ritonavir (LPV/r) and lamivudine/zidovudine (3TC/ZDV) is more effective in reducing HIV-1 viral load and preventing MTCT among HIV infected pregnant women in Botswana.


Condition Intervention Phase
HIV Infections
Drug: Trizivir
Drug: Lamivudine/Zidovudine
Drug: Lopinavir/Ritonavir
Drug: Nevirapine
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver)
Primary Purpose: Prevention
Official Title: Lopinavir/Ritonavir/Combivir vs. Abacavir/Zidovudine/Lamivudine for Virologic Efficacy and the Prevention of Mother-to-Child HIV Transmission Among Breastfeeding Women With CD4 Counts Greater Than or Equal to 200 Cells/mm3 in Botswana

Resource links provided by NLM:


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

Primary Outcome Measures:
  • Virologic suppression [ Time Frame: Throughout study ] [ Designated as safety issue: No ]
  • Infant's HIV status [ Time Frame: Throughout study ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • HIV-1 RNA levels in plasma and breast milk [ Time Frame: At study entry and Months 1, 3, and 5 ] [ Designated as safety issue: No ]
  • HIV-1 DNA levels in breast milk [ Time Frame: At Months 1, 3, and 5 ] [ Designated as safety issue: No ]
  • Time from randomization to the first adverse event requiring discontinuation of any of the drugs that formed the initial regimen by treatment arm and compared to Mashi study [ Time Frame: Throughout study ] [ Designated as safety issue: No ]
  • Time from randomization to the first Grade 3 or higher adverse event by treatment arm and compared to Mashi study [ Time Frame: Throughout study ] [ Designated as safety issue: Yes ]
  • Occurrence of Grade 3 or higher adverse events by type, grade, body system, and association with study treatment compared to Mashi study [ Time Frame: Throughout study ] [ Designated as safety issue: Yes ]
  • Premature birth and very premature birth, defined as 37 and 32 weeks gestation or less, respectively [ Time Frame: At study entry ] [ Designated as safety issue: No ]
  • Low birth weight and very low birth weight, defined as less than 2,500 g and less than 1,500 g, respectively [ Time Frame: At study entry ] [ Designated as safety issue: No ]
  • Growth and developmental delay, defined as standard norms and neurodevelopmental screening [ Time Frame: Throughout study ] [ Designated as safety issue: Yes ]
  • Maternal mortality [ Time Frame: Throughout study ] [ Designated as safety issue: Yes ]
  • Maternal morbidity, defined as occurrence of Grade 3 or 4 adverse events, hospitalizations, and AIDS-defining or AIDS-associated diagnoses [ Time Frame: Throughout study ] [ Designated as safety issue: Yes ]
  • Change in maternal CD4 count from baseline over time [ Time Frame: Through Month 24 ] [ Designated as safety issue: No ]
  • Infant mortality [ Time Frame: Throughout study ] [ Designated as safety issue: Yes ]
  • Comparison of neurodevelopment at 2 years of age in the Mashi study and this study [ Time Frame: Throughout study ] [ Designated as safety issue: No ]
  • Adherence, as measured by questionnaire and pill count [ Time Frame: Throughout study ] [ Designated as safety issue: No ]
  • Occurrence of HIV-1 RNA genetic mutations associated with viral resistance in maternal plasma and breast milk and infant plasma among transmitting mother-infant pairs at the nearest time to transmission [ Time Frame: Throughout study ] [ Designated as safety issue: No ]
  • Antiretroviral therapy (ARV) toxicities and viral load differences by maternal HLA type, for subset of up to 500 women with HLA-type available [ Time Frame: Throughout study ] [ Designated as safety issue: Yes ]
  • ARV concentrations in breast milk and serum and in their infants' serum for all transmitting mother-infant pairs and a matched group of nontransmitting pairs [ Time Frame: Throughout study ] [ Designated as safety issue: No ]

Enrollment: 730
Study Start Date: June 2006
Study Completion Date: September 2010
Primary Completion Date: March 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1A
Participants in Arm 1A will have CD4 counts of 200 cells/mm3 or more and will receive TZV twice daily. Once in labor, these participants will continue to take TZV twice daily and will also be given additional ZDV.
Drug: Trizivir
300 mg abacavir sulfate/150 mg lamivudine/300 mg zidovudine tablet taken orally twice daily
Other Name: TZV
Experimental: 1B
Participants in Arm 1B will have CD4 counts of 200 cells/mm3 or more and will receive LPV/RTV and 3TC/ZDV twice daily. Once in labor, these participants will continue to take TZV twice daily and will also be given additional ZDV.
Drug: Lamivudine/Zidovudine
150 mg lamivudine/300 mg zidovudine tablet taken orally twice daily
Other Names:
  • 3TC/ZDV
  • Combivir
Drug: Lopinavir/Ritonavir
400 mg lopinavir/100 mg ritonavir tablet taken orally twice daily
Other Name: LPV/RTV
Experimental: 2
Participants in Arm 2 will have CD4 counts less than 200 cells/mm3 and will receive NVP once daily for the first 14 days, then twice daily, and 3TC/ZDV twice daily; these women will be in the observational group.
Drug: Nevirapine
200 mg tablet taken orally daily for the first 14 days before receiving 200 mg tablet taken orally twice daily
Other Name: NVP

Detailed Description:

While perinatal HIV infection has become rare in developed countries through the use of highly active antiretroviral therapy (HAART), it remains a serious problem in developing countries. Botswana has a population of approximately 1.7 million; the prevalence of HIV in Botswana is about 37.4%. In the developed world, HAART has revolutionized the prevention of MTCT among nonbreastfed infants. This trial will compare the effectiveness of a protease inhibitor (PI)-based regimen versus a triple nucleoside reverse transcriptase inhibitor (NRTI)-based regimen in preventing MTCT of HIV.

This study will last up to 24 months for mothers and their children. Participants will be stratified based on their CD4 count at screening. Women with CD4 counts of 200 cells/mm3 or more will be in one of two treatment groups and will be randomly assigned to receive either TZV twice daily or LPV/RTV and 3TC/ZDV twice daily. Once in labor, treatment group participants will continue to take their assigned HAART regimen and will also be given additional ZDV. Women with CD4 counts less than 200 cells/mm3 will receive nevirapine (NVP) once daily for the first 14 days, then twice daily, and 3TC/ZDV twice daily; these women will be in the observational group.

Shortly after birth, infants will receive single-dose NVP. A 1-month supply of ZDV will be provided to the mother to administer daily to her child. Mothers will stop HAART at 6 months postpartum or when they stop breastfeeding, whichever occurs earlier. A clinical evaluation, blood collection, and HIV prevention counseling will occur at all maternal visits. An obstetrical exam and physical exam will occur at selected visits. Women will provide at least four samples of breast milk during the first 5 months postpartum. For infants, a clinical evaluation will occur at every visit, and a physical exam and blood collection will occur at selected visits.

  Eligibility

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria for Mothers:

  • HIV-infected
  • At least at 26th week of pregnancy (treatment group) or 18th week of pregnancy (observational group) but not beyond the 34th week of pregnancy
  • Able to complete study visits until at least 6 months postpartum
  • Citizen of Botswana

Exclusion Criteria for Mothers:

  • Taken ARVs for more than 1 week, other than ZDV, during current or prior pregnancy. Women who have received single-dose NVP in a prior pregnancy are not excluded.
  • Certain abnormal laboratory values
  • Plan to formula feed
  • Known fetal abnormalities that suggest the fetus will not survive to 6 months of gestational age
  • Known allergy or medical contraindication to any of the study drugs
  • Require certain medications
  • Previous participation in the "Prevention of Milk-Borne Transmission of HIV-1C in Botswana" (Mashi) study
  • Currently incarcerated
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00270296

Locations
Botswana
Princess Marina Hosp., BHP Study Clinic, Gaborone Shapiro CRS
Gabarone, Botswana
Athlone Hosp., BHP Study Clinic, Lobatse Shapiro CRS
Lobatse, Botswana
Deborah Reteif Hosp., BHP Study Clinic, Mochudi Shapiro CRS
Mochudi, Botswana
Scottish Livingstone Hosp., BHP Study Clinic, Molepolole Shapiro CRS
Molepolole, Botswana
Sponsors and Collaborators
Harvard School of Public Health
Investigators
Principal Investigator: Roger Shapiro, MD, MPH Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Botswana-Harvard School of Public Health Partnership for Research and Education
Principal Investigator: Claire Moffat, MD, MPH Department of Immunology and Infectious Diseases, Harvard School of Public Health, Botswana-Harvard School of Public Health Partnership for Research and Education
  More Information

Additional Information:
Publications:

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Responsible Party: National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier: NCT00270296     History of Changes
Other Study ID Numbers: BHP 016, 10430, U01 AI064002
Study First Received: December 22, 2005
Last Updated: November 7, 2012
Health Authority: United States: Food and Drug Administration

Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):
Treatment Naive
MTCT
HIV Seronegativity

Additional relevant MeSH terms:
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
Zidovudine
Nevirapine
Lamivudine
Lamivudine, zidovudine drug combination
Ritonavir
Lopinavir
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Reverse Transcriptase Inhibitors
Nucleic Acid Synthesis Inhibitors
Enzyme Inhibitors
Anti-Retroviral Agents
Antiviral Agents
Anti-Infective Agents
Therapeutic Uses
Anti-HIV Agents
HIV Protease Inhibitors
Protease Inhibitors

ClinicalTrials.gov processed this record on April 17, 2014