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Antimalarial Pharmacology in Children and Pregnant Women in Uganda

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ClinicalTrials.gov Identifier: NCT01717885
Recruitment Status : Completed
First Posted : October 31, 2012
Last Update Posted : October 28, 2016
Sponsor:
Collaborator:
Information provided by (Responsible Party):

Study Description
Brief Summary:

The burden of malaria is greatest in children and pregnant women in sub-Saharan Africa. Malaria is one of the most important infectious diseases in the world. Uganda reports among the highest transmission intensities in the world. Children and pregnant women are the most vulnerable populations. HIV is also reported at high rates for these populations. If malaria and HIV require treatment at the same time, there is a high risk for drug-drug interactions. This study will:

  1. Determine if the use of anti-HIV medications including lopinavir/ritonavir (LPV/r), nevirapine (NVP) and efavirenz (EFV) will affect the pharmacokinetic (PK) exposure of antimalarial medications (specifically artemether-lumefantrine, AL) during the treatment for uncomplicated malaria in HIV-infected children and pregnant women, and
  2. Evaluate the impact of age and pregnancy on the PK exposure of AL.

Condition or disease
Malaria HIV

  Show Detailed Description

Study Design

Study Type : Observational
Actual Enrollment : 473 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Antimalarial Pharmacology in HIV Infected and Uninfected Children and Pregnant Women in Uganda
Study Start Date : August 2012
Primary Completion Date : December 2015
Study Completion Date : September 2016

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS Malaria
U.S. FDA Resources

Groups and Cohorts

Group/Cohort
HIV+children on LPV/r
HIV+ children who are stabilized on a LPV/r based ART regimen
HIV+ children on nevirapine
HIV+ children who are stabilized on an nevirapine based ART regimen
HIV+ children on efavirenz
HIV+ children who are stabilized on an efavirenz based ART regimen
HIV+ pregnant women on LPV/r
HIV+ pregnant women who are stabilized on an LPV/r based ART regimen
HIV+ pregnant women on NVP
HIV+ pregnant women who are stabilized on an nevirapine based ART regimen
HIV+ pregnant women on EFV
HIV+ pregnant women stabilized on an efavirenz based ART regimen
HIV negative children
HIV negative children that will serve as a control for HIV positive children on either a LPV/r, NVP or EFV based ART regimen and will be compared to HIV negative non-pregnant adults
HIV negative adults
HIV negative adults that will serve as a control for comparing results to HIV negative children and HIV negative pregnant women
HIV negative pregnant women
HIV negative pregnant women who will serve as a control for HIV positive pregnant women on either a LPV/r, NVP or EFV based ART regimen and will be compared to HIV negative non-pregnant adults


Outcome Measures

Primary Outcome Measures :
  1. Primary outcome measurement is the area under the plasma concentration versus time curve for all drug analytes. [ Time Frame: At time of the last dose of a 6 dose regimen and up to 42 days of F/U ]
    Pharmacokinetic exposure for the antimalarial medication is estimated through sparse or intensive blood sampling around the last dose and for several days following the last dose.


Secondary Outcome Measures :
  1. Malaria reinfection (recrudescence or new infection) [ Time Frame: From Day 0 to 42 days of F/U when using artemether-lumefantrine for uncomplicated malaria ]
    The association between PK exposure and malaria reinfection is the main secondary outcome.

  2. Parasite clearance rate [ Time Frame: Days 0 to 42 of follow-up ]
    To assess the relationship between artemisinin exposure and parasite clearance

  3. AL and ART toxicity [ Time Frame: Days 0 to 42 of follow-up ]
    To assess the relationship between artemether, lumefantrine and antiretroviral exposure and toxicity, particularly neutropenia


Biospecimen Retention:   Samples With DNA
Samples are for drug level measurements,parasite density. RNA samples are for host transcriptional and molecular markers of resistance. Samples are also retained for future use including possible genetic testing for drug metabolism variants

Eligibility Criteria

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Ages Eligible for Study:   6 Months and older   (Child, Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
HIV infected and uninfected children and pregnant women residing in Tororo, Uganda and receiving care at local health care facilities including the Tororo District Hospital (TDH), perinatal facilities, HIV clinics and the IDRC research clinic. HIV uninfected children, pregnant women and non-pregnant adults also enrolled through TDH, perinatal facilities or other area clinics. Each participant can enroll at the time they present to one of the clinics with uncomplicated malaria
Criteria

Inclusion Criteria:

ALL PARTICIPANTS

  1. Residency within 60 km of the study clinic
  2. Agreement to come to clinic for all follow-up clinical and PK evaluations
  3. Provision of informed consent

HIV-INFECTED PARTICIPANTS

Children:

1) Enrollment in Promote I or meets enrollment criteria and recruited from TDH/TASO or other referral site

  1. 6 months to 8 years of age
  2. Weight ≥6 kg
  3. Confirmed HIV infection (positive rapid HIV test to be confirmed by Western Blot or HIV RNA after enrollment)
  4. On a stable ART regimen for at least 10 days prior to enrollment
  5. If co-enrolled from PROMOTE, willingness to undergo intensive PK sampling during a single episode of uncomplicated malaria, and/or population PK/parasite clearance time studies during multiple episodes of uncomplicated malaria.
  6. If enrolled from TDH, willingness to undergo intensive PK sampling during a single episode of malaria or population PK/parasite clearance time studies during episodes of uncomplicated malaria.

Pregnant women

  1. Enrollment in Promote Project 2 or meets enrollment criteria and recruited from TDH/TASO or other referral site
  2. On a stable ART regimen for at least 10 days prior to enrollment
  3. Presentation with uncomplicated malaria at the time of enrollment
  4. Confirmed pregnancy (apparent pregnancy, positive pregnancy test or pregnancy by ultrasound)
  5. Confirmed HIV infection (positive rapid HIV test to be confirmed by Western Blot or HIV RNA after enrollment)
  6. 16 years of age or older
  7. Estimated gestational age between 12 and 38 weeks by last menstrual period and report of quickening
  8. Willingness to undergo intensive PK sampling during episodes of uncomplicated malaria during pregnancy.

HIV UNINFECTED PARTICIPANTS

Children:

  1. Enrollment from TDH or other referral site
  2. 6 months to 8 years of age
  3. Weight ≥6 kg
  4. Confirmed HIV negative test (negative rapid HIV test to be confirmed by Western Blot or HIV RNA after enrollment)
  5. Presentation with uncomplicated falciparum malaria as indicated by positive smear for malaria parasites along with clinical evidence of infection (fever or history of fever in the past 24 hours) with planned treatment with AL.

7) Willingness to undergo intensive PK sampling during a single episode of malaria or population PK/parasite clearance time studies during episodes of uncomplicated malaria.

Non-pregnant adults:

  1. Age ≥ 16 years
  2. Confirmed HIV negative test (negative rapid HIV test to be confirmed by Western Blot or HIV RNA after enrollment).
  3. Presentation with uncomplicated falciparum malaria as indicated by positive smear for malaria parasites along with clinical evidence of infection (fever or history of fever in the past 24 hours) with planned treatment with AL.
  4. Negative pregnancy test
  5. Willingness to undergo intensive PK sampling during treatment for a single episode of uncomplicated malaria

Pregnant women:

  1. Age ≥ 16 years
  2. Confirmed HIV negative test (negative rapid HIV test to be confirmed by Western Blot or HIV RNA after enrollment)
  3. Confirmed pregnancy (apparent pregnancy, positive pregnancy test or pregnancy by ultrasound)
  4. Estimated gestational age between 12 and 38 weeks by last menstrual period and report of quickening
  5. Presentation with uncomplicated malaria as indicated by positive smear for malaria parasites along with clinical evidence of infection (fever or history of fever in the past 24 hours) with planned treatment with AL.
  6. No evidence of imminent delivery or threatened abortion at the time of presentation with malaria.
  7. Willingness to undergo intensive PK sampling during episodes of uncomplicated malaria during pregnancy.

Exclusion Criteria:

  1. History of significant comorbidities such as malignancy, active tuberculosis or other WHO stage 4 disease
  2. Current infection with non-falciparum species
  3. Receipt of any medications known to affect cytochrome p450 (CYP450) metabolism (except ART) within 14 days of study enrollment (see 4.2.2)
  4. Hemoglobin < 7.0 g/dL
  5. Prior treatment for malaria within 14 days of study enrollment (intensive PK study participants only)
  6. Signs or evidence of complicated malaria, defined as unarousable coma OR ANY TWO OF THE FOLLOWING SYMPTOMS: Recent febrile convulsions, altered consciousness, lethargy, unable to drink, unable to stand/sit due to weakness, severe anemia (Hb < 5.0 gm/dL), respiratory distress, jaundice
Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01717885


Locations
Uganda
IDRC- Tororo Research Clinic and Tororo District Hospital
Tororo, Uganda
Sponsors and Collaborators
University of California, San Francisco
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Investigators
Study Director: Francesca T Aweeka, Pharm.D. University of California, San Francisco
Principal Investigator: Sunil Parikh, MD MPH Yale University
Principal Investigator: Norah Mwebaza, MBChB, MSc Makerere University
Principal Investigator: Myaing Nyunt, MD PhD Johns Hopkins University
More Information

Publications:
Responsible Party: University of California, San Francisco
ClinicalTrials.gov Identifier: NCT01717885     History of Changes
Other Study ID Numbers: 10-04798
R01HD068174 ( U.S. NIH Grant/Contract )
First Posted: October 31, 2012    Key Record Dates
Last Update Posted: October 28, 2016
Last Verified: October 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Keywords provided by University of California, San Francisco:
Pharmacokinetics
Antimalarial
HIV
Antiretrovirals
Childhood development
Pregnancy

Additional relevant MeSH terms:
Efavirenz
Nevirapine
Antimalarials
Reverse Transcriptase Inhibitors
Nucleic Acid Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Anti-Retroviral Agents
Antiviral Agents
Anti-Infective Agents
Cytochrome P-450 CYP2C9 Inhibitors
Cytochrome P-450 Enzyme Inhibitors
Cytochrome P-450 CYP2C19 Inhibitors
Cytochrome P-450 CYP2B6 Inducers
Cytochrome P-450 Enzyme Inducers
Cytochrome P-450 CYP3A Inducers
Anti-HIV Agents
Antiprotozoal Agents
Antiparasitic Agents