Prevention of Pregnancy-associated Malaria in HIV-infected Women: Cotrimoxazole Prophylaxis Versus Mefloquine (PACOME)
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| ClinicalTrials.gov Identifier: NCT00970879 |
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Recruitment Status :
Completed
First Posted : September 3, 2009
Last Update Posted : January 23, 2013
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| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Malaria in Pregnancy HIV Infections | Drug: cotrimoxazole Drug: mefloquine | Phase 3 |
Malaria infection during pregnancy can have adverse effects on both mother and fetus, including maternal anaemia and low birth weight which are responsible for mother and infant mortality. It is a particular problem for women in their first and second pregnancies and for women who are HIV-positive. Maternal HIV infection potentiates many of these adverse effects. In HIV-infected women, the World Health Organization (WHO) advocates the use of insecticide-treated bednets, and drugs : If the CD4 cell count is below 350/mm3 or the HIV disease is in WHO stage 2, 3 or 4, cotrimoxazole prophylaxis for the prevention of pneumocystosis and toxoplasmosis is indicated, that is assumed to also protect those women from malaria. Otherwise, they have to receive at least three doses of intermittent preventive treatment (IPT), most commonly with sulfadoxine-pyrimethamine (SP) given at the antenatal care visits. If IPT with SP has been a subject of many investigations, cotrimoxazole efficacy has never been assessed in prevention of malaria during pregnancy.
The investigators aim to evaluate the efficacy of cotrimoxazole prophylaxis in prevention of malaria during pregnancy in HIV-infected women. The investigators postulate that cotrimoxazole prophylaxis is not inferior to IPT in all women, unrelated to their CD4 cell count. In the control arm, the investigators will use mefloquine as IPT. The safety and efficacy of this drug have already been assessed in HIV-negative patients (NCT00274235).
A randomized controlled trial will be conducted in five hospitals in Benin. Pregnant women will be enrolled both in the Antenatal Care unit and in the Infectious Diseases unit of each setting. All women will receive insecticide-treated bednets at enrolment. Randomization will be stratified by hospital and CD4 cell count range. Women assigned to cotrimoxazole will receive cotrimoxazole prophylaxis daily during all the course of pregnancy. Women assigned to mefloquine IPT will receive mefloquine three times during pregnancy. Women randomised in this arm and having a low CD4 cell count or an advanced HIV disease will also receive cotrimoxazole prophylaxis in prevention of HIV/AIDS opportunistic infections. Drug efficacy will be judged on the prevalence of placental malaria at delivery.
This study will contribute to updating the recommendations concerning the prevention of malaria during pregnancy in HIV-infected women.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 430 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Prevention |
| Official Title: | Prevention of Pregnancy-associated Malaria in HIV-infected Women : Randomised Controlled Trial Testing Cotrimoxazole Prophylaxis Versus Intermittent Preventive Treatment With Mefloquine |
| Study Start Date : | December 2009 |
| Actual Primary Completion Date : | July 2012 |
| Actual Study Completion Date : | December 2012 |
| Arm | Intervention/treatment |
|---|---|
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Experimental: cotrimoxazole (high)
CD4 cell count≥350/mm3
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Drug: cotrimoxazole
800 mg sulfamethoxazole and 160 mg trimethoprim daily, from 28 weeks of gestation until delivery |
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Active Comparator: mefloquine
CD4 cell count≥350/mm3
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Drug: mefloquine
mefloquine 15 mg/Kg three times, between 16 and 28 weeks, 24 and 32 weeks, then 28 and 36 weeks of pregnancy |
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Experimental: cotrimoxazole (low)
CD4 cell count<350/mm3
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Drug: cotrimoxazole
800 mg sulfamethoxazole and 160 mg trimethoprim daily, from 28 weeks of gestation until delivery |
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Active Comparator: mefloquine & cotrimoxazole
CD4 cell count<350/mm3
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Drug: cotrimoxazole
800 mg sulfamethoxazole and 160 mg trimethoprim daily, from 28 weeks of gestation until delivery Drug: mefloquine mefloquine 15 mg/Kg three times, between 16 and 28 weeks, 24 and 32 weeks, then 28 and 36 weeks of pregnancy |
- proportion of placental malaria (presence of parasites in the placental blood smear at delivery) [ Time Frame: delivery ]
- placental malaria mean parasite density at delivery [ Time Frame: delivery ]
- proportion of low birth weight infants (<2500 g) and mean birth weight [ Time Frame: delivery ]
- proportion of maternal anaemia (<11g/dl) and severe maternal anaemia (<8g/dl) at delivery and during pregnancy [ Time Frame: course of pregnancy and delivery ]
- cord blood malaria infection at delivery (infant parasitemia) [ Time Frame: delivery ]
- pre-term deliveries (< 37 weeks) [ Time Frame: delivery ]
- spontaneous abortions (early:<28 weeks, late: ≥28 weeks) and still births [ Time Frame: course of pregnancy ]
- congenital anomalies [ Time Frame: first 6 months of life ]
- safety profile of the two treatments: proportion and detailed description of adverse effects in each treatment arm [ Time Frame: course of pregnancy (mother) anf first 6 months of life (infant) ]
- Mother-to-child HIV transmission rate in each treatment arm [ Time Frame: 2 months after breastfeeding cessation ]
- To document the effect of cotrimoxazole in reducing infections in HIV-infected women, we will measure the incidence of bacterial and parasitic infections (other than malaria) during pregnancy [ Time Frame: course of pregnancy ]
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| Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
| Sexes Eligible for Study: | Female |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Confirmed HIV seropositivity
- Permanent residency in the study catchment's area
- Confirmed pregnancy, gestational age< 28 weeks
- More than 18 years of age
- Karnofsky index ≥80
- Willingness to deliver at the hospital
- Written informed consent
Exclusion Criteria:
- History of allergy to study drugs : sulpha drugs, mefloquine, quinine
- History or presence of major illnesses : severe renal disease , severe hepatic disease, severe neuropsychiatric disease
- Mefloquine or halofantrine received within the 4 weeks prior to enrolment
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): NCT00970879
| Benin | |
| Hôpital d'Instruction des Armées Camp Guézo | |
| Cotonou, Benin | |
| Hôpital de la Mère et de l'Enfant Lagune | |
| Cotonou, Benin | |
| Hôpital de zone de Suru Lere | |
| Cotonou, Benin | |
| Unviversity Hospital Hubert Koutoukou Maga | |
| Cotonou, Benin | |
| Clinique Louis Pasteur | |
| Porto-Novo, Benin | |
| Principal Investigator: | Marcel D Zannou, Professor | Cotonou University Hospital & Faculté des Sciences de la Santé, Benin | |
| Study Chair: | Pierre-Marie Girard, Professor | Saint Antoine Hospital, Assistance Publique-Hôpitaux se Paris | |
| Study Director: | Michel Cot, MD, PHD | Institut de Recherche pour le Developpement |
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | Lise Denoeud-Ndam, MD, MPH, Institut de Recherche pour le Developpement |
| ClinicalTrials.gov Identifier: | NCT00970879 History of Changes |
| Other Study ID Numbers: |
IRD-Sidaction-01 |
| First Posted: | September 3, 2009 Key Record Dates |
| Last Update Posted: | January 23, 2013 |
| Last Verified: | January 2013 |
Keywords provided by Lise Denoeud-Ndam, Institut de Recherche pour le Developpement:
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malaria pregnancy HIV |
prevention cotrimoxazole mefloquine |
Additional relevant MeSH terms:
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HIV Infections Malaria Lentivirus Infections Retroviridae Infections RNA Virus Infections Virus Diseases Sexually Transmitted Diseases, Viral Sexually Transmitted Diseases Immunologic Deficiency Syndromes Immune System Diseases Protozoan Infections |
Parasitic Diseases Mefloquine Trimethoprim, Sulfamethoxazole Drug Combination Antimalarials Antiprotozoal Agents Antiparasitic Agents Anti-Infective Agents Anti-Infective Agents, Urinary Renal Agents Anti-Bacterial Agents |