Optimizing Pediatric HIV-1 Treatment, Nairobi, Kenya - Full Text View

Purpose

Given the high mortality associated with infant HIV-1 and the fact that surrogate markers are poorly predictive of mortality risk,empiric highly active antiretroviral therapy (HAART) initiation is started in infants younger than 12 months. A problem with this approach is that it obligates infants to life-long therapy, which may be associated with cumulative drug toxicity, poor adherence, and treatment failure. Early HAART for prevention of mortality during the first 2 years of life has potential to salvage immune function and alter viral set-point, allowing withdrawal of therapy, perhaps for several years, until subsequent CD4% decline requires it. This untested approach is attractive because it combines the survival benefits of early pediatric HAART therapy with the benefits of antiretroviral deferral.

One hundred and fifty infants who initiated HAART at <13 months of age will be treated with HAART regimen for 24 months after which those who have immune reconstitution and adequate growth (~100) will be randomized to continued versus deferred therapy. Clinical outcomes, growth, and toxicity will be compared in these children to determine if interruption is a safe and beneficial strategy. Follow-up in this studies will be closely monitored by an external Data Safety and Monitoring Board (DSMB).

Condition	Intervention
HIV Infections	Drug: HAART


Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	Optimizing Pediatric HIV-1 Treatment, Nairobi, Kenya (0-4.5 Month Randomized Controlled Trial)

Resource links provided by NLM:

MedlinePlus related topics: HIV/AIDS

U.S. FDA Resources

Further study details as provided by University of Washington:

Primary Outcome Measures:

Growth at 18 Months Post-randomization [ Time Frame: 18 months of post-randomization follow-up ] [ Designated as safety issue: Yes ]
Weight and height will be transformed to the weight-for-age Z-score (i.e., WAZ) and height-for-age Z-score (i.e., HAZ) using World Health Organization Child Growth Standards, taking into account the infant's age and gender.

Secondary Outcome Measures:

Morbidity [ Time Frame: 18 months post-randomization ] [ Designated as safety issue: Yes ]
severe adverse events including death, pneumonia, diarrhea, and other adverse events


Enrollment:	140
Study Start Date:	September 2007
Study Completion Date:	December 2014
Primary Completion Date:	July 2013 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
No Intervention: Interrupted HAART After 24 months of treatment with HAART, half the eligible infants will be randomized to interrupted treatment and followed for 18 months.
Active Comparator: Continued HAART After 24 months of treatment with HAART, half the eligible infants will be randomized to continued treatment with HAART for 18 months.	Drug: HAART Combination first line antiretrovirals as previously described.

Detailed Description:

Hypothesis: Deferring antiretroviral therapy in infants who have immune reconstitution and adequate growth following early therapy of primary infection (initiated HAART during primary infection at less than 13 months of age) will not compromise clinical status or growth and may spare antiretroviral toxicity.

Specific Aim/Primary Objective: To compare growth and morbidity in infants (who initiated HAART during primary infection at less than or equal to 13 months of age with subsequently normalized CD4% and growth following 24 months of HAART) randomized to deferred versus continuous therapy and followed for an additional 18 months.

Secondary Aim/Secondary Objective: To determine predictors of non-progression of HIV among the infants, including: age, adherence, HIV-1 specific immune responses, baseline HIV-1 RNA, CD4 percent and immune activation.

Design: Randomized clinical trial involving HIV-1 treatment of infants (<13 months old) for 24 months, followed by randomization and 18 months follow-up of children randomized to continued versus deferred treatment. This trial is unblinded.

Population: HIV-1 infected infants (<13 months) newly initiating HAART and HIV-1 infected infants already receiving HAART who initiated HAART at age <13 months will be enrolled. After 24 months of treatment follow-up, children with CD4% > 25% and normalized growth will be retained in the study and randomized.

Sample size: 150 infants will be enrolled of which 100 are expected to be eligible for randomization (50 in each arm).

Treatment: All infants will be treated with HAART according to WHO and Kenyan national guidelines. The specific regimens that will be used as a part of this study are:

First line regimen

AZT/3TC/NVP (zidovudine/lamivudine/nevirapine)
d4T/3TC/NVP (stavudine/lamivudine/nevirapine)
AZT/3TC/ABC (zidovudine/lamivudine/abacavir)
d4T/3TC/ABC (stavudine/lamivudine/abacavir)
ABC/3TC/NVP (abacavir/lamivudine/nevirapine)

Second line regimen - ddI/ABC/LPV/r (didanosine/abacavir/lopinavir-ritonavir (Kaletra))

For infants with prior exposure to nevirapine as part of PMTCT:

First line regimen

- AZT/3TC/LPV/r (zidovudine/lamivudine/lopinavir-ritonavir (kaletra))

Eligibility


Ages Eligible for Study:	up to 54 Months (Child)
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

A. Infants newly initiating HAART

Less than 13 months of age
HIV-1 DNA detection with confirmation (positive on two HIV-1 DNA filter paper tests)
Caregiver of infant plans to reside in Nairobi for at least 3 years (reported by caregiver)
Caregiver is able to provide sufficient location information

B. Infants already receiving HAART

Initiated HAART at <13 months of age
Records confirming HIV positive status
Documentation of CD4% and weight prior to HAART initiation
Must be on 1st line drug regimen

Eligibility for randomization:

Completed 24 months of treatment with HAART
Normalized growth: weight for height z-score (WHZ) > -0.5; Child's weight must be above the 5th weight-for-age percentile and the weight curve must not be flat or falling (i.e. cross 2 major percentile lines or more over the past 3 months)
CD4% > 25
Children who recently initiated or who require anti-tuberculosis treatment at the time of randomization will be ineligible for randomization.

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: NCT00428116

Sponsors and Collaborators

University of Washington

Fred Hutchinson Cancer Research Center

University of Nairobi

Investigators


Principal Investigator:	Dalton Wamalwa, MMed, MPH	Department of Paediatrics and Child Health, Kenyatta National Hospital, University of Nairobi
Principal Investigator:	Grace C John-Stewart, MD, PhD	University of Washington

More Information


Responsible Party:	Grace John-Stewart, Professor, University of Washington
ClinicalTrials.gov Identifier:	NCT00428116 History of Changes
Other Study ID Numbers:	30201-D 2R01HD023412-16 06-1885-D 02
Study First Received:	January 22, 2007
Results First Received:	June 8, 2015
Last Updated:	July 24, 2015
Health Authority:	United States: Institutional Review Board

Keywords provided by University of Washington:


HIV-1 Pediatric HAART Treatment Naive

Additional relevant MeSH terms:


HIV Infections Lentivirus Infections Retroviridae Infections RNA Virus Infections Virus Diseases	Sexually Transmitted Diseases, Viral Sexually Transmitted Diseases Immunologic Deficiency Syndromes Immune System Diseases

ClinicalTrials.gov processed this record on September 27, 2016