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Pediatric Urgent Start of Highly Active Antiretroviral Treatment (HAART) (PUSH)

This study has been completed.
University of Nairobi
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Information provided by (Responsible Party):
Grace John-Stewart, University of Washington Identifier:
First received: August 21, 2012
Last updated: November 30, 2015
Last verified: November 2015

Design: Randomized clinical trial involving hospitalized HIV-1 infected children. Children will be randomized to randomized to urgent (<48 hours) versus early antiretroviral therapy (7-14 days). This trial will be unblinded.

Population: Hospitalized HIV-1 infected children who are antiretroviral therapy (ART) naïve ≤ 12 years of age.

Sample size: 360 children will be randomized (180 per arm).

Treatment: All infants will be treated with ART according to World Health Organization (WHO) and Kenyan national guidelines.

Study duration: Enrollment into the study will occur over the course of 36-48 months and each infant will be routinely followed for a maximum of 6 months.

Study site: Kenyan hospitals.

Primary hypothesis:

HIV-1 infected children hospitalized with severe co-infection either may be unsalvageable due to too far advanced immunosuppression/co-infection or may benefit from urgent ART.

Secondary hypotheses:

Urgent ART during an acute infection could potentially result in increased risk of immune reconstitution inflammatory syndrome (IRIS) or drug toxicities/interactions.

Specific aims:

  1. To compare the 6 month all-cause mortality rate, incidence of immune reconstitution inflammatory syndrome (IRIS), and incidence of drug toxicity in HIV-1 infected children (≤ 12 years old) presenting to hospital with a serious infection randomized to urgent (<48 hours) versus early ART (7-14 days).
  2. To determine co-factors for mortality, IRIS, and drug toxicity. Potential cofactors will include: baseline weight-for-age, height-for-age, weight-for-height (Z-scores), CD4, HIV-1 RNA, type of co-infection, age, rate of viral load and CD4 change following ART, immune activation markers, pathogen and HIV-1 specific immune responses.

Secondary aim: To determine etiologies of IRIS and to compare immune reconstitution to HIV, TB, EBV and CMV following ART overall and in each trial arm.

Condition Intervention
Human Immunodeficiency Virus
Immune Reconstitution Inflammatory Syndrome
Other: Urgent ART
Other: Early ART

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Urgent Versus Post-Stabilization ART in HIV-1 Infected Children With Severe Co-Infections

Resource links provided by NLM:

Further study details as provided by University of Washington:

Primary Outcome Measures:
  • All-cause mortality [ Time Frame: 6 months post-HAART initiation ]

Secondary Outcome Measures:
  • Immune Reconstitution and Inflammatory Syndrome (IRIS) [ Time Frame: 6 months post-HAART initiation ]
  • Drug toxicity [ Time Frame: 6 months post-HAART initiation ]

Enrollment: 185
Study Start Date: March 2013
Study Completion Date: November 2015
Primary Completion Date: November 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Urgent ART

Initiation of highly active antiretroviral therapy (HAART) within 48 hours of enrollment.

Antiretroviral therapy will include regimens recommended by the Kenyan Ministry of Health.

Other: Urgent ART
Children will be started on HAART <48 hours after enrollment.
Other Name: HAART regimens recommended by WHO and Kenya MOH.
Active Comparator: Early ART
Initiation of HAART 7-14 days after enrollment.
Other: Early ART
Children will be started on ART after stabilization 7-14 days after enrollment.

Detailed Description:
Children will be followed and compared for 6-month mortality.

Ages Eligible for Study:   up to 12 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Aged ≤ 12 years old (reported)
  • HIV-1 positive (for example, two rapid HIV-1 antibody tests for children >18 months and not breastfeeding, or one HIV-1 DNA/RNA test for children ≤18 months or who are breastfeeding)
  • Not currently receiving antiretroviral therapy (history of pMTCT does not affect eligibility)
  • Eligible to receive ART, according to current WHO guidelines
  • Caregiver plans to reside in study catchment area for at least 6 months (reported)
  • Caregiver provides sufficient locator information

Exclusion Criteria:

  • Suspected meningitis, any other central nervous system infection, or encephalitis
  Contacts and Locations
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Please refer to this study by its identifier: NCT02063880

Kisumu, Kenya
Kisumu District Hospital
Kisumu, Kenya
Mbagathi District Hospital
Nairobi, Kenya, 0202
Kenyatta National Hospital
Nairobi, Kenya
Sponsors and Collaborators
University of Washington
University of Nairobi
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Principal Investigator: Grace John Stewart, MD, PhD University of Washington
  More Information

Responsible Party: Grace John-Stewart, Professor, Global Health, University of Washington Identifier: NCT02063880     History of Changes
Other Study ID Numbers: 41540-D
2R01HD023412-21 ( US NIH Grant/Contract Award Number )
Study First Received: August 21, 2012
Last Updated: November 30, 2015

Keywords provided by University of Washington:

Additional relevant MeSH terms:
Immunologic Deficiency Syndromes
Acquired Immunodeficiency Syndrome
HIV Infections
Immune Reconstitution Inflammatory Syndrome
Immune System Diseases
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Slow Virus Diseases processed this record on April 25, 2017