Using Nevirapine to Prevent Mother-to-Child HIV Transmission During Breastfeeding

January 24, 2023 updated by: National Institute of Allergy and Infectious Diseases (NIAID)

A Phase III Trial to Determine the Efficacy and Safety of an Extended Regimen of Nevirapine in Infants Born to HIV-Infected Women to Prevent Vertical HIV Transmission During Breastfeeding

The many benefits of breastfeeding are well documented. However, because of the risk of mother-to-child transmission (MTCT) of HIV from an HIV infected mother to her infant, there is considerable concern over the practice, especially in developing countries. The purpose of this study is to determine the safety and effectiveness of the anti-HIV drug nevirapine (NVP) in preventing MTCT of HIV in breastfeeding infants born to HIV infected women in South Africa, Tanzania, Uganda, and Zimbabwe.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Breastfeeding provides general health, growth, and development benefits to an infant and significantly decreases the risk of certain acute and chronic diseases. Breastfeeding also decreases financial burden on the mother by decreasing the need for infant formula and health care for the infant. However, clinical evidence has shown that HIV can be readily transmitted through breast milk, although the risk of HIV MTCT over time while breastfeeding has been difficult to determine. Given the many advantages of breastfeeding and the significant obstacles to substituting formula for breast milk in developing countries, there is an urgent need to make breastfeeding by HIV infected women safe. This study will evaluate the safety and efficacy of an extended NVP regimen for prevention of MTCT of HIV through breastfeeding.

This study will last approximately 3.5 years. Mother/infant pairs will be enrolled over a period of 18 to 24 months. During the third trimester of pregnancy, HIV infected participants will receive HIV counseling and the intrapartum/neonatal two-dose NVP prophylaxis regimen to prevent MTCT. Mothers will also be given infant feeding options counseling and information on administering the study drug to the infant. Infants who were randomly assigned to receive a placebo and older than 6 weeks of age as of 08/10/07 OR to receive NVP will continue their treatment assignment. Infants who were randomly assigned to receive a placebo and are 6 weeks of age or less as of 08/10/07 will receive open-label NVP through Day 42 of life. For all other participants, all randomized infants will receive extended NVP through 6 weeks (Day 42) of life. All eligible infants will be randomly assigned to one of two groups at Week 6 following birth. The first group will receive extended NVP treatment; the second group will receive nevirapine placebo. Randomized infants will receive the extended NVP or NVP placebo through the first 6 months of life or until cessation of breastfeeding, whichever occurs earlier. Mothers will be instructed to begin giving their infants their assigned intervention starting at Day 3 to Day 7 postpartum. All mothers and infants outside of the study will be offered the local standard of care antiretroviral (ARV) regimen for the prevention of MTCT, but these ARVs will not be provided by the study.

Follow-up evaluations will be conducted at Weeks 2 and 6 and Months 3, 6, 12, and 18 for mothers, and at Weeks 2, 5, 6, and 8 and Months 3, 4, 5, 6, 9, 12, and 18 for infants. Study visits will include physical examinations, blood tests (including HIV tests), and medical histories. Study participants will be followed for up to 3.5 years.

Study Type

Interventional

Enrollment (Actual)

2026

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • South Africa
    • KwaZulu-Natal
      • Umlazi, KwaZulu-Natal, South Africa
        • CAPRISA Umlazi CRS
  • Tanzania
      • Dar es Salaam, Tanzania
        • Muhimbili University of Health and Allied Sciences (MUHAS) CRS
  • Uganda
    • Mpigi
      • Kampala, Mpigi, Uganda
        • Makerere University- JHU Research Collaboration {MUJHU CARE LTD} CRS
  • Zimbabwe
      • Chitungwiza, Zimbabwe
        • St Mary's CRS
      • Chitungwiza, Zimbabwe
        • Seke North CRS

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Note: As of 08/10/07, the arm assignments for current and new participants have changed. Please see the above description for this trial for more information.

Inclusion Criteria for Mothers:

  • 18 years of age or older
  • HIV infected
  • In third trimester of pregnancy, or at most 3 days post-delivery
  • If baby is not yet born, planning to deliver at a facility where the study is being conducted
  • Plan to breastfeed

Exclusion Criteria for Mothers:

  • Complications with this pregnancy
  • Serious medical condition that would interfere with the study (e.g., that would prevent breastfeeding or adherence to the follow-up schedule), as judged by the on-site clinician

Inclusion Criteria for Infants:

  • Born to an HIV infected mother who is eligible for the study
  • Weighed at least 2000 grams (4.4 lbs) at birth
  • Blood sample obtained from the infant for HIV-1 DNA PCR, CBC with differential, and ALT
  • Infants in a multiple birth are eligible only if both/all infants are eligible for the study and assigned to the same study group
  • Able to breastfeed (e.g., mother and infant alive with no condition apparent that would prevent breastfeeding)

Exclusion Criteria for Infants:

  • HIV DNA PCR positive at birth
  • ALT of Grade 2 or higher at birth
  • Hemoglobin, absolute neutrophil count, or platelet count of Grade 3 or higher at birth
  • Skin rash of Grade 2B (urticaria), Grade 3, or above
  • Confirmed or suspected clinical hepatitis
  • Serious illness or condition that would interfere with compliance with study procedures

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: 2A
For infants: extended treatment with NVP
Drug: Nevirapine
10 mg/ml oral suspension taken once daily up to 6 months of age. Dosage will increase throughout study.
Other Names:
  • NVP
Placebo Comparator: 2B
For infants: extended treatment with NVP placebo
Drug: Nevirapine placebo
Oral suspension taken once daily up to 6 months of age
Other Names:
  • NVP placebo

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
HIV Infection in Infants Determined to be HIV Uninfected at 6 Weeks Enrolled in Each Arm of the Study
Time Frame: At Month 6
At Month 6
Frequency and Severity of Adverse Reactions Among Participating Infants
Time Frame: 6 weeks through 18 months
For those infants who were randomized at 6 weeks and who initiated study drug we looked at the frequency and severity of adverse reactions through 18 months of study. The severity of all AEs was graded according to the DAIDS Table for Grading the Severity of Adult and Pediatric Adverse Events. The term severity is described as the intensity grade or level for specific event (i.e. mild, moderate, severe, or life-threatening). Severity is not the same as seriousness.
6 weeks through 18 months

Secondary Outcome Measures

Outcome Measure
Time Frame
Proportion of Infants Who Are Alive and HIV-uninfected in the Two Arms
Time Frame: At Months 6 and 18
At Months 6 and 18
Relative Rates of HIV Infection in the Two Arms
Time Frame: At Month 18
At Month 18
Infant Survival Rates (Mortality Regardless of HIV Infection) in the Two Arms
Time Frame: At Month 18
At Month 18

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

National Institute of Allergy and Infectious Diseases (NIAID)

Collaborators

National Institute on Drug Abuse (NIDA)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
National Institute of Mental Health (NIMH)

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

January 1, 2007

Primary Completion (Actual)

September 1, 2011

Study Completion (Actual)

November 1, 2011

Study Registration Dates

First Submitted

December 11, 2003

First Submitted That Met QC Criteria

December 12, 2003

First Posted (Estimate)

December 15, 2003

Study Record Updates

Last Update Posted (Estimate)

February 16, 2023

Last Update Submitted That Met QC Criteria

January 24, 2023

Last Verified

January 1, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • HPTN 046
  • 10142 (DAIDS ES)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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