FEM-PrEP (Truvada®): Study to Assess the Role of Truvada® in Preventing HIV Acquisition in Women
Phase 3, Multi-center, Double-blind, Randomized, Placebo-controlled Effectiveness and Safety Study to Assess the Role of Truvada® in Preventing HIV Acquisition in Women
This Phase III, double-blind, randomized, placebo-controlled trial enrolled HIV-negative women from 4 sites in 3 countries (Kenya, Tanzania, South Africa). The study's purpose was to investigate the safety and effectiveness of a once-daily Truvada® pill (compared with placebo) in preventing HIV among HIV-uninfected women at risk of becoming infected through sexual intercourse.
The study population included HIV-antibody-negative women between the ages of 18-35 who were at risk of HIV acquisition through sexual intercourse. Each participant was randomized to take either a daily single oral tablet of Truvada®, which is a fixed-dose combination of emtricitabine (FTC; 200 mg) and tenofovir disoproxil fumarate (TDF; 300 mg), or an identical placebo.
After enrollment, each participant was followed every four weeks. All participants were followed for an additional eight weeks after study drug was stopped. Incidence rates of HIV infection were compared between the two groups (active drug and placebo) using the intent-to-treat principle.
調査の概要
詳細な説明
This Phase III, double-blind, randomized, placebo-controlled trial enrolled HIV-negative women from 4 sites in 3 countries (Kenya, Tanzania, South Africa). The study's purpose was to investigate the safety and effectiveness of a once-daily Truvada® pill (compared with placebo) in preventing HIV among HIV-uninfected women at risk of becoming infected through sexual intercourse.
The study population included HIV-antibody-negative women between the ages of 18-35 who were at risk of HIV acquisition through sexual intercourse. Each participant was randomized to take either a daily single oral tablet of Truvada®, which is a fixed-dose combination of emtricitabine (FTC; 200 mg) and tenofovir disoproxil fumarate (TDF; 300 mg), or an identical placebo. All participants received risk reduction counseling and condoms. Women had to be using a study-approved effective non-barrier contraceptive method at the time of enrollment and were asked to do so for the whole period they were on study drug. They received contraceptive counseling throughout the study. Any diagnosed, treatable sexually transmitted infection was treated free of charge.
After enrollment, each participant was followed every four weeks. All participants were followed for an additional eight weeks after study drug was stopped. Participants at risk for Hepatitis B Virus (HBV) flare were followed every four weeks for 12 weeks after stopping study product. Participants who acquired HIV infection during the study stopped taking the study drug at the time of HIV diagnosis, and will be followed for 52 weeks post diagnosis and were referred for care and treatment. Participants who became pregnant stopped taking the study drug but continued follow-up visits. Incidence rates of HIV infection were compared between the two groups (active drug and placebo) using the intent-to-treat principle.
研究の種類
入学 (実際)
段階
- フェーズ 3
連絡先と場所
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- Willing and able (see criterion 2) to provide written informed consent to be screened for and to participate in the trial
- Able to answer a percentage of informed consent screening (75%) and enrollment (100%) comprehension quiz questions correctly
- Between 18-35 years old, inclusive
- At higher risk of becoming HIV infected
- Have a final negative result according to the site-specific screening HIV testing algorithm and a final negative result at enrollment according to the study HIV testing algorithm
Willing to participate in all aspects of the study and to comply with study procedures, for up to 60 weeks, including:
- Be randomized
- Use study product as directed
- Adhere to follow-up schedule and willing to be contacted by site staff between study visits (by phone and/or in person)
- Use a study-approved effective non-barrier method of contraception for the duration of the study
- Take study product, as evidenced by swallowing a vitamin tablet that is similar in size to the study product at enrollment
- Provide contact information and agrees to some form of contact method throughout the study
- Not intending to relocate out of the area for the duration of the study participation and does not have a job or other obligations that may require long absences from the area ( > 1 month at a time)
- In general good health and have no condition (social or medical) which, in the opinion of the Site Investigator, would make study participation unsafe or complicate data interpretation
- Not pregnant or breastfeeding, and does not anticipate a desire for pregnancy during the 52 weeks of on-product participation
Medically eligible at screening including:
- Adequate renal function (serum creatinine ≤ upper limit of normal (ULN) of local range and creatinine clearance ≥ 60ml/min estimated by the Cockcroft-Gault Creatinine Clearance Formula
- Adequate hepatic function (hepatic transaminases ALT and AST < 2x ULN [according to local normal ranges])
- HBsAg negative
- Serum phosphorus levels above the lower limit of the local normal range (according to local normal ranges - grade 3 & 4 hypophosphatemia will be excluded even if within normal local ranges)
- Not received or receiving an experimental HIV vaccine, participating in another HIV prevention study or participating in any other clinical trial with a biomedical intervention
- No clinical signs of liver disease (e.g., ascites, spider angiomata, hepatomegaly, jaundice)
- No definite evidence of glycosuria or proteinuria (i.e., no repeated positive [ ≥ + 1 ] urine dipstick). If a urine dipstick is positive for either glucose and/or protein at the first test, a second urine sample will be tested.
- No history of pathological bone fractures
- No history of adverse reaction to latex
- Not taking any of the following medications: nephrotoxic agents; aminoglycoside antibiotics (including gentamicin); intravenous (IV) amphotericin B; cidofovir; cisplatin; foscarnet; IV pentamidine; oral or IV vancomycin; oral or IV gancyclovir; other agents with significant nephrotoxic potential; drugs that slow renal excretion; probenecid; immune system modulators; systemic chemotherapeutic agents (i.e. cancer treatment medications); systemic corticosteroids; interleukin-2 (IL-2); immunomodulators; interferon (alpha, beta, or gamma); other antiretrovirals (including nucleoside analogs, non-nucleoside reverse transcriptase inhibitors, protease inhibitors or investigational antiretroviral agents)
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:防止
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:4倍
武器と介入
参加者グループ / アーム |
介入・治療 |
---|---|
実験的:Truvada Arm
Daily single oral tablet of Truvada (TDF/FTC), a fixed-dose combination of emtricitabine (FTC; 200 mg) and tenofovir disoproxil fumarate (TDF; 300 mg).
|
Daily single oral tablet of Truvada - a fixed-dose combination of emtricitabine (FTC; 200 mg) and tenofovir disoproxil fumarate (TDF; 300 mg).
他の名前:
|
プラセボコンパレーター:Placebo Arm
Daily single oral tablet of Placebo.
Tablets are identical to Truvada tablets in taste and appearance; however, they contain no active ingredients.
|
Daily single oral tablet of Placebo.
Tablets are identical to Truvada tablets in taste and appearance; however, they contain no active ingredients.
|
この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
HIV Infection
時間枠:Cumulative HIV infection between enrollment and 52 weeks
|
HIV Seroconversion, with time to infection refined based on PCR results obtained from stored specimens.
|
Cumulative HIV infection between enrollment and 52 weeks
|
Confirmed Grade 2 or Higher Serum Creatinine Toxicity
時間枠:cumulative toxicity through 52 weeks of product use and 4 weeks post product
|
Repeat specimens were collected to confirm chemistry toxicities.
Grade 2 or higher serum creatinine toxicity was defined as ≥1.4 times the upper limit of normal
|
cumulative toxicity through 52 weeks of product use and 4 weeks post product
|
Frequency of Adverse Events (AEs) During and Within 4 Weeks After Study Product Administration
時間枠:10-26 months per site
|
The total number of adverse events in the placebo and Truvada arms during and within 4 weeks after study product administration.
|
10-26 months per site
|
Confirmed Grade 3 or Higher Reduction in Phosphorus
時間枠:Through 52 weeks on product and 4 weeks post-product
|
Repeat specimens were collected to confirm chemistry toxicities.
Grade 3 phosphorus reduction was defined as ≤2.4mg/dL
|
Through 52 weeks on product and 4 weeks post-product
|
Confirmed Grade 3 or Higher ALT Elevation
時間枠:Through 52 weeks on product and 4 weeks post-product
|
Grade 3 or higher ALT elevation was defined as ≥ 2.6 times the upper limit of normal
|
Through 52 weeks on product and 4 weeks post-product
|
Confirmed Grade 3 or Higher AST Elevation
時間枠:Through 52 weeks on product and 4 weeks post-product
|
Grade 3 or higher AST elevation was defined as ≥ 2.6 times the upper limit of normal
|
Through 52 weeks on product and 4 weeks post-product
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Plasma HIV RNA Level (HIV-1 Viral Load)
時間枠:up to 16 weeks
|
Viral load at the time of HIV detection, HIV conversion and through 16 weeks
|
up to 16 weeks
|
CD4+ T-cell Count
時間枠:Up to 16 weeks
|
CD4+ T-cell Count at the Time of HIV Seroconversion through 16 weeks
|
Up to 16 weeks
|
FTC and/or Tenofovir Resistance
時間枠:up to 52 weeks
|
Genotypic resistance to FTC and/or tenofovir at the time of HIV diagnosis and 4 weeks later. If resistance was present, testing was repeated at weeks 12, 24, 36 and 52 as necessary (resistance testing will stop if no resistance is detected). participants were classified as having resistance if they had one or more visits in which resistance was detected, even if the resistance became undetectable over time. |
up to 52 weeks
|
Pregnancy Complications
時間枠:up to 60 weeks
|
Reported complications during pregnancy, including spontaneous abortion, vaginal or uterine bleeding, emergency c-section and other complications
|
up to 60 weeks
|
Pill Counts and Participant Report of Adherence to Once-daily Pill Taking
時間枠:Up to 52 weeks
|
Pill counts and participant report of adherence to once-daily pill taking reported as mean days study product could have been used according to pill counts
|
Up to 52 weeks
|
Participant Report of Change in Number of Sexual Partners
時間枠:Up to 52 weeks
|
Difference in mean number of reported sexual partners between final study visit and enrollment visit
|
Up to 52 weeks
|
協力者と研究者
スポンサー
捜査官
- 主任研究者:Lut Van Damme, MD, MS, PhD、FHI 360
- 主任研究者:Amy Corneli, PhD, MPH、FHI 360
- スタディディレクター:Jennifer Deese, MPH、FHI 360
出版物と役立つリンク
一般刊行物
- Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, Malahleha M, Owino F, Manongi R, Onyango J, Temu L, Monedi MC, Mak'Oketch P, Makanda M, Reblin I, Makatu SE, Saylor L, Kiernan H, Kirkendale S, Wong C, Grant R, Kashuba A, Nanda K, Mandala J, Fransen K, Deese J, Crucitti T, Mastro TD, Taylor D; FEM-PrEP Study Group. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012 Aug 2;367(5):411-22. doi: 10.1056/NEJMoa1202614. Epub 2012 Jul 11.
- Mandala J, Nanda K, Wang M, De Baetselier I, Deese J, Lombaard J, Owino F, Malahleha M, Manongi R, Taylor D, Van Damme L. Liver and renal safety of tenofovir disoproxil fumarate in combination with emtricitabine among African women in a pre-exposure prophylaxis trial. BMC Pharmacol Toxicol. 2014 Dec 24;15:77. doi: 10.1186/2050-6511-15-77.
- Grant RM, Liegler T, Defechereux P, Kashuba AD, Taylor D, Abdel-Mohsen M, Deese J, Fransen K, De Baetselier I, Crucitti T, Bentley G, Agingu W, Ahmed K, Damme LV. Drug resistance and plasma viral RNA level after ineffective use of oral pre-exposure prophylaxis in women. AIDS. 2015 Jan 28;29(3):331-7. doi: 10.1097/QAD.0000000000000556.
- Todd CS, Deese J, Wang M, Hubacher D, Steiner MJ, Otunga S, Van Damme L; FEM-PrEP Study Group. Sino-implant (II)(R) continuation and effect of concomitant tenofovir disoproxil fumarate-emtricitabine use on plasma levonorgestrel concentrations among women in Bondo, Kenya. Contraception. 2015 Mar;91(3):248-52. doi: 10.1016/j.contraception.2014.10.008. Epub 2014 Oct 22.
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
キーワード
追加の関連 MeSH 用語
その他の研究ID番号
- 10015 (その他の識別子:Fred Hutch/University of Washington Cancer Consortium)
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