- ICH GCP
- Amerikanska kliniska prövningsregistret
- Klinisk prövning NCT00076791
Safety of Tenofovir Disoproxil Fumarate (TDF) and Emtricitabine/TDF in HIV Infected Pregnant Women and Their Infants
A Phase I Study of the Safety, Tolerance, and Pharmacokinetics of Tenofovir Disoproxil Fumarate (TDF) and the Combination of TDF Plus Emtricitabine in HIV-1 Infected Pregnant Women and Their Infants
Studieöversikt
Status
Betingelser
Intervention / Behandling
Detaljerad beskrivning
The majority of perinatally infected infants are infected during the labor and delivery process, but recent studies suggest that additional factors, such as postexposure prophylaxis, are likely to be involved in the prevention of MTCT of HIV. It is possible that antiretroviral dosing only during labor and short-term dosing to newly born infants would be sufficiently effective to prevent MTCT of HIV. TDF is a nucleoside reverse transcriptase inhibitor that has demonstrated significant effectiveness in preventing MTCT of simian immunodeficiency virus (SIV) in a primate model of HIV. FTC/TDF is a combination of two NRTIs being studied because this combination has the potential to prevent MTCT, while protecting the mother from developing resistance that may develop with single drug therapy. This study will evaluate the safety, tolerance, and pharmacokinetics (PK) of single doses of TDF and FTC/TDF in both HIV infected pregnant women and their newborn infants.
Cohort 1 is now closed. Each participant in Cohort 1 received a single 600 mg oral dose of TDF at the start of active labor or 4 hours prior to C-section, with concurrent administration of standard intravenous zidovudine (ZDV) prophylaxis and/or other antiretrovirals prescribed by her physician. The infants from Cohort 1 received only the standard 6 weeks of oral ZDV prophylaxis postpartum. PK blood samples were taken from mothers at predose and 1, 2, 4, 8, 12, and 24 hours postdose and at the time of delivery; PK blood samples were taken from infants at 12, 24, and 36 hours after birth.
Pregnant women with HIV infection entering this study will be assigned to Cohort 2, as all infants in Cohort 1 have completed the 6 to 8 week study visit and all Cohort 1 data have been reviewed. Mothers in Cohort 2 will receive a single dose of 900 mg of TDF combined with 600 mg emtricitabine, along with standard ZDV prophylaxis and/or other antiretrovirals prescribed by her physician. Infants will receive a single dose of TDF at 4 mg/kg combined with 3 mg/kg emtricitabine as soon as possible after delivery and within 6 hours of age as well as the standard 6 weeks of oral ZDV prophylaxis after birth. Blood samples from mothers and infants will be taken as for Cohort 1.
Mothers will be followed for 12 weeks postpartum or for 2 years after giving birth if viral resistance to TDF or FTC/TDF is demonstrated at Weeks 1, 6, or 12. In addition to the PK studies, blood collection will occur around the time of delivery, at screening, study entry, at delivery, and after delivery at various times up to Week 12. Physical exams will be done at screening, study entry, at delivery, and after delivery at various times up to Week 8. Infants will be followed until age 2. Blood will be collected and physical exams will be done at birth and at various times up to Week 96. Mothers are encouraged to coenroll in PACTG P1025, Pharmacokinetic Study of Anti-HIV Drugs During Pregnancy.
Studietyp
Inskrivning (Faktisk)
Fas
- Fas 1
Kontakter och platser
Studieorter
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District of Columbia
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Washington, District of Columbia, Förenta staterna, 20010
- Children's National Med. Ctr. Washington DC NICHD CRS
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Washington, District of Columbia, Förenta staterna, 20010
- Washington Hosp. Ctr. NICHD CRS
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Florida
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Miami, Florida, Förenta staterna, 33136
- Univ. of Miami Ped. Perinatal HIV/AIDS CRS
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Illinois
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Chicago, Illinois, Förenta staterna, 60608
- Mt. Sinai Hosp. Med. Ctr. - Chicago, Womens & Childrens HIV Program
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Michigan
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Detroit, Michigan, Förenta staterna, 48201
- Children's Hospital of Michigan NICHD CRS
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New Jersey
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Newark, New Jersey, Förenta staterna, 07101-1709
- NJ Med. School CRS
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New York
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Bronx, New York, Förenta staterna, 10457
- Bronx-Lebanon Hosp. IMPAACT CRS
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New York, New York, Förenta staterna, 10016
- Nyu Ny Nichd Crs
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Pennsylvania
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Philadelphia, Pennsylvania, Förenta staterna, 19102-1192
- Hahnemann Univ. Hosp.
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Tennessee
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Memphis, Tennessee, Förenta staterna
- Regional Med. Ctr. at Memphis
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Memphis, Tennessee, Förenta staterna
- St. Jude/UTHSC CRS
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San Juan, Puerto Rico
- San Juan City Hosp. PR NICHD CRS
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Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Beskrivning
Inclusion Criteria for Mothers:
- HIV infected
- 34 weeks or more (third trimester) into pregnancy at study screening
- Have access to a participating AIDS clinical trial unit (ACTU) and are willing to be followed at location for the duration of the study
Exclusion Criteria for Mothers:
- Prior treatment with TDF, including coformulated drugs that contain TDF, during current pregnancy
- Active opportunistic infection and/or serious bacterial infection at time of study entry
- Certain abnormal laboratory values at study screening
- Chronic malabsorption or chronic diarrhea
- Certain medical or obstetrical complications during the current pregnancy
- Fetal abnormalities as measured by ultrasound screening performed at 18 weeks into pregnancy or later
- Intend to breastfeed
- Current alcohol abuse or use of illicit substances
- Participation in any other therapeutic or vaccine perinatal treatment trial during the current pregnancy, unless given permission by the protocol chairs
- Require certain medications
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Förebyggande
- Tilldelning: Icke-randomiserad
- Interventionsmodell: Parallellt uppdrag
- Maskning: Ingen (Open Label)
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
---|---|
Aktiv komparator: 1
Each participant in Cohort 1 received a single 600 mg oral dose of TDF at the start of active labor or 4 hours prior to C-section, with concurrent administration of standard intravenous zidovudine (ZDV) prophylaxis and/or other antiretrovirals prescribed by her physician.
The infants from Cohort 1 received only the standard 6 weeks of oral ZDV prophylaxis postpartum.
|
900 mg of TDF combined with 600 mg emtricitabine
600 mg oral dose of TDF
|
Aktiv komparator: 2
Mothers in Cohort 2 will receive a single dose of 900 mg of TDF combined with 600 mg emtricitabine, along with standard ZDV prophylaxis and/or other antiretrovirals prescribed by her physician.
Infants will receive a single dose of TDF at 4 mg/kg combined with 3 mg/kg emtricitabine as soon as possible after delivery and within 6 hours of age as well as the standard 6 weeks of oral ZDV prophylaxis after birth.
|
900 mg of TDF combined with 600 mg emtricitabine
600 mg oral dose of TDF
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Vad mäter studien?
Primära resultatmått
Resultatmått |
Tidsram |
---|---|
Adverse experiences with a severity of Grade 3 or 4 and adverse pregnancy outcomes that cannot be directly attributed to a cause besides study treatment
Tidsram: Throughout study
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Throughout study
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Sekundära resultatmått
Resultatmått |
Tidsram |
---|---|
Maternal viral load
Tidsram: during active labor and 24 to 48 hours, 7 days, 6 to 8 weeks, and 12 weeks postpartum
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during active labor and 24 to 48 hours, 7 days, 6 to 8 weeks, and 12 weeks postpartum
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viral resistance to emtricitabine/tenofovir disoproxil fumarate using bulk sequencing
Tidsram: at Weeks 1, 6, and 12 postpartum
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at Weeks 1, 6, and 12 postpartum
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infant HIV DNA PCR
Tidsram: at 24 to 48 hours, 6 to 8 weeks, 4 months, and 6 months of life
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at 24 to 48 hours, 6 to 8 weeks, 4 months, and 6 months of life
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Samarbetspartners och utredare
Samarbetspartners
Utredare
- Studiestol: Patricia M. Flynn, MD, Department of Infectious Disease, St. Jude's Children's Research Hospital
- Studiestol: Arlene D. Bardeguez, MD, MPH, FACOG, Obstetrics, Gynecology, and Women's Health, University of Medicine and Dentistry of New Jersey
Publikationer och användbara länkar
Allmänna publikationer
- Abrams EJ. Prevention of mother-to-child transmission of HIV--successes, controversies and critical questions. AIDS Rev. 2004 Jul-Sep;6(3):131-43.
- Antoniou T, Park-Wyllie LY, Tseng AL. Tenofovir: a nucleotide analog for the management of human immunodeficiency virus infection. Pharmacotherapy. 2003 Jan;23(1):29-43. doi: 10.1592/phco.23.1.29.31915.
- Kourtis AP, Duerr A. Prevention of perinatal HIV transmission: a review of novel strategies. Expert Opin Investig Drugs. 2003 Sep;12(9):1535-44. doi: 10.1517/13543784.12.9.1535.
- Moodley J, Moodley D. Management of human immunodeficiency virus infection in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2005 Apr;19(2):169-83. doi: 10.1016/j.bpobgyn.2004.10.007. Epub 2004 Dec 15.
- Thorne C, Newell ML. The safety of antiretroviral drugs in pregnancy. Expert Opin Drug Saf. 2005 Mar;4(2):323-35. doi: 10.1517/14740338.4.2.323.
Studieavstämningsdatum
Studera stora datum
Studiestart
Primärt slutförande (Faktisk)
Avslutad studie (Faktisk)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Uppskatta)
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Nyckelord
Ytterligare relevanta MeSH-villkor
- RNA-virusinfektioner
- Virussjukdomar
- Infektioner
- Blodburna infektioner
- Smittsamma sjukdomar
- Sexuellt överförbara sjukdomar, virala
- Sexuellt överförbara sjukdomar
- Lentivirusinfektioner
- Retroviridae-infektioner
- Immunologiska bristsyndrom
- Immunsystemets sjukdomar
- HIV-infektioner
- Molekylära mekanismer för farmakologisk verkan
- Anti-infektionsmedel
- Antivirala medel
- Omvända transkriptashämmare
- Nukleinsyrasynteshämmare
- Enzyminhibitorer
- Anti-HIV-medel
- Antiretrovirala medel
- Tenofovir
- Emtricitabin
- Emtricitabin, Tenofovir Disoproxil Fumarate Läkemedelskombination
Andra studie-ID-nummer
- P394
- 10034 (Registeridentifierare: DAIDS ES)
- PACTG 394
- IMPAACT 394
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