A Study of HIV Levels During Pregnancy and After Childbirth

NCT ID: NCT00041964

Last Updated: 2012-07-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

129 participants

Study Classification

OBSERVATIONAL

Brief Summary

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The purpose of this study is to find out if HIV-infected pregnant women taking anti-HIV drugs have an increased amount of HIV in their blood (viral load) after having the baby.

The purpose of A5153s, a substudy of A5150, is to characterize two anti-HIV drugs (nelfinavir \[NFV\] and lopinavir/ritonavir \[LPV/r\]) in HIV-infected women during pregnancy and after childbirth.

Sometimes pregnant women have an increase in their HIV viral load after their baby is born. This study will try to find out how often this happens. It will also examine possible reasons why the increase in viral load occurs.

Detailed Description

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Limited data suggest that HIV-infected pregnant women develop postpartum viral rebound. However, viral load changes in the postpartum period have not been adequately characterized. Changes in adherence to antiretroviral therapy, pregnancy-related changes in pharmacokinetics of antiretroviral medications, and decline in immune competence are mechanisms by which postpartum viral load rebound may occur. This study is designed to characterize the incidence and magnitude of postpartum viral rebound during the initial 24 weeks postpartum and to explore the mechanisms and consequences of viral rebound.

Eligible patients are evaluated at gestational weeks 34 and 36, at delivery, and at regular visits for 96 weeks postpartum. Most evaluations include a medical history, physical exam, laboratory tests, and adherence and quality-of-life questionnaires. Viral load and CD4/CD8 cell counts are measured frequently.

Patients are expected to receive at least 8 weeks of stable HAART before delivery, and to continue HAART throughout the remainder of the study. The choice of HAART is left to the primary provider. No antiretroviral drugs are provided by this study.

Patients participating in the A5153s substudy receive either NFV or LPV/r as part of their HAART. Pharmacokinetic blood sampling takes place at 36 weeks gestation, 6 weeks postpartum, and 24 weeks postpartum. Patients record the administration times and doses of their NFV or LPV/r for 48 hours prior to each substudy visit, and hold their regularly scheduled doses of antiretroviral medications on substudy days. Patients arrive at the clinic fasting (no food or drink for the previous 8 hours) and are given a standardized breakfast prior to supervised administration of their NFV or LPV/r dose. An intravenous catheter is placed in an arm vein for blood collection at pre-dose and 1, 2, 4, and 6 hours post-dose.

Conditions

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HIV Infections Pregnancy

Keywords

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Lopinavir Pregnancy Trimester, Third Pregnancy Complications, Infectious HIV Protease Inhibitors Ritonavir Nelfinavir Viral Load puerperium

Eligibility Criteria

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Inclusion Criteria

Patients may be eligible for this study if they:

* Are age 13 or older.
* Are between 22 and 30 weeks pregnant.
* Have had their pregnancy confirmed by ultrasound at 14 weeks gestation or later.
* Are infected with HIV.
* Are planning to receive at least 8 weeks of highly active antiretroviral therapy (HAART) by the time they have their baby.
* Are available for follow-up for the duration of the study.

Exclusion Criteria

Patients may not be eligible for this study if they:

* Intend to terminate their pregnancy.
* Intend to breast-feed their baby.
* Are carrying a baby with major abnormalities, including spina bifida, anencephaly, hydrops, or ascites.
* Have taken certain medications.
* Are enrolled in other studies that require large blood draws.
* Will be taking anti-HIV drugs only to prevent mother-to-child transmission of HIV, and not to treat the maternal infection itself.
* Actively abuse drugs or alcohol in a way that would interfere with participation in the study.
Minimum Eligible Age

13 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Allergy and Infectious Diseases (NIAID)

NIH

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Beverly Sha

Role: STUDY_CHAIR

Alice Stek

Role: STUDY_CHAIR

Locations

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Univ of Alabama at Birmingham

Birmingham, Alabama, United States

Site Status

Los Angeles County Medical Center/USC

Los Angeles, California, United States

Site Status

UCLA School of Medicine

Los Angeles, California, United States

Site Status

UCSD Mother, Child & Adolescent HIV Program

San Diego, California, United States

Site Status

San Francisco General Hosp

San Francisco, California, United States

Site Status

Univ of Florida- Health Science Ctr

Jacksonville, Florida, United States

Site Status

Emory Univ

Atlanta, Georgia, United States

Site Status

University of Hawaii

Honolulu, Hawaii, United States

Site Status

Northwestern University

Chicago, Illinois, United States

Site Status

Cook County Hosp Core Ctr

Chicago, Illinois, United States

Site Status

Rush Presbyterian - Saint Luke's Med Ctr

Chicago, Illinois, United States

Site Status

Chicago Childrens Memorial Hospital (Pediatric)

Chicago, Illinois, United States

Site Status

Indiana Univ Hosp

Indianapolis, Indiana, United States

Site Status

Hutzel Hospital

Detroit, Michigan, United States

Site Status

Childrens Hospital of Michigan

Detroit, Michigan, United States

Site Status

Hennepin County Med Clinic

Minneapolis, Minnesota, United States

Site Status

Univ of Med & Dentistry of NJ/Univ Hosp

Newark, New Jersey, United States

Site Status

NYU/Bellevue

New York, New York, United States

Site Status

Columbia University

New York, New York, United States

Site Status

State Univ of New York at Stony Brook

Stony Brook, New York, United States

Site Status

Jacobi Med Ctr

The Bronx, New York, United States

Site Status

Univ of North Carolina

Chapel Hill, North Carolina, United States

Site Status

Duke Univ Med Ctr

Durham, North Carolina, United States

Site Status

Case Western Reserve Univ

Cleveland, Ohio, United States

Site Status

MetroHealth Med Ctr

Cleveland, Ohio, United States

Site Status

University of Pittsburgh

Pittsburgh, Pennsylvania, United States

Site Status

Miriam Hosp / Brown Univ

Providence, Rhode Island, United States

Site Status

The Regional Med Ctr, Memphis

Memphis, Tennessee, United States

Site Status

Comprehensive Care Clinic

Nashville, Tennessee, United States

Site Status

University of Texas, Southwestern Medical Center

Dallas, Texas, United States

Site Status

Univ of Washington (Seattle)

Seattle, Washington, United States

Site Status

San Juan City Hosp

San Juan, , Puerto Rico

Site Status

Countries

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United States Puerto Rico

References

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Melvin AJ, Burchett SK, Watts DH, Hitti J, Hughes JP, McLellan CL, King PD, Johnson EJ, Williams BL, Frenkel LM, Coombs RW. Effect of pregnancy and zidovudine therapy on viral load in HIV-1-infected women. J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Mar 1;14(3):232-6. doi: 10.1097/00042560-199703010-00006.

Reference Type BACKGROUND
PMID: 9117455 (View on PubMed)

Rich KC, Siegel JN, Jennings C, Rydman RJ, Landay AL. CD4+ lymphocytes in perinatal human immunodeficiency virus (HIV) infection: evidence for pregnancy-induced immune depression in uninfected and HIV-infected women. J Infect Dis. 1995 Nov;172(5):1221-7. doi: 10.1093/infdis/172.5.1221.

Reference Type BACKGROUND
PMID: 7594657 (View on PubMed)

Cao Y, Krogstad P, Korber BT, Koup RA, Muldoon M, Macken C, Song JL, Jin Z, Zhao JQ, Clapp S, Chen IS, Ho DD, Ammann AJ. Maternal HIV-1 viral load and vertical transmission of infection: the Ariel Project for the prevention of HIV transmission from mother to infant. Nat Med. 1997 May;3(5):549-52. doi: 10.1038/nm0597-549.

Reference Type BACKGROUND
PMID: 9142125 (View on PubMed)

Burns DN, Landesman S, Minkoff H, Wright DJ, Waters D, Mitchell RM, Rubinstein A, Willoughby A, Goedert JJ. The influence of pregnancy on human immunodeficiency virus type 1 infection: antepartum and postpartum changes in human immunodeficiency virus type 1 viral load. Am J Obstet Gynecol. 1998 Feb;178(2):355-9. doi: 10.1016/s0002-9378(98)80025-2.

Reference Type BACKGROUND
PMID: 9500499 (View on PubMed)

Sha BE, Tierney C, Cohn SE, Sun X, Coombs RW, Frenkel LM, Kalams SA, Aweeka FT, Bastow B, Bardeguez A, Kmack A, Stek A; Aids Clinical Trials Group ACTG A5150 Team. Postpartum viral load rebound in HIV-1-infected women treated with highly active antiretroviral therapy: AIDS Clinical Trials Group Protocol A5150. HIV Clin Trials. 2011 Jan-Feb;12(1):9-23. doi: 10.1310/hct1201-9.

Reference Type RESULT
PMID: 21388937 (View on PubMed)

Other Identifiers

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ACTG A5153s

Identifier Type: -

Identifier Source: secondary_id

AACTG A5150

Identifier Type: -

Identifier Source: secondary_id

AACTG A5153s

Identifier Type: -

Identifier Source: secondary_id

ACTG A5150

Identifier Type: -

Identifier Source: org_study_id