Trial Outcomes & Findings for HIV Protease Inhibitors for the Prevention of Malaria in Ugandan Children (NCT NCT00978068)

NCT ID: NCT00978068

Last Updated: 2018-12-28

Results Overview

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

176 participants

Primary outcome timeframe

Time from randomization to at least 24 months of follow up or until end of the study

Results posted on

2018-12-28

Participant Flow

Children were recruited from September 2009 through July 2011.

A total of 404 children were screened for eligibility; 228 were found not to be eligible. The main reasons for ineligibility were: 136 Were not eligible for ART 34 Were on ART with detectable viral load 32 Were HIV- 8 Had not received ART but had prior exposure to nevirapine

Participant milestones

Participant milestones
Measure
LPV/r + 2 NRTIs
LPV/r + 2 NRTIs: Group 1 Lopinavir/ritonavir (LPV/r) +2 nucleoside reverse transcriptase inhibitor (NRTI) The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be Abacavir. Stavudine will be used in the event that a participant is unable to take Abacavir for safety or other reasons.
NVP or EFV + 2 NRTIs
NVP or EFV + 2 NRTIs: Group 2 Nevirapine (NVP) or Efavirenz (EFV) + 2 NRTI NVP will be used for children \< 3 years of age and EFV for children ≥3 years of age. The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be stavudine.
Overall Study
STARTED
87
89
Overall Study
Initiated Study Drugs
84
86
Overall Study
COMPLETED
83
80
Overall Study
NOT COMPLETED
4
9

Reasons for withdrawal

Reasons for withdrawal
Measure
LPV/r + 2 NRTIs
LPV/r + 2 NRTIs: Group 1 Lopinavir/ritonavir (LPV/r) +2 nucleoside reverse transcriptase inhibitor (NRTI) The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be Abacavir. Stavudine will be used in the event that a participant is unable to take Abacavir for safety or other reasons.
NVP or EFV + 2 NRTIs
NVP or EFV + 2 NRTIs: Group 2 Nevirapine (NVP) or Efavirenz (EFV) + 2 NRTI NVP will be used for children \< 3 years of age and EFV for children ≥3 years of age. The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be stavudine.
Overall Study
Were Awaiting Initiation of ART
2
2
Overall Study
Death
1
2
Overall Study
Lost to Follow-up
1
2
Overall Study
Physician Decision
0
1
Overall Study
Unable to Comply with Study
0
2

Baseline Characteristics

HIV Protease Inhibitors for the Prevention of Malaria in Ugandan Children

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
LPV/r + 2 NRTIs
n=84 Participants
LPV/r + 2 NRTIs: Group 1 Lopinavir/ritonavir (LPV/r) +2 nucleoside reverse transcriptase inhibitor (NRTI) The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be Abacavir. Stavudine will be used in the event that a participant is unable to take Abacavir for safety or other reasons.
NVP or EFV + 2 NRTIs
n=86 Participants
NVP or EFV + 2 NRTIs: Group 2 Nevirapine (NVP) or Efavirenz (EFV) + 2 NRTI NVP will be used for children \< 3 years of age and EFV for children ≥3 years of age. The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be stavudine.
Total
n=170 Participants
Total of all reporting groups
Age, Continuous
2.9 years
n=5 Participants
3.1 years
n=7 Participants
3.1 years
n=5 Participants
Sex: Female, Male
Female
41 Participants
n=5 Participants
41 Participants
n=7 Participants
82 Participants
n=5 Participants
Sex: Female, Male
Male
43 Participants
n=5 Participants
45 Participants
n=7 Participants
88 Participants
n=5 Participants
Previous ART to Enrollment
No Previous ART
57 participants
n=5 Participants
58 participants
n=7 Participants
115 participants
n=5 Participants
Previous ART to Enrollment
Previous ART
27 participants
n=5 Participants
28 participants
n=7 Participants
55 participants
n=5 Participants
WHO Clinical HIV stage
Stage I (Asymptomatic)
60 participants
n=5 Participants
66 participants
n=7 Participants
126 participants
n=5 Participants
WHO Clinical HIV stage
Stage II (mod. unexplained weight loss)
16 participants
n=5 Participants
15 participants
n=7 Participants
31 participants
n=5 Participants
WHO Clinical HIV stage
Stage III (unexplained severe weight loss)
2 participants
n=5 Participants
1 participants
n=7 Participants
3 participants
n=5 Participants
WHO Clinical HIV stage
Stage IV (HIV wasting syndrome)
6 participants
n=5 Participants
4 participants
n=7 Participants
10 participants
n=5 Participants
CD4 Percentage
No Previous ART
14 % of white cells that are CD4 cells
n=5 Participants
16 % of white cells that are CD4 cells
n=7 Participants
16 % of white cells that are CD4 cells
n=5 Participants
CD4 Percentage
Previous ART
31 % of white cells that are CD4 cells
n=5 Participants
30 % of white cells that are CD4 cells
n=7 Participants
30 % of white cells that are CD4 cells
n=5 Participants
Viral Load
No Previous ART
5.4 log10copies/mL
n=5 Participants
5.5 log10copies/mL
n=7 Participants
5.5 log10copies/mL
n=5 Participants
Viral Load
Previous ART
NA log10copies/mL
n=5 Participants
NA log10copies/mL
n=7 Participants
NA log10copies/mL
n=5 Participants
Hemoglobin
10.4 g/dL
STANDARD_DEVIATION 1.3 • n=5 Participants
10.6 g/dL
STANDARD_DEVIATION 1.5 • n=7 Participants
10.5 g/dL
STANDARD_DEVIATION 1.4 • n=5 Participants
Result of Baseline Blood Smear for Asexual Parasites
Positive
10 participants
n=5 Participants
11 participants
n=7 Participants
21 participants
n=5 Participants
Result of Baseline Blood Smear for Asexual Parasites
Negative
74 participants
n=5 Participants
75 participants
n=7 Participants
149 participants
n=5 Participants

PRIMARY outcome

Timeframe: Time from randomization to at least 24 months of follow up or until end of the study

Outcome measures

Outcome measures
Measure
Group 1: LPV/r + 2 NRTIs
n=84 Participants
Lopinavir/ritonavir (LPV/r) +2 nucleoside reverse transcriptase inhibitor (NRTI) The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be Abacavir. Stavudine will be used in the event that a participant is unable to take Abacavir for safety or other reasons.
Group 2: Nevirapine (NVP) or Efavirenz (EFV) + 2 NRTIs
n=86 Participants
NVP will be used for children \< 3 years of age and EFV for children ≥3 years of age. The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be stavudine.
Incidence-density of Malaria Defined as the Number of Incident Episodes of Malaria Per Time at Risk.
1.32 Episodes/ Person-Yr at Risk
2.25 Episodes/ Person-Yr at Risk

SECONDARY outcome

Timeframe: 28 days after antimalarial therapy

The rates of adverse events, defined as severity grade 2 or higher that are possibly, probably or definitely related to study drugs over the course of the 28-day period after antimalarial therapy with artemether-lumefantrine (AL).

Outcome measures

Outcome measures
Measure
Group 1: LPV/r + 2 NRTIs
n=84 Participants
Lopinavir/ritonavir (LPV/r) +2 nucleoside reverse transcriptase inhibitor (NRTI) The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be Abacavir. Stavudine will be used in the event that a participant is unable to take Abacavir for safety or other reasons.
Group 2: Nevirapine (NVP) or Efavirenz (EFV) + 2 NRTIs
n=86 Participants
NVP will be used for children \< 3 years of age and EFV for children ≥3 years of age. The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be stavudine.
Percentage of Uncomplicated Malaria Episodes With Accompanying Adverse Events That Occurred in the 28 Days Following Antimalarial Therapy
71.0 % uncomplicated malaria episodes w/ AEs
79.3 % uncomplicated malaria episodes w/ AEs

SECONDARY outcome

Timeframe: Time from randomization to at least 24 months of follow up or until end of the study

Outcome measures

Outcome measures
Measure
Group 1: LPV/r + 2 NRTIs
n=84 Participants
Lopinavir/ritonavir (LPV/r) +2 nucleoside reverse transcriptase inhibitor (NRTI) The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be Abacavir. Stavudine will be used in the event that a participant is unable to take Abacavir for safety or other reasons.
Group 2: Nevirapine (NVP) or Efavirenz (EFV) + 2 NRTIs
n=86 Participants
NVP will be used for children \< 3 years of age and EFV for children ≥3 years of age. The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be stavudine.
Incidence-density of Malaria Defined as the Number of Incident Episodes of Complicated Malaria Per Time at Risk.
0.024 Episodes/ Person-Yr at Risk
0.026 Episodes/ Person-Yr at Risk

SECONDARY outcome

Timeframe: Enrollment to 6 months follow up

Population: Among patients who were followed for 6 months, malaria did not develop in 34 patients in the NNRTI group and 44 in the lopinavir-ritonavir group; data on 10 patients in the NNRTI group and 7 in the lopinavir-ritonavir group were censored before the 6-month follow-up assessment.

To assess the effect of ART independently of potential interactions with antimalarial therapy after treatment for malaria, we compared the two groups with respect to the time to the first episode of malaria. Cumulative risk was estimated using the Kaplan-Meier product-limit formula.

Outcome measures

Outcome measures
Measure
Group 1: LPV/r + 2 NRTIs
n=84 Participants
Lopinavir/ritonavir (LPV/r) +2 nucleoside reverse transcriptase inhibitor (NRTI) The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be Abacavir. Stavudine will be used in the event that a participant is unable to take Abacavir for safety or other reasons.
Group 2: Nevirapine (NVP) or Efavirenz (EFV) + 2 NRTIs
n=86 Participants
NVP will be used for children \< 3 years of age and EFV for children ≥3 years of age. The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be stavudine.
Estimates of the 6-month Risk of a First Episode of Malaria
40.7 Cumulative Risk Percentage
Interval 30.9 to 52.2
52.5 Cumulative Risk Percentage
Interval 42.0 to 63.9

SECONDARY outcome

Timeframe: 28 days after antimalarial therapy

Population: The risk of recurrence was assessed among patients who had had uncomplicated malaria that had been treated with artemether-lumefantrine.

To assess the effect of potential interactions between ART and artemether-lumefantrine, the risks of recurrent parasitemia at 28 days were compared between the two groups.

Outcome measures

Outcome measures
Measure
Group 1: LPV/r + 2 NRTIs
n=84 Participants
Lopinavir/ritonavir (LPV/r) +2 nucleoside reverse transcriptase inhibitor (NRTI) The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be Abacavir. Stavudine will be used in the event that a participant is unable to take Abacavir for safety or other reasons.
Group 2: Nevirapine (NVP) or Efavirenz (EFV) + 2 NRTIs
n=86 Participants
NVP will be used for children \< 3 years of age and EFV for children ≥3 years of age. The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be stavudine.
28-day Risk of Recurrent Parasitemia
14.0 Cummulative Risk Percentage
Interval 8.7 to 22.2
40.8 Cummulative Risk Percentage
Interval 33.9 to 48.6

SECONDARY outcome

Timeframe: 28 days after antimalarial therapy

Population: The risk of recurrence was assessed among patients who had had uncomplicated malaria that had been treated with artemether-lumefantrine.

To assess the effect of potential interactions between ART and artemether-lumefantrine, the risks of recurrent malaria at 63 days were compared between the two groups.

Outcome measures

Outcome measures
Measure
Group 1: LPV/r + 2 NRTIs
n=84 Participants
Lopinavir/ritonavir (LPV/r) +2 nucleoside reverse transcriptase inhibitor (NRTI) The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be Abacavir. Stavudine will be used in the event that a participant is unable to take Abacavir for safety or other reasons.
Group 2: Nevirapine (NVP) or Efavirenz (EFV) + 2 NRTIs
n=86 Participants
NVP will be used for children \< 3 years of age and EFV for children ≥3 years of age. The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be stavudine.
63-day Risk of Recurrent Malaria
28.1 Cumulative Risk Percentage
Interval 20.2 to 38.3
54.2 Cumulative Risk Percentage
Interval 46.4 to 62.2

Adverse Events

Group 1

Serious events: 11 serious events
Other events: 41 other events
Deaths: 0 deaths

Group 2

Serious events: 9 serious events
Other events: 43 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Group 1
n=84 participants at risk
LPV/r + 2 NRTIs LPV/r + 2 NRTIs: Group 1 Lopinavir/ritonavir (LPV/r) +2 nucleoside reverse transcriptase inhibitor (NRTI) The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be Abacavir. Stavudine will be used in the event that a participant is unable to take Abacavir for safety or other reasons.
Group 2
n=86 participants at risk
NVP or EFV + 2 NRTIs NVP or EFV + 2 NRTIs: Group 2 Nevirapine (NVP) or Efavirenz (EFV) + 2 NRTI NVP will be used for children \< 3 years of age and EFV for children ≥3 years of age. The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be stavudine.
Blood and lymphatic system disorders
Anemia
2.4%
2/84 • Time from randomization to at least 24 months of follow up or until end of the study
3.5%
3/86 • Time from randomization to at least 24 months of follow up or until end of the study
Psychiatric disorders
Altered mental status
0.00%
0/84 • Time from randomization to at least 24 months of follow up or until end of the study
1.2%
1/86 • Time from randomization to at least 24 months of follow up or until end of the study
Respiratory, thoracic and mediastinal disorders
Cough
1.2%
1/84 • Time from randomization to at least 24 months of follow up or until end of the study
0.00%
0/86 • Time from randomization to at least 24 months of follow up or until end of the study
Blood and lymphatic system disorders
Dehydration
0.00%
0/84 • Time from randomization to at least 24 months of follow up or until end of the study
1.2%
1/86 • Time from randomization to at least 24 months of follow up or until end of the study
Gastrointestinal disorders
Diarrhea
1.2%
1/84 • Time from randomization to at least 24 months of follow up or until end of the study
1.2%
1/86 • Time from randomization to at least 24 months of follow up or until end of the study
Respiratory, thoracic and mediastinal disorders
Dyspnea/respiratory distress
4.8%
4/84 • Time from randomization to at least 24 months of follow up or until end of the study
3.5%
3/86 • Time from randomization to at least 24 months of follow up or until end of the study
Hepatobiliary disorders
Elevated ALT
2.4%
2/84 • Time from randomization to at least 24 months of follow up or until end of the study
2.3%
2/86 • Time from randomization to at least 24 months of follow up or until end of the study
Endocrine disorders
Elevated Temperature/Fever
2.4%
2/84 • Time from randomization to at least 24 months of follow up or until end of the study
1.2%
1/86 • Time from randomization to at least 24 months of follow up or until end of the study
Metabolism and nutrition disorders
Malnutrition
1.2%
1/84 • Time from randomization to at least 24 months of follow up or until end of the study
0.00%
0/86 • Time from randomization to at least 24 months of follow up or until end of the study
Blood and lymphatic system disorders
Neutropenia/Absolute neutrophil count
8.3%
7/84 • Time from randomization to at least 24 months of follow up or until end of the study
10.5%
9/86 • Time from randomization to at least 24 months of follow up or until end of the study
Nervous system disorders
Seizure
2.4%
2/84 • Time from randomization to at least 24 months of follow up or until end of the study
1.2%
1/86 • Time from randomization to at least 24 months of follow up or until end of the study
Renal and urinary disorders
Hypoglycemia
0.00%
0/84 • Time from randomization to at least 24 months of follow up or until end of the study
1.2%
1/86 • Time from randomization to at least 24 months of follow up or until end of the study
Skin and subcutaneous tissue disorders
Stevens-Johnson Syndrome
0.00%
0/84 • Time from randomization to at least 24 months of follow up or until end of the study
1.2%
1/86 • Time from randomization to at least 24 months of follow up or until end of the study
Blood and lymphatic system disorders
Thrombocytopenia Platelets, decreased
3.6%
3/84 • Time from randomization to at least 24 months of follow up or until end of the study
1.2%
1/86 • Time from randomization to at least 24 months of follow up or until end of the study
Metabolism and nutrition disorders
Unintentional weight loss
0.00%
0/84 • Time from randomization to at least 24 months of follow up or until end of the study
1.2%
1/86 • Time from randomization to at least 24 months of follow up or until end of the study
Gastrointestinal disorders
Vomiting
1.2%
1/84 • Time from randomization to at least 24 months of follow up or until end of the study
1.2%
1/86 • Time from randomization to at least 24 months of follow up or until end of the study

Other adverse events

Other adverse events
Measure
Group 1
n=84 participants at risk
LPV/r + 2 NRTIs LPV/r + 2 NRTIs: Group 1 Lopinavir/ritonavir (LPV/r) +2 nucleoside reverse transcriptase inhibitor (NRTI) The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be Abacavir. Stavudine will be used in the event that a participant is unable to take Abacavir for safety or other reasons.
Group 2
n=86 participants at risk
NVP or EFV + 2 NRTIs NVP or EFV + 2 NRTIs: Group 2 Nevirapine (NVP) or Efavirenz (EFV) + 2 NRTI NVP will be used for children \< 3 years of age and EFV for children ≥3 years of age. The same NRTI choice strategy will be used for both arms. Lamivudine will be used with all children. The second NRTI will be zidovudine unless the participant has a hemoglobin \< 8 gm/dL, in which case it will be stavudine.
Blood and lymphatic system disorders
Anemia
2.4%
2/84 • Time from randomization to at least 24 months of follow up or until end of the study
4.7%
4/86 • Time from randomization to at least 24 months of follow up or until end of the study
Endocrine disorders
Chills
2.4%
2/84 • Time from randomization to at least 24 months of follow up or until end of the study
0.00%
0/86 • Time from randomization to at least 24 months of follow up or until end of the study
Gastrointestinal disorders
Diarrhea
0.00%
0/84 • Time from randomization to at least 24 months of follow up or until end of the study
1.2%
1/86 • Time from randomization to at least 24 months of follow up or until end of the study
Hepatobiliary disorders
Elevated ALT
2.4%
2/84 • Time from randomization to at least 24 months of follow up or until end of the study
3.5%
3/86 • Time from randomization to at least 24 months of follow up or until end of the study
Hepatobiliary disorders
Elevated AST
1.2%
1/84 • Time from randomization to at least 24 months of follow up or until end of the study
1.2%
1/86 • Time from randomization to at least 24 months of follow up or until end of the study
Endocrine disorders
Elevated Temperature
22.6%
19/84 • Time from randomization to at least 24 months of follow up or until end of the study
27.9%
24/86 • Time from randomization to at least 24 months of follow up or until end of the study
Blood and lymphatic system disorders
Neutropenia
28.6%
24/84 • Time from randomization to at least 24 months of follow up or until end of the study
24.4%
21/86 • Time from randomization to at least 24 months of follow up or until end of the study
Skin and subcutaneous tissue disorders
Pallor
0.00%
0/84 • Time from randomization to at least 24 months of follow up or until end of the study
1.2%
1/86 • Time from randomization to at least 24 months of follow up or until end of the study
Skin and subcutaneous tissue disorders
Rash (non-infectious)
0.00%
0/84 • Time from randomization to at least 24 months of follow up or until end of the study
1.2%
1/86 • Time from randomization to at least 24 months of follow up or until end of the study
Metabolism and nutrition disorders
Severe Malnutrition
0.00%
0/84 • Time from randomization to at least 24 months of follow up or until end of the study
1.2%
1/86 • Time from randomization to at least 24 months of follow up or until end of the study
Blood and lymphatic system disorders
Thrombocytopenia Platelets, decreased
10.7%
9/84 • Time from randomization to at least 24 months of follow up or until end of the study
7.0%
6/86 • Time from randomization to at least 24 months of follow up or until end of the study
Metabolism and nutrition disorders
Unintentional weight loss
1.2%
1/84 • Time from randomization to at least 24 months of follow up or until end of the study
0.00%
0/86 • Time from randomization to at least 24 months of follow up or until end of the study
Blood and lymphatic system disorders
WBC, decreased
1.2%
1/84 • Time from randomization to at least 24 months of follow up or until end of the study
2.3%
2/86 • Time from randomization to at least 24 months of follow up or until end of the study

Additional Information

Tamara Clark

University of California, San Francisco

Phone: 415-206-8790

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place