Perinatal Antiretroviral Intensification for PMTCT of HIV in Late Comers

NCT ID: NCT01511237

Last Updated: 2021-10-22

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

Clinical Phase

PHASE3

Total Enrollment

379 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-12-31

Study Completion Date

2017-03-31

Brief Summary

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The purpose is to evaluate the efficacy of maternal and infant perinatal antiretroviral prophylaxis intensification for the prevention of mother-to-child intrapartum transmission of HIV-1 in women receiving less than 8 weeks of antiretroviral prophylaxis during pregnancy.

Detailed Description

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Design: a multicenter, phase III, single-arm trial.

Perinatal antiretroviral intensification (study treatment) is defined as the addition to the standard of care\* for mothers and infants of:

* Mothers: One NVP 200 mg tablet at onset of labor with continuation of HAART for four weeks postpartum
* Newborn: AZT+3TC+ NVP for 2 weeks, followed by AZT+3TC for 2 weeks:

* NVP syrup 2 mg/kg every 24 hours for seven days, followed by NVP syrup 4 mg/kg every 24 hours for seven days. Newborns less than 2500 g will be administered 2mg/kg NVP syrup at each intake
* AZT syrup 4 mg/ kg will be given every 12 hours for four weeks (preterm infants less than 30 weeks will be administered 2 mg/kg every 12 hours; preterm 30-35 weeks will receive 2 mg/kg every 12 hours for the first 2 weeks, increased to 3 mg/kg for the next 2 weeks).
* 3TC syrup 2 mg/kg every 12 hours for four weeks.

* The standard of care in Thailand is defined as:
* Maternal antiretroviral treatment: ZDV 300 mg, 3TC 150mg and LPV/r 400/100 twice a day starting as soon possible after 14 weeks of pregnancy + ZDV 300 mg every 3 hours during labor; this treatment may be continued, stopped or modified after delivery upon the recommendation of the internist.
* Newborn: ZDV 4 mg/kg every 12 hours for 4 weeks (ZDV dosing adjusted for premature infants).

Conditions

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HIV Infections

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Perinatal intensification

Perinatal antiretroviral intensification (study treatment):

* Mothers: One NVP 200 mg tablet at onset of labor with continuation of HAART for four weeks postpartum
* Newborn: AZT+3TC+ NVP for 2 weeks, followed by AZT+3TC for 2 weeks

The standard of care in Thailand is defined as:

* Maternal: ZDV 300 mg, 3TC 150mg and LPV/r 400/100 twice a day starting as soon possible after 14 weeks of pregnancy + ZDV 300 mg every 3 hours during labor
* Newborn: ZDV 4 mg/kg every 12 hours for 4 weeks (ZDV dosing adjusted for premature infants).

Group Type EXPERIMENTAL

Nevirapine, zidovudine, lamivudine

Intervention Type DRUG

* Mothers: One NVP 200 mg tablet at onset of labor with continuation of HAART for four weeks postpartum
* Newborn: AZT+3TC+ NVP for 2 weeks, followed by AZT+3TC for 2 weeks:

* NVP syrup 2 mg/kg every 24 hours for seven days, followed by NVP syrup 4 mg/kg every 24 hours for seven days. Newborns less than 2500 g will be administered 2mg/kg NVP syrup at each intake
* AZT syrup 4 mg/ kg will be given every 12 hours for four weeks (preterm infants less than 30 weeks will be administered 2 mg/kg every 12 hours; preterm 30-35 weeks will receive 2 mg/kg every 12 hours for the first 2 weeks, increased to 3 mg/kg for the next 2 weeks).
* 3TC syrup 2 mg/kg every 12 hours for four weeks.

Interventions

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Nevirapine, zidovudine, lamivudine

* Mothers: One NVP 200 mg tablet at onset of labor with continuation of HAART for four weeks postpartum
* Newborn: AZT+3TC+ NVP for 2 weeks, followed by AZT+3TC for 2 weeks:

* NVP syrup 2 mg/kg every 24 hours for seven days, followed by NVP syrup 4 mg/kg every 24 hours for seven days. Newborns less than 2500 g will be administered 2mg/kg NVP syrup at each intake
* AZT syrup 4 mg/ kg will be given every 12 hours for four weeks (preterm infants less than 30 weeks will be administered 2 mg/kg every 12 hours; preterm 30-35 weeks will receive 2 mg/kg every 12 hours for the first 2 weeks, increased to 3 mg/kg for the next 2 weeks).
* 3TC syrup 2 mg/kg every 12 hours for four weeks.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Evidence of HIV infection, as documented by two serology tests obtained at two different dates;
* All HIV infected pregnant women will be enrolled, either in the intervention arm or an observational study group.

* Women more than 30 weeks gestational age at start of antiretroviral treatment will be eligible for the intervention. They will actually receive the study intervention if they present in labor after less than 8 weeks of treatment duration;
* Women with no ANC will receive standard care and will be enrolled in an observational study group(and their infant will receive standard of care perinatal antiretroviral intensification)
* Women with less than 30 weeks gestational age at start of treatment will receive standard care and will also be enrolled in the Observational Reference group;
* Agreement not to breastfeed;
* Consent to participate and to be followed for the duration of the study

Exclusion Criteria

* Evidence of pre-existing fetal anomalies incompatible with life;
* Concurrent participation to any other clinical trial without prior agreement of the two study teams
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Harvard School of Public Health (HSPH)

OTHER

Sponsor Role collaborator

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NIH

Sponsor Role collaborator

Institut de Recherche pour le Developpement

OTHER_GOV

Sponsor Role lead

Responsible Party

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Marc Lallemant

Senior Researcher

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Marc Lallemant, MD

Role: PRINCIPAL_INVESTIGATOR

Institut de Recherche pour le Developpement

Locations

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Prapokklao Hospital

Chanthaburi, Changwat Chanthaburi, Thailand

Site Status

Mae Chan Hospital

Mae Chan, Changwat Chiang Rai, Thailand

Site Status

Phan Hospital

Phan, Changwat Chiang Rai, Thailand

Site Status

Banglamung Hospital

Bang Lamung, Changwat Chon Buri, Thailand

Site Status

Chonburi Hospital

Chon Buri, Changwat Chon Buri, Thailand

Site Status

Panasnikom Hospital

Chon Buri, Changwat Chon Buri, Thailand

Site Status

Chiang Kham Hospital

Chiang Kham, Changwat Phayao, Thailand

Site Status

Buddhachinaraj Hospital

Phitsanulok, Changwat Phitsanulok, Thailand

Site Status

Hat Yai Hospital

Hat Yai, Changwat Songkhla, Thailand

Site Status

Chomthong Hospital

Chom Thong, Chiang Mai, Thailand

Site Status

Fang Hospital

Fang, Chiang Mai, Thailand

Site Status

Nakornping Hospital

Mae Rim, Chiang Mai, Thailand

Site Status

Sanpatong Hospital

San Pa Tong, Chiang Mai, Thailand

Site Status

Chiangrai Prachanukroh Hospital

Chiang Rai, Chiangrai, Thailand

Site Status

Wiangpapao Hospital

Chiang Rai, Chiangrai, Thailand

Site Status

Chiang Saen Hospital

Chiang Saen, Chiangrai, Thailand

Site Status

Mahasarakam Hospital

Maha Sarakham, Mahasarakam, Thailand

Site Status

Nakhonpathom Hospital

Nakhon Pathom, Nakhonpathom, Thailand

Site Status

Samutprakarn Hospital

Mueang Samut Prakan, Samutprakarn, Thailand

Site Status

Samutsakhon Hospital

Samut Sakhon, Samutsakhon, Thailand

Site Status

Bhumibol Adulyadej Hospital

Bangkok, , Thailand

Site Status

Nopparat Rajathanee Hospital

Bangkok, , Thailand

Site Status

Bhuddasothorn Hospital

Chachoengsao, , Thailand

Site Status

Health Promotion Center Region 10, Chiang Mai

Chiang Mai, , Thailand

Site Status

Kalasin Hospital

Kalasin, , Thailand

Site Status

Khon Kaen Hospital

Khon Kaen, , Thailand

Site Status

Regional Health Promotion Centre 6, Khon Kaen

Khon Kaen, , Thailand

Site Status

Lampang Hospital

Lampang, , Thailand

Site Status

Lamphun Hospital

Lamphun, , Thailand

Site Status

Maharaj Nakhon Si Thammarat Hospital

Nakhon Si Thammarat, , Thailand

Site Status

Nong Khai Hospital

Nong Khai, , Thailand

Site Status

Pranangklao Hospital

Nonthaburi, , Thailand

Site Status

Phayao Provincial Hospital

Phayao, , Thailand

Site Status

Vachira Phuket Hospital

Phuket, , Thailand

Site Status

Rayong Hospital

Rayong, , Thailand

Site Status

Songkhla Hospital

Songkhla, , Thailand

Site Status

Countries

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Thailand

References

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Cressey TR, Punyawudho B, Le Coeur S, Jourdain G, Saenjum C, Capparelli EV, Jittayanun K, Phanomcheong S, Luvira A, Borkird T, Puangsombat A, Aarons L, Sukrakanchana PO, Urien S, Lallemant M; PHPT-5 study team. Assessment of Nevirapine Prophylactic and Therapeutic Dosing Regimens for Neonates. J Acquir Immune Defic Syndr. 2017 Aug 15;75(5):554-560. doi: 10.1097/QAI.0000000000001447.

Reference Type BACKGROUND
PMID: 28489732 (View on PubMed)

Lallemant Marc, Amzal Billy, Urien Saik, Sripan Patumrat, Cressey Tim R, Ngo-Giang-Huong Nicole, Rawangban Boonsong, Sabsanong Prapan, Siriwachirachai Thitiporn, Jarupanich Tapnarong, Kanjanavikai Prateep, Wanasiri Phaiboon, Koetsawang Suporn, Jourdain Gonzague, Le Cœur Sophie, for the PHPT-5 team. 2015. -"Antiretroviral Intensification to Prevent Intrapartum HIV Transmission in Late Comers". 8th IAS Conference on HIV Pathogenesis Treatment & Prevention, Vancouver, Canada, 19-22 July 2015.

Reference Type RESULT

Lallemant M, Amzal B, Sripan P, Urien S, Cressey TR, Ngo-Giang-Huong N, Klinbuayaem V, Rawangban B, Sabsanong P, Siriwachirachai T, Jarupanich T, Kanjanavikai P, Wanasiri P, Koetsawang S, Jourdain G, Le Coeur S; PHPT-5 site investigators. Perinatal Antiretroviral Intensification to Prevent Intrapartum HIV Transmission When Antenatal Antiretroviral Therapy Is Initiated Less Than 8 Weeks Before Delivery. J Acquir Immune Defic Syndr. 2020 Jul 1;84(3):313-322. doi: 10.1097/QAI.0000000000002350.

Reference Type RESULT
PMID: 32205720 (View on PubMed)

Related Links

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Other Identifiers

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R01HD052461

Identifier Type: NIH

Identifier Source: secondary_id

View Link

R01HD056953

Identifier Type: NIH

Identifier Source: secondary_id

View Link

PHPT-5 Second Phase

Identifier Type: -

Identifier Source: org_study_id