Trial Outcomes & Findings for Daily Trimethoprim-sulfamethoxazole or Weekly Chloroquine Among Adults on ART in Malawi (NCT NCT01650558)

NCT ID: NCT01650558

Last Updated: 2022-07-28

Results Overview

Incidence of severe events (composite of death and WHO stage 3 and 4 illness)

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

1499 participants

Primary outcome timeframe

22-66 months

Results posted on

2022-07-28

Participant Flow

Participant milestones

Participant milestones
Measure
Standard of Care Trimethoprim Sulfamethoxazol (TS) Prophylaxis
Participants will continue standard of care daily TS prophylaxis (two tablets each of 80 mg trimethoprim and 400 mg sulfamethoxazole or one tablet each of 160 mg trimethoprim and 800 mg sulfamethoxazole).
Chloroquine (CQ) Prophylaxis
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and start weekly CQ prophylaxis at 300 mg.
Discontinuation of Standard of Care (Control Arm)
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and receive no prophylaxis.
Overall Study
STARTED
500
500
499
Overall Study
COMPLETED
417
408
424
Overall Study
NOT COMPLETED
83
92
75

Reasons for withdrawal

Reasons for withdrawal
Measure
Standard of Care Trimethoprim Sulfamethoxazol (TS) Prophylaxis
Participants will continue standard of care daily TS prophylaxis (two tablets each of 80 mg trimethoprim and 400 mg sulfamethoxazole or one tablet each of 160 mg trimethoprim and 800 mg sulfamethoxazole).
Chloroquine (CQ) Prophylaxis
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and start weekly CQ prophylaxis at 300 mg.
Discontinuation of Standard of Care (Control Arm)
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and receive no prophylaxis.
Overall Study
Migration out of study area
61
71
56
Overall Study
Lost to Follow-up
10
13
6
Overall Study
Death
10
6
8
Overall Study
Withdrawal by Subject
1
1
3
Overall Study
Non-compliant participant
1
0
2
Overall Study
Physician Decision
0
1
0

Baseline Characteristics

Daily Trimethoprim-sulfamethoxazole or Weekly Chloroquine Among Adults on ART in Malawi

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Standard of Care Trimethoprim Sulfamethoxazol (TS) Prophylaxis
n=500 Participants
Participants will continue standard of care daily TS prophylaxis (two tablets each of 80 mg trimethoprim and 400 mg sulfamethoxazole or one tablet each of 160 mg trimethoprim and 800 mg sulfamethoxazole).
Chloroquine (CQ) Prophylaxis
n=500 Participants
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and start weekly CQ prophylaxis at 300 mg..
Discontinuation of Standard of Care (Control Arm)
n=499 Participants
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and receive no prophylaxis.
Total
n=1499 Participants
Total of all reporting groups
Age, Categorical
<=18 years
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
Age, Categorical
Between 18 and 65 years
494 Participants
n=5 Participants
496 Participants
n=7 Participants
480 Participants
n=5 Participants
1470 Participants
n=4 Participants
Age, Categorical
>=65 years
6 Participants
n=5 Participants
4 Participants
n=7 Participants
19 Participants
n=5 Participants
29 Participants
n=4 Participants
Age, Continuous
39.1 years
STANDARD_DEVIATION 9.7 • n=5 Participants
38.7 years
STANDARD_DEVIATION 9.6 • n=7 Participants
39.4 years
STANDARD_DEVIATION 10.1 • n=5 Participants
39.1 years
STANDARD_DEVIATION 9.8 • n=4 Participants
Sex: Female, Male
Female
375 Participants
n=5 Participants
374 Participants
n=7 Participants
386 Participants
n=5 Participants
1135 Participants
n=4 Participants
Sex: Female, Male
Male
125 Participants
n=5 Participants
126 Participants
n=7 Participants
113 Participants
n=5 Participants
364 Participants
n=4 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
Race (NIH/OMB)
Asian
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
Race (NIH/OMB)
Black or African American
500 Participants
n=5 Participants
500 Participants
n=7 Participants
499 Participants
n=5 Participants
1499 Participants
n=4 Participants
Race (NIH/OMB)
White
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
Region of Enrollment
Malawi
500 participants
n=5 Participants
500 participants
n=7 Participants
499 participants
n=5 Participants
1499 participants
n=4 Participants

PRIMARY outcome

Timeframe: 22-66 months

Incidence of severe events (composite of death and WHO stage 3 and 4 illness)

Outcome measures

Outcome measures
Measure
Standard of Care Trimethoprim Sulfamethoxazol (TS) Prophylaxis
n=500 Participants
Participants will continue standard of care daily TS prophylaxis (two tablets each of 80 mg trimethoprim and 400 mg sulfamethoxazole or one tablet each of 160 mg trimethoprim and 800 mg sulfamethoxazole).
Chloroquine (CQ) Prophylaxis
n=500 Participants
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and start weekly CQ prophylaxis at 300 mg.
Discontinuation of Standard of Care (Control Arm)
n=499 Participants
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and receive no prophylaxis.
Severe Events
3.3 Events per 100 participant-years
4.2 Events per 100 participant-years
4.2 Events per 100 participant-years

SECONDARY outcome

Timeframe: Throughout study participation, measured every six months (2-5.5 years).

Number of participants who ever have a detectable viral load (\>400 copies/ml).

Outcome measures

Outcome measures
Measure
Standard of Care Trimethoprim Sulfamethoxazol (TS) Prophylaxis
n=500 Participants
Participants will continue standard of care daily TS prophylaxis (two tablets each of 80 mg trimethoprim and 400 mg sulfamethoxazole or one tablet each of 160 mg trimethoprim and 800 mg sulfamethoxazole).
Chloroquine (CQ) Prophylaxis
n=500 Participants
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and start weekly CQ prophylaxis at 300 mg.
Discontinuation of Standard of Care (Control Arm)
n=499 Participants
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and receive no prophylaxis.
Number of Participants With at Least One Detectable HIV Viral Load
24 Participants
36 Participants
33 Participants

SECONDARY outcome

Timeframe: Every 6 months for 22-66 months

Number of Participants with at Least One CD4 Count \<200

Outcome measures

Outcome measures
Measure
Standard of Care Trimethoprim Sulfamethoxazol (TS) Prophylaxis
n=500 Participants
Participants will continue standard of care daily TS prophylaxis (two tablets each of 80 mg trimethoprim and 400 mg sulfamethoxazole or one tablet each of 160 mg trimethoprim and 800 mg sulfamethoxazole).
Chloroquine (CQ) Prophylaxis
n=500 Participants
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and start weekly CQ prophylaxis at 300 mg.
Discontinuation of Standard of Care (Control Arm)
n=499 Participants
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and receive no prophylaxis.
CD4 Cell Count
24 Participants
23 Participants
27 Participants

SECONDARY outcome

Timeframe: 32-66 months

Incidence of any WHO HIV stage 2, 3, or 4 illness

Outcome measures

Outcome measures
Measure
Standard of Care Trimethoprim Sulfamethoxazol (TS) Prophylaxis
n=500 Participants
Participants will continue standard of care daily TS prophylaxis (two tablets each of 80 mg trimethoprim and 400 mg sulfamethoxazole or one tablet each of 160 mg trimethoprim and 800 mg sulfamethoxazole).
Chloroquine (CQ) Prophylaxis
n=500 Participants
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and start weekly CQ prophylaxis at 300 mg.
Discontinuation of Standard of Care (Control Arm)
n=499 Participants
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and receive no prophylaxis.
WHO HIV Stage 2, 3, 4 Illness
4.0 Events per 100 participant-years
5.7 Events per 100 participant-years
5.8 Events per 100 participant-years

SECONDARY outcome

Timeframe: 32-66 months

Incidence of bacterial infections and malaria

Outcome measures

Outcome measures
Measure
Standard of Care Trimethoprim Sulfamethoxazol (TS) Prophylaxis
n=500 Participants
Participants will continue standard of care daily TS prophylaxis (two tablets each of 80 mg trimethoprim and 400 mg sulfamethoxazole or one tablet each of 160 mg trimethoprim and 800 mg sulfamethoxazole).
Chloroquine (CQ) Prophylaxis
n=500 Participants
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and start weekly CQ prophylaxis at 300 mg.
Discontinuation of Standard of Care (Control Arm)
n=499 Participants
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and receive no prophylaxis.
Bacterial Infections and Malaria
27.8 Events per 100 participant-years
37.4 Events per 100 participant-years
36.3 Events per 100 participant-years

SECONDARY outcome

Timeframe: 32-66 months

Occurrence of adverse events that are greater than or equal to Grade 3 that require discontinuation of TS or CQ prophylaxis

Outcome measures

Outcome measures
Measure
Standard of Care Trimethoprim Sulfamethoxazol (TS) Prophylaxis
n=500 Participants
Participants will continue standard of care daily TS prophylaxis (two tablets each of 80 mg trimethoprim and 400 mg sulfamethoxazole or one tablet each of 160 mg trimethoprim and 800 mg sulfamethoxazole).
Chloroquine (CQ) Prophylaxis
n=500 Participants
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and start weekly CQ prophylaxis at 300 mg.
Discontinuation of Standard of Care (Control Arm)
n=499 Participants
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and receive no prophylaxis.
Adverse Events Greater Than or Equal to Grade 3 That Are Related to the Study Product
0 Events per 100 participant-years
0.24 Events per 100 participant-years
0 Events per 100 participant-years

OTHER_PRE_SPECIFIED outcome

Timeframe: 32-66 months

Occurrence of bacterial or malaria infection with CQ or TS resistant organism

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: 32-66 months

Clinical and parasitological response to antimalarial therapy in cases of uncomplicated malaria

Outcome measures

Outcome data not reported

Adverse Events

Standard of Care Trimethoprim Sulfamethoxazo (TS) Prophylaxis

Serious events: 72 serious events
Other events: 488 other events
Deaths: 10 deaths

Chloroquine (CQ) Prophylaxis

Serious events: 99 serious events
Other events: 483 other events
Deaths: 6 deaths

Discontinuation of Standard of Care (Control Arm)

Serious events: 116 serious events
Other events: 488 other events
Deaths: 8 deaths

Serious adverse events

Serious adverse events
Measure
Standard of Care Trimethoprim Sulfamethoxazo (TS) Prophylaxis
n=500 participants at risk
Participants will continue standard of care daily TS prophylaxis (two tablets each of 80 mg trimethoprim and 400 mg sulfamethoxazole or one tablet each of 160 mg trimethoprim and 800 mg sulfamethoxazole).
Chloroquine (CQ) Prophylaxis
n=500 participants at risk
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and start weekly CQ prophylaxis at 300 mg.
Discontinuation of Standard of Care (Control Arm)
n=499 participants at risk
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and receive no prophylaxis.
Infections and infestations
Infections
4.4%
22/500 • Number of events 24 • 2 to 5.5 years
6.4%
32/500 • Number of events 36 • 2 to 5.5 years
8.0%
40/499 • Number of events 48 • 2 to 5.5 years
Pregnancy, puerperium and perinatal conditions
Pregnancy, puerperium and perinatal
3.0%
15/500 • Number of events 21 • 2 to 5.5 years
5.2%
26/500 • Number of events 29 • 2 to 5.5 years
5.8%
29/499 • Number of events 32 • 2 to 5.5 years
Nervous system disorders
Nervous
1.8%
9/500 • Number of events 9 • 2 to 5.5 years
2.2%
11/500 • Number of events 20 • 2 to 5.5 years
1.4%
7/499 • Number of events 8 • 2 to 5.5 years
Injury, poisoning and procedural complications
Injuries
2.0%
10/500 • Number of events 10 • 2 to 5.5 years
1.4%
7/500 • Number of events 7 • 2 to 5.5 years
0.60%
3/499 • Number of events 3 • 2 to 5.5 years
Gastrointestinal disorders
Gastrointestinal
0.60%
3/500 • Number of events 3 • 2 to 5.5 years
1.6%
8/500 • Number of events 8 • 2 to 5.5 years
1.6%
8/499 • Number of events 9 • 2 to 5.5 years
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Neoplasms
0.80%
4/500 • Number of events 5 • 2 to 5.5 years
1.0%
5/500 • Number of events 5 • 2 to 5.5 years
1.8%
9/499 • Number of events 9 • 2 to 5.5 years
Surgical and medical procedures
Surgical and medical
1.0%
5/500 • Number of events 5 • 2 to 5.5 years
1.2%
6/500 • Number of events 6 • 2 to 5.5 years
1.2%
6/499 • Number of events 6 • 2 to 5.5 years
General disorders
General
0.40%
2/500 • Number of events 2 • 2 to 5.5 years
0.80%
4/500 • Number of events 6 • 2 to 5.5 years
1.2%
6/499 • Number of events 6 • 2 to 5.5 years
Reproductive system and breast disorders
Reproductive system
0.60%
3/500 • Number of events 3 • 2 to 5.5 years
1.2%
6/500 • Number of events 7 • 2 to 5.5 years
0.60%
3/499 • Number of events 3 • 2 to 5.5 years
Respiratory, thoracic and mediastinal disorders
Respiratory
0.40%
2/500 • Number of events 2 • 2 to 5.5 years
0.60%
3/500 • Number of events 4 • 2 to 5.5 years
0.60%
3/499 • Number of events 5 • 2 to 5.5 years
Blood and lymphatic system disorders
Blood
0.80%
4/500 • Number of events 4 • 2 to 5.5 years
0.20%
1/500 • Number of events 2 • 2 to 5.5 years
0.40%
2/499 • Number of events 2 • 2 to 5.5 years
Psychiatric disorders
Psychiatric
0.20%
1/500 • Number of events 1 • 2 to 5.5 years
0.60%
3/500 • Number of events 3 • 2 to 5.5 years
0.40%
2/499 • Number of events 2 • 2 to 5.5 years
Eye disorders
Eye
0.20%
1/500 • Number of events 1 • 2 to 5.5 years
0.20%
1/500 • Number of events 1 • 2 to 5.5 years
0.40%
2/499 • Number of events 2 • 2 to 5.5 years
Vascular disorders
Vascular
0.00%
0/500 • 2 to 5.5 years
0.00%
0/500 • 2 to 5.5 years
0.80%
4/499 • Number of events 4 • 2 to 5.5 years
Metabolism and nutrition disorders
Metabolism
0.00%
0/500 • 2 to 5.5 years
0.40%
2/500 • Number of events 2 • 2 to 5.5 years
0.20%
1/499 • Number of events 1 • 2 to 5.5 years
Cardiac disorders
Cardiac
0.20%
1/500 • Number of events 1 • 2 to 5.5 years
0.20%
1/500 • Number of events 1 • 2 to 5.5 years
0.00%
0/499 • 2 to 5.5 years
Endocrine disorders
Endocrine
0.20%
1/500 • Number of events 1 • 2 to 5.5 years
0.00%
0/500 • 2 to 5.5 years
0.20%
1/499 • Number of events 1 • 2 to 5.5 years
Hepatobiliary disorders
Hepatobiliary
0.40%
2/500 • Number of events 2 • 2 to 5.5 years
0.00%
0/500 • 2 to 5.5 years
0.00%
0/499 • 2 to 5.5 years
Musculoskeletal and connective tissue disorders
Musculoskeletal
0.20%
1/500 • Number of events 1 • 2 to 5.5 years
0.20%
1/500 • Number of events 1 • 2 to 5.5 years
0.00%
0/499 • 2 to 5.5 years
Renal and urinary disorders
Renal
0.40%
2/500 • Number of events 2 • 2 to 5.5 years
0.00%
0/500 • 2 to 5.5 years
0.00%
0/499 • 2 to 5.5 years

Other adverse events

Other adverse events
Measure
Standard of Care Trimethoprim Sulfamethoxazo (TS) Prophylaxis
n=500 participants at risk
Participants will continue standard of care daily TS prophylaxis (two tablets each of 80 mg trimethoprim and 400 mg sulfamethoxazole or one tablet each of 160 mg trimethoprim and 800 mg sulfamethoxazole).
Chloroquine (CQ) Prophylaxis
n=500 participants at risk
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and start weekly CQ prophylaxis at 300 mg.
Discontinuation of Standard of Care (Control Arm)
n=499 participants at risk
Participants will discontinue standard of care trimethoprim sulfamethoxazol prophylaxis and receive no prophylaxis.
Infections and infestations
Infections
82.8%
414/500 • 2 to 5.5 years
85.6%
428/500 • 2 to 5.5 years
88.8%
443/499 • 2 to 5.5 years
General disorders
General
60.8%
304/500 • 2 to 5.5 years
53.4%
267/500 • 2 to 5.5 years
62.5%
312/499 • 2 to 5.5 years
Investigations
Investigations
59.6%
298/500 • 2 to 5.5 years
61.4%
307/500 • 2 to 5.5 years
55.7%
278/499 • 2 to 5.5 years
Gastrointestinal disorders
Gastrointestinal
49.6%
248/500 • 2 to 5.5 years
48.6%
243/500 • 2 to 5.5 years
58.3%
291/499 • 2 to 5.5 years
Musculoskeletal and connective tissue disorders
Musculoskeletal
51.2%
256/500 • 2 to 5.5 years
44.6%
223/500 • 2 to 5.5 years
52.9%
264/499 • 2 to 5.5 years
Blood and lymphatic system disorders
Blood
48.0%
240/500 • 2 to 5.5 years
44.4%
222/500 • 2 to 5.5 years
41.1%
205/499 • 2 to 5.5 years
Nervous system disorders
Nervous
43.4%
217/500 • 2 to 5.5 years
41.8%
209/500 • 2 to 5.5 years
44.9%
224/499 • 2 to 5.5 years
Skin and subcutaneous tissue disorders
Skin
28.0%
140/500 • 2 to 5.5 years
26.6%
133/500 • 2 to 5.5 years
27.7%
138/499 • 2 to 5.5 years
Eye disorders
Eye
24.4%
122/500 • 2 to 5.5 years
26.0%
130/500 • 2 to 5.5 years
25.3%
126/499 • 2 to 5.5 years
Reproductive system and breast disorders
Reproductive system
17.0%
85/500 • 2 to 5.5 years
18.8%
94/500 • 2 to 5.5 years
18.6%
93/499 • 2 to 5.5 years
Injury, poisoning and procedural complications
Injuries
17.0%
85/500 • 2 to 5.5 years
16.4%
82/500 • 2 to 5.5 years
15.8%
79/499 • 2 to 5.5 years
Respiratory, thoracic and mediastinal disorders
Respiratory
11.8%
59/500 • 2 to 5.5 years
13.0%
65/500 • 2 to 5.5 years
11.8%
59/499 • 2 to 5.5 years
Vascular disorders
Vascular
3.4%
17/500 • 2 to 5.5 years
5.8%
29/500 • 2 to 5.5 years
6.2%
31/499 • 2 to 5.5 years
Pregnancy, puerperium and perinatal conditions
Pregnancy, puerperium and perinatal
3.4%
17/500 • 2 to 5.5 years
5.4%
27/500 • 2 to 5.5 years
5.8%
29/499 • 2 to 5.5 years
Metabolism and nutrition disorders
Metabolism
4.6%
23/500 • 2 to 5.5 years
5.2%
26/500 • 2 to 5.5 years
4.4%
22/499 • 2 to 5.5 years
Ear and labyrinth disorders
Ear and labyrinth
3.6%
18/500 • 2 to 5.5 years
4.8%
24/500 • 2 to 5.5 years
3.6%
18/499 • 2 to 5.5 years
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Neoplasms
3.0%
15/500 • 2 to 5.5 years
4.6%
23/500 • 2 to 5.5 years
3.2%
16/499 • 2 to 5.5 years
Cardiac disorders
Cardiac
2.6%
13/500 • 2 to 5.5 years
3.0%
15/500 • 2 to 5.5 years
3.8%
19/499 • 2 to 5.5 years
Renal and urinary disorders
Renal
2.2%
11/500 • 2 to 5.5 years
3.4%
17/500 • 2 to 5.5 years
3.8%
19/499 • 2 to 5.5 years
Psychiatric disorders
Psychiatric
1.4%
7/500 • 2 to 5.5 years
2.0%
10/500 • 2 to 5.5 years
1.0%
5/499 • 2 to 5.5 years
Surgical and medical procedures
Surgical and medical
1.2%
6/500 • 2 to 5.5 years
1.2%
6/500 • 2 to 5.5 years
1.4%
7/499 • 2 to 5.5 years
Hepatobiliary disorders
Hepatobiliary
0.40%
2/500 • 2 to 5.5 years
0.40%
2/500 • 2 to 5.5 years
0.60%
3/499 • 2 to 5.5 years
Endocrine disorders
Endocrine
0.20%
1/500 • 2 to 5.5 years
0.20%
1/500 • 2 to 5.5 years
0.40%
2/499 • 2 to 5.5 years
Congenital, familial and genetic disorders
Congenital, familial and genetic
0.00%
0/500 • 2 to 5.5 years
0.20%
1/500 • 2 to 5.5 years
0.20%
1/499 • 2 to 5.5 years

Additional Information

Miriam K. Laufer, M.D., M.P.H.

University of Maryland School of Medicine

Phone: 410-706-5333

Results disclosure agreements

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