Safety and Efficacy of the Universal Use of EFV-TDF-FTC and AZT-3TC-LPV/r Combinations in Pregnant and Breastfeeding Women to Prevent mother-to Child Transmission of HIV-1 o, Resource-limited Settings: A Multicentre Randomized Phase 3 Clinical Trial
试验速览
- 阶段
- 3 期
- 状态
- 撤回
- 发起方
- 试验地点
- 2
- 主要终点
- cumulative occurence of : -adverse pregnancy outcomes (spontaneous abortion, stillbirth, congenital abnormality requiring surgical correction in children < 1 yr of age); -paediatric HIV infection; -infant mortality
研究概览
简要总结
To assess the maternal and infant safety of a single daily fixed-dose combination of TDF/FTC/EFV (Atripla®), compared to the association of LPV/r (Kaletra® or Aluvia®) and 3TC/ZDV (Combivir®) given to African women to prevent overall MTCT in populations practicing breastfeeding.
详细描述
The prevention of MTCT during pregnancy and through breastfeeding exposure remains challenging to date in most resource-limited settings. Peripartum HIV transmission is already amenable to ARV interventions. These ARV regimens, partially efficacious are insufficiently used despite their apparent simplicity. The postnatal transmission via breastfeeding remains a serious additional threat.
This is a multicentric, non-inferiority, randomized controlled trial aiming at assessing the maternal and infant safety of a single daily fixed-dose combination of TDF/FTC/EFV (Atripla®), compared to the association of LPV/r (Kaletra® or Aluvia®) and 3TC/ZDV (Combivir®) given to African women (in Cote d'Ivoire an in Zambia) to prevent MTCT overall in breastfeeding population.
The fixed-dose combination of Tenofovir/Emtricitabine/Efavirenz (TDF/FTC/EFV or Atripla®) is a highly effective HAART combination and the simplest ARV regimen currently available in resource-limited settings and is therefore likely to become soon the lead first-line HAART regimen for adults in such settings. Its anticipated widespread prescription in women of childbearing age requires the proper documentation of its use in pregnancy and during breastfeeding.
The combination of ZDV/3TC (Combivir®) and Lopinavir/ritonavir (LPV/r) (Kaletra® or Aluvia®) is chosen as a reference regimen as it is one of the most commonly used first-line HAART for adults and the reference regimen for PMTCT in industrialised settings.
The maternal ARV regimen will be initiated as soon as possible from 20 weeks of gestation until at least the cessation of breastfeeding (with the advice to cease at six months). The decision to stop or continue the maternal ARV regimen after breastfeeding cessation will be based on the baseline maternal CD4 count and the maternal clinical stage at baseline and/or at breastfeeding cessation. A woman with a baseline CD4 <500 cells/ml will always be proposed to continue her treatment after breastfeeding cessation. A woman with a baseline CD4 count >500 will be asked to stop her treatment after breastfeeding cessation unless she has reached the WHO clinical stage IV at that time.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •being pregnant, presenting in at least the 20th week of pregnancy and no later than 2 weeks before the expected term;
- •at least 18 years of age;
- •diagnosed as infected with HIV-1 only;
- •not currently taking any ARV drugs;
- •having not been exposed to NVP in the 6 months preceding enrolment;
- •willing to breastfeed their forthcoming child;
- •residing and planning to continue to reside within the predefined catchment areas until 12 months after delivery;
- •being able to give informed consent for enrolment in the study;
- •lacking any medical contraindication to any of the proposed ARV medications;
- •and accepting the principle of being randomized to receive one of the ARV regimens evaluated within the study, to prevent MTCT and for their own health when required.
排除标准
- •presenting within 2 weeks before the expected term;
- •currently taking ARV drugs;
- •having been exposed to NVP in the 6 months preceding enrolment;
- •not willing to breastfeed their forthcoming child;
- •having severe renal insufficiency (creatin clearance < 60ml/min);
- •diagnosed as infected with HIV-2 only or dually infected HIV-1 and HIV-2;
- •hemoglobin < 7 g/dL in the month preceding inclusion
- •HBs Ag positive
- •Women meeting one of the three last exclusion criteria (HIV-2 infection or co-infection, hemoglobin < 7 g/dL, HBs Ag positive) will not be randomized but will all received Atripla and be followed-up in an ancillary open cohort according the same procedures and agenda.
研究组 & 干预措施
Atripla (R)
干预措施: Efavirenz-Tenofovir-Emtricitabine (Drug)
Combivir (R) + Kaletra (R) or Aluvia (R)
干预措施: Zidovudine-Lamivudine-Lopinavir/Ritonavir (Drug)
结局指标
主要结局
cumulative occurence of : -adverse pregnancy outcomes (spontaneous abortion, stillbirth, congenital abnormality requiring surgical correction in children < 1 yr of age); -paediatric HIV infection; -infant mortality
时间窗: at 6 and 12 months following delivery/birth
次要结局
- occurence of grade 4 events in treated women, and of grade 3 or 4 events in ARV-exposed infants(at 6 and 12 months following delivery/birth)
- frequency of virological failure (>300 copies/mL) and viral resistance profile(at 6 month and 12 months post-delivery)
- frequency of premature delivery (<37 weeks) and frequency of low birth weight (<2500 g)(at delivery/birth)
- cumulative incidence of paediatric HIV infection(at 12 months after delivery)
- tolerability of the ARV combination in treated women(at 6 and 12 months following delivery/birth)