HIV Infections, Pregnancy
Conditions
Keywords
Thailand, Developing countries, prophylaxis, mother to child transmission, HIV-1, HIV-1 infection, HIV Seronegativity
Brief summary
The purpose of this study was to assess the efficacy of a single dose of the drug nevirapine (NVP) given to pregnant women at onset of labor and to their infant 48-72 hours after birth in addition to standard oral zidovudine (ZDV or AZT) prophylaxis for the prevention of mother-to-child transmission of HIV-1.
Detailed description
Multicenter, randomized, three arms, double-blind, controlled study. Study population was HIV-infected pregnant women who were on ZDV prophylaxis for more than two weeks and gave informed consent. If eligible, women completed a baseline check-up. Women meeting selection criteria were randomly assigned to receive one of three study regimens, in addition to ZDV prophylaxis: 1. One dose maternal NVP treatment at onset of labor, and one dose of infant NVP treatment 48-72 hours after birth 2. One dose maternal NVP treatment at onset of labor, and one dose of infant placebo 48-72 hours after birth 3. One dose maternal placebo at onset of labor, and one dose of infant placebo 48-72 hours after birth. This was the reference study arm. Follow-up of women and infants was carried out on an outpatient basis except for delivery and the first three days after delivery. AMENDMENT After the first interim analysis, enrollment in Placebo-Placebo arm was terminated on May 2, 2002, according to the recommendation of the Data and Safety Monitoring Board. The target sample size was increased to 660, instead of 510, in each of the two remaining arms (N-N and N-P) to ensure enough power to test for non-inferiority between these arms with a limit of 2.5%.
Interventions
DRUGSingle dose nevirapine to the mother and to the child
One maternal 200 mg NVP dose at the onset of labor, and one dose of infant NVP (0.6 ml/6mg) between 48-72 hours after birth. \[Infants less than 2,500g received only 0.2mL/kg\]
DRUGSingle dose nevirapine to the mother and placebo to the child
One maternal 200 mg NVP dose at the onset of labor, and one dose of infant placebo (0.6 ml) between 48-72 hours after birth. \[Infants less than 2,500g received only 0.2mL/kg\]
DRUGSingle dose placebo to the mother and to the child
One maternal placebo dose at the onset of labor, and one dose of infant placebo (0.6 ml) between 48-72 hours after birth. \[Infants less than 2,500g received only 0.2mL/kg\]
Sponsors
Harvard School of Public Health (HSPH)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
ANRS, Emerging Infectious Diseases
Institut de Recherche pour le Developpement
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE
Eligibility
Sex/Gender
FEMALE
Healthy volunteers
No
Inclusion criteria
Pre-Entry Criteria Women were eligible for the study if they: * have evidence of HIV infection (documented by two HIV antibody tests on two different dates); * were to be provided ZDV Prophylaxis (starting at 28 weeks or as soon as possible thereafter); * intended to carry the pregnancy to term; * intended to deliver at and bring their infant to a study site for at least 12 months after delivery; and * could provide informed consent. Inclusion criteria Women are eligible for the study if they: * met all pre-entry criteria; * agreed not to breastfeed; * consented to participate and to be followed for the duration of the study; * presented the following laboratory values within 14 days prior to randomization: * hemoglobin \> 8.0 mg/dl * absolute neutrophil count \> 1000 cells/mm3 * platelets \> 100,000 cells/mm3 * serum creatinine \< 1.5 mg/dl (women with a serum creatinine \> 1.5 mg/dl must have a measured eight-hour urine creatinine clearance \> 70 ml/min) * SGPT less than 10 times the upper limit of normal NOTE: Women with a Grade 2 or Grade 3 SGPT value (between 2.6 and 10 times the upper limit of normal) were allowed on study; they were monitored monthly until delivery. If at any point their SGPT value rose to a Grade 4 (more than 10 times the upper limit of normal), they should not be dosed with the Study Drug.
Exclusion criteria
* evidence of pre-existing fetal anomalies incompatible with life; * known hypersensitivity to any benzodiazepine or to NVP; * receipt of antiretroviral agent other than ZDV; * receipt of non-allowed concomitant treatment; * uncontrolled hypertension; * concurrent participation in another clinical trial; * women with a CD4 count \<200/µL or history of oral candidiasis if they were not receiving PCP prophylaxis.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Definitive HIV infection in infants as assessed by positive HIV DNA PCR on two peripheral blood samples | — |
Secondary
| Measure | Time frame |
|---|---|
| Tolerance of nevirapine, in particular rashes. | — |
Countries
Thailand
Outcome results
None listed