HIV-1 Infection, PREGNANCY
Conditions
Keywords
HIV-1, HIV mother to child prevention, Raltegravir, Pharmacokinetic
Brief summary
The purpose of this study is to assess the evolution of raltegravir concentration in the mother (between the 3rd trimester of pregnancy and one month post-delivery) and her neonate, when this drug is used to prevent mother-to-child HIV-1 transmission as part of a combined antiretroviral regimen.
Detailed description
1. Objectives 1. Principal objective * To study pharmacokinetic properties of raltegravir in pregnant women infected by HIV-1, during the third trimester of pregnancy (between 30 and 37 weeks of amenorrhea) and 1 month after childbirth (between W4 and W6 postpartum), as well as in their neonate. 2. Secondary objectives * Estimate the frequency of women receiving raltegravir and having indetectable viral load at delivery (and those having a strictly indetectable viral load, with no signal under the threshold of the technique used). * Describe the tolerance to raltegravir in pregnant women during the third trimester and in her neonates 2. Methodology * National multicenter pharmacokinetic study conducted among pregnant women infected by HIV-1 and exposed to raltegravir during pregnancy. 3. Statistical method * Method of population pharmacokinetic with 5 samples: before the drug intake, 0.5, 3, 8 and 12 hours after the intake at each of the 2 visits (between 30 and 37 weeks of amenorrhea, and 4 to 6 weeks after delivery).
Interventions
OTHERStudy of pharmacokinetic properties of raltegravir during the 3rd trimester of pregnancy
Introduction of a catheter for performing 5 blood samples in pregnant women infected by HIV-1, before the raltegravir intake, 0.5, 3, 8 and 12 hours after the intake at each of two visits (between 30 and 37 weeks of amenorrhea, and 4 to 6 weeks after delivery)
Sponsors
ANRS, Emerging Infectious Diseases
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Pregnant woman, between 30 and 37 weeks of amenorrhea * 18 years old and over * Infected by HIV-1 * Receiving a therapeutic combination, stable for at least 15 days before inclusion, with raltegravir at the standard dose (400 mg twice daily) which the doctor plans to maintain till the end of pregnancy and at least one month after delivery * Informed consent signed by mother and investigator (at the latest day of pre-inclusion and before any examination conducted as part of research) * Affiliated person or beneficiary of a social security system (medical aid of state or AME is not a social security system) * Participant agreeing to be registered in the national file of the people who participate in biomedical researches
Exclusion criteria
* Infected by HIV-2 * Under 18 years old * Receiving therapeutic association with atazanavir (Reyataz®), fosamprenavir (Telzir®), or efavirenz ( contained in Sustiva® and Atripla®) * Currently using medication, drugs or alcohol which can interfere with the research: rifampicine, phénobarbital, phénytoïne, topical gastrointestinal, antiacid and adsorbents * Presenting a clinical situation or acute pathology incompatible with the realisation of a pharmacokinetic study. * Planned absence which could hinder research participation (travel abroad, moving, imminent transfer ...) * Participating in another research, except the French perinatal survey (ANRS CO1 EPF or ANRS CO11 observatory), including an exclusion period still in progress at the pre-inclusion * Person under guardianship, or deprived of freedom by a judicial or administrative decision
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Comparison of the AUC and raltegravir trough concentration during and after pregnancy | 5 samples: before the drug intake, 0.5, 3, 8 and 12 hours after the intake at each of the 2 visits (between 30 and 37 weeks of amenorrhea, and 4 to 6 weeks after delivery) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Study of genetic polymorphism which could modify raltegravir concentrations | Up to 72 hours after delivery | — |
| Proportion of women having a viral load < 50 cp/mL at delivery | Up to 72 hours after delivery | — |
| Proportion of maternal-to-child HIV transmission | Up to 72 hours after delivery | — |
| Estimation of placental transfer of raltegravir | Up to 72 hours after delivery | Cmin, Cmax, AUC, t1/2 of raltegravir in newborns. |
| Clinical and biological anomaly occurring during the third trimester of pregnancy and during the first 6 months of life of the neonate. | Month 6 | Number of newborns with adverse events as a measure of safety and tolerability. Newborns will be followed up to 24 weeks of age. |
| Estimation of neonatal elimination of raltegravir | Up to 72 hours after delivery | Cmin, Cmax, AUC, t1/2 of raltegravir in newborns. |
| Untimely stop of raltegravir for toxicity or intolerance | Up to 72 hours after delivery | — |
Countries
France
Outcome results
None listed