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Pre-Exposure Prophylaxis Study of Lenacapavir and Emtricitabine/Tenofovir Alafenamide in Adolescent Girls and Young Women at Risk of HIV Infection

A Phase 3, Double-Blinded, Multicenter, Randomized Study to Evaluate Safety and Efficacy of Twice Yearly Long-Acting Subcutaneous Lenacapavir, and Daily Oral Emtricitabine/Tenofovir Alafenamide for Pre-Exposure Prophylaxis in Adolescent Girls and Young Women at Risk of HIV Infection

Status
Active, not recruiting
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04994509
Acronym
PURPOSE 1
Enrollment
5368
Registered
2021-08-06
Start date
2021-08-30
Completion date
2028-01-01
Last updated
2026-03-30

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Pre-Exposure Prophylaxis of HIV Infection

Brief summary

The goal of this study is to evaluate the efficacy of the study drugs, lenacapavir (LEN) and emtricitabine/tenofovir alafenamide (F/TAF) in preventing HIV infection, in adolescent girls and young women (AGYW). The primary objective of this study is to evaluate the efficacy of LEN and F/TAF for HIV-1 PrEP in AGYW at risk of HIV-1 infection.

Interventions

Tablets administered orally without regard to food

DRUGSubcutaneous (SC) Lenacapavir (LEN)

Administered via SC injections

DRUGF/TAF

Tablets administered orally

DRUGF/TDF

Tablets administered orally

Administered via SC injections

Tablets administered orally

DRUGPTM F/TAF

Tablets administered orally

Tablets administered orally

Sponsors

Gilead Sciences
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Investigator)

Eligibility

Sex/Gender
FEMALE
Age
16 Years to 25 Years
Healthy volunteers
Yes

Inclusion criteria

Key Inclusion Criteria: * Incidence Phase * HIV-1 status unknown at initial screening and no prior human immunodeficiency virus (HIV)-1 testing within the last 3 months. * Sexually active (has had \> 1 vaginal intercourse within the last 3 months) with cisgender male individuals (CGM). * Randomized Phase * Negative fourth generation HIV-1 antibody (Ab)/antigen (Ag) test confirmed with central HIV-1 testing. * Estimated glomerular filtration rate (GFR) ≥ 60 mL/min at screening. * Body weight ≥ 35 kg. Key

Exclusion criteria

* Prior receipt of an HIV vaccine. * Prior use of any long-acting systemic HIV pre-exposure prophylaxis (PrEP) or prior HIV postexposure prophylaxis (PEP) in the past 12 weeks. Note: Other protocol defined Inclusion/

Design outcomes

Primary

MeasureTime frameDescription
Incidence Phase: Recent Infection Testing Algorithm (RITA) Estimate of the Background Human Immunodeficiency-1 Virus Infection Incidence Rate (bHIV) Per 100 Person Years (PY)Incidence Phase Screening Visit (Day 1)bHIV per 100 PY in the Incidence Phase was calculated using RITA. The RITA incorporated HIV-1 testing results and recency assay testing results to estimate the bHIV. Recency assay testing was performed for participants in the All Screened Set found to have HIV-1 infection at the Incidence Phase Screening Visit as defined below. Participants were considered to have recent HIV-1 infection if the normalized optical density (ODn) was below 1.5 threshold using the Sedia limiting antigen avidity enzyme immunoassay (LAg-EIA) and the HIV-1 RNA (viral load) was \> 75 copies/mL of blood. HIV-1 infection was defined as participants having at least one of the following central lab results at the Incidence Phase screening visit: * Positive HIV-1/2 differentiation Ab, OR * Positive HIV-1 ribonucleic acid (RNA) qualitative test, OR * HIV-1 RNA quantitative test ≥200 copies/mL.
Randomized Blinded Phase: HIV-1 Incidence Reported Per 100 PY for LEN and F/TAF Compared to Participants in All Screened SetWhen at least 50% of the participants completed 52 weeks of follow-up after randomization or permanently discontinued from the study (maximum 143 weeks)HIV-1 incidence per 100 PY for LEN and F/TAF was calculated as the number of participants who acquired HIV-1 divided by the total of a) for participants not diagnosed with HIV-1, sum of all duration of follow-up time in years, while at risk of HIV-1 infection (where a year is 365.25 days) and b) for participants diagnosed with HIV-1, sum of all duration of follow-up time up to confirmed HIV-1 diagnoses. HIV-1 diagnosis was determined by an HIV adjudication committee who reviewed potential HIV-1 infection events in the randomized participants. The committee, in a blinded, consistent, and unbiased manner, determined whether HIV test results confirmed HIV-1 infection and determined the date of diagnosis for each case, defined as the date of the earliest study visit with evidence of HIV infection considering both prospective HIV testing and back-testing of archived samples. bHIV incidence per 100 PY in All Screened Set was estimated as described in outcome measure#1.

Secondary

MeasureTime frameDescription
Randomized Blinded Phase: HIV-1 Incidence Reported Per 100 PY for LEN, F/TAF and F/TDFWhen at least 50% of the participants completed 52 weeks of follow-up after randomization or permanently discontinued from the study (maximum 143 weeks)HIV-1 incidence per 100 PY was calculated as the number of participants who acquired HIV-1 divided by the total of a) for participants not diagnosed with HIV-1, sum of all duration of follow-up time in years, while at risk of HIV-1 infection (where a year is 365.25 days) and b) for participants diagnosed with HIV-1, sum of all duration of follow-up time up to confirmed HIV-1 diagnoses. HIV-1 diagnosis was determined by an HIV adjudication committee who reviewed potential HIV-1 infection events in the randomized participants. The committee, in a blinded, consistent, and unbiased manner, determined whether HIV test results confirmed HIV-1 infection and determined the date of diagnosis for each case, defined as the date of the earliest study visit with evidence of HIV infection considering both prospective HIV testing and back-testing of archived samples.
Randomized Blinded Phase: HIV-1 Incidence Among Participants Adherent to LENWhen at least 50% of the participants completed 52 weeks of follow-up after randomization or permanently discontinued from the study (maximum 143 weeks)A participant was defined as adherent to LEN if they have received all per-protocol administrations of LEN within 28 weeks since the previous administration. The incidence of HIV-1 infection per 100 PY calculation is defined in outcome measure #2.
Randomized Blinded Phase: Percentage of Participants Adherent to F/TAF in HIV-1 Diagnosed Participants and Their Matched ControlsWhen at least 50% of the participants completed 52 weeks of follow-up after randomization or permanently discontinued from the study (maximum 143 weeks)A participant's adherence to F/TAF was measured by tenofovir diphosphate (TFV-DP) in dried blood spot (DBS) samples, where \<450 fmol/punch associates with an adherence of \<2 days per week. The data is reported in two categories: low adherence (\<2 days per week) and not low adherence (\>= 2 days per week).
Randomized Blinded Phase: Percentage of Participants Experiencing Treatment-Emergent Adverse Events (TEAEs)When all participants have a minimum of 52 weeks of exposure to study drug or permanent discontinuation, whichever occurs first (maximum approximately 3 years)TEAEs are defined as 1 or both of the following: * Any adverse events (AEs) leading to premature discontinuation of study drug, or * Any AEs with an onset date on or after the study drug start date and no later than the last exposure date after permanent discontinuation of the study drug. An AE was any untoward medical occurrence in a clinical study participant administered a study drug that did not necessarily had a causal relationship with the treatment.
Randomized Blinded Phase: Percentage of Participants Experiencing Clinically Significant Laboratory AbnormalitiesWhen all participants have a minimum of 52 weeks of exposure to study drug or permanent discontinuation, whichever occurs first (maximum approximately 3 years)Treatment-emergent laboratory abnormalities were defined as values that increased at least 1 toxicity grade from baseline at any post-baseline visit, up to and including the last exposure date for participants who permanently discontinued study drug, or the last available date in the database snapshot for participants who were still on treatment at the time of an analysis.

Countries

South Africa, Uganda

Contacts

STUDY_DIRECTORGilead Study Director

Gilead Sciences

Participant flow

Recruitment details

8402 participants were screened. Out of 8402, 8094 participants had at least 1 non-missing HIV-1 diagnosis based on HIV test results from a central laboratory. Therefore, 8094 participants were considered for screening in the Incidence Phase and were included in the All Screened Set.

Pre-assignment details

Participants were enrolled at study sites in South Africa and Uganda. Data submitted represent primary analysis performed on data collected by the Primary Analysis Completion Date (Per pre-specified analysis, this is the date by when at least 50% of the planned randomized participants were followed up for at least 52 weeks in the study or prematurely discontinued from the study). Complete data will be submitted within 1 year of actual study completion date.

Participants by arm

ArmCount
Randomized Blinded Phase: Lenacapavir
Participants received LEN 927 mg SC injection, every 26 weeks starting on Day 1 up to approximately 52 weeks. Participants also received loading dose of LEN 600 mg tablet orally, once daily on Day 1 and Day 2. Participants received PTM F/TDF tablet or PTM F/TAF tablet orally, once daily, up to approximately 52 weeks.
2,140
Randomized Blinded Phase: F/TAF
Participants received F/TAF tablet on Day 1 orally, once daily up to approximately 52 weeks. Participants also received PTM LEN SC injection every 26 weeks starting on Day 1 up to approximately 52 weeks and PTM LEN tablet orally once daily on Day 1 and Day 2.
2,135
Randomized Blinded Phase: F/TDF
Participants received F/TDF tablet on Day 1 orally, once daily up to approximately 52 weeks. Participants received PTM LEN SC injection, every 26 weeks starting on Day 1 up to approximately 52 weeks and PTM LEN tablet orally once daily on Day 1 and Day 2.
1,070
Total5,345

Baseline characteristics

CharacteristicRandomized Blinded Phase: LenacapavirRandomized Blinded Phase: F/TAFRandomized Blinded Phase: F/TDFTotal
Age, Categorical
<=18 years
287 Participants256 Participants125 Participants668 Participants
Age, Categorical
>=65 years
0 Participants0 Participants0 Participants0 Participants
Age, Categorical
Between 18 and 65 years
1853 Participants1879 Participants945 Participants4677 Participants
Age, Continuous21 years
STANDARD_DEVIATION 2.2
21 years
STANDARD_DEVIATION 2.1
21 years
STANDARD_DEVIATION 2.1
21 years
STANDARD_DEVIATION 2.1
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants0 Participants0 Participants0 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
2140 Participants2135 Participants1070 Participants5345 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
2137 Participants2134 Participants1068 Participants5339 Participants
Race (NIH/OMB)
More than one race
3 Participants1 Participants2 Participants6 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
0 Participants0 Participants0 Participants0 Participants
Region of Enrollment
South Africa
1811 Participants1788 Participants909 Participants4508 Participants
Region of Enrollment
Uganda
329 Participants347 Participants161 Participants837 Participants
Sex: Female, Male
Female
2140 Participants2135 Participants1070 Participants5345 Participants
Sex: Female, Male
Male
0 Participants0 Participants0 Participants0 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
0 / 2,1506 / 2,1450 / 1,073
other
Total, other adverse events
1,757 / 2,1401,550 / 2,135756 / 1,070
serious
Total, serious adverse events
59 / 2,14085 / 2,13535 / 1,070

Outcome results

Primary

Incidence Phase: Recent Infection Testing Algorithm (RITA) Estimate of the Background Human Immunodeficiency-1 Virus Infection Incidence Rate (bHIV) Per 100 Person Years (PY)

bHIV per 100 PY in the Incidence Phase was calculated using RITA. The RITA incorporated HIV-1 testing results and recency assay testing results to estimate the bHIV. Recency assay testing was performed for participants in the All Screened Set found to have HIV-1 infection at the Incidence Phase Screening Visit as defined below. Participants were considered to have recent HIV-1 infection if the normalized optical density (ODn) was below 1.5 threshold using the Sedia limiting antigen avidity enzyme immunoassay (LAg-EIA) and the HIV-1 RNA (viral load) was \> 75 copies/mL of blood. HIV-1 infection was defined as participants having at least one of the following central lab results at the Incidence Phase screening visit: * Positive HIV-1/2 differentiation Ab, OR * Positive HIV-1 ribonucleic acid (RNA) qualitative test, OR * HIV-1 RNA quantitative test ≥200 copies/mL.

Time frame: Incidence Phase Screening Visit (Day 1)

Population: Participants in the All Screened Set were analyzed. The All Screened Set included all participants who were screened for HIV-1 in the Incidence Phase and had a non-missing HIV-1 diagnosis based on HIV test results at Incidence Phase screening. As the outcome measure was assessed prior to Randomized Blinded Phase, the data is reported in one arm consisting of all participants screened in Incidence Phase.

ArmMeasureValue (NUMBER)
Participants Screened for HIV-1 in Incidence PhaseIncidence Phase: Recent Infection Testing Algorithm (RITA) Estimate of the Background Human Immunodeficiency-1 Virus Infection Incidence Rate (bHIV) Per 100 Person Years (PY)2.407 HIV-1 events per 100 person-years
Primary

Randomized Blinded Phase: HIV-1 Incidence Reported Per 100 PY for LEN and F/TAF Compared to Participants in All Screened Set

HIV-1 incidence per 100 PY for LEN and F/TAF was calculated as the number of participants who acquired HIV-1 divided by the total of a) for participants not diagnosed with HIV-1, sum of all duration of follow-up time in years, while at risk of HIV-1 infection (where a year is 365.25 days) and b) for participants diagnosed with HIV-1, sum of all duration of follow-up time up to confirmed HIV-1 diagnoses. HIV-1 diagnosis was determined by an HIV adjudication committee who reviewed potential HIV-1 infection events in the randomized participants. The committee, in a blinded, consistent, and unbiased manner, determined whether HIV test results confirmed HIV-1 infection and determined the date of diagnosis for each case, defined as the date of the earliest study visit with evidence of HIV infection considering both prospective HIV testing and back-testing of archived samples. bHIV incidence per 100 PY in All Screened Set was estimated as described in outcome measure#1.

Time frame: When at least 50% of the participants completed 52 weeks of follow-up after randomization or permanently discontinued from the study (maximum 143 weeks)

Population: Participants in the LEN and F/TAF groups in the Full Analysis Set (FAS) were analyzed. The FAS included all randomized participants who received at least 1 dose of any study drug and had not been diagnosed with HIV-1 on or prior to the first dose date. Per prespecified analysis, HIV-1 incidence for this outcome measure was reported only for participants who received LEN and F/TAF. The HIV-1 incidence was compared with participants in All Screened Set.

ArmMeasureValue (NUMBER)
Participants Screened for HIV-1 in Incidence PhaseRandomized Blinded Phase: HIV-1 Incidence Reported Per 100 PY for LEN and F/TAF Compared to Participants in All Screened Set0.000 HIV-1 events per 100 person-years
Randomized Blinded Phase: F/TAFRandomized Blinded Phase: HIV-1 Incidence Reported Per 100 PY for LEN and F/TAF Compared to Participants in All Screened Set2.018 HIV-1 events per 100 person-years
Incidence Phase: All Screened Participants With Non-missing HIV-1 DiagnosisRandomized Blinded Phase: HIV-1 Incidence Reported Per 100 PY for LEN and F/TAF Compared to Participants in All Screened Set2.407 HIV-1 events per 100 person-years
Comparison: Null Hypothesis 01: LEN/bHIV\>= 1; Null hypothesis was to be rejected if HIV-1 incidence in LEN was significantly lower than bHIV.p-value: <0.000195% CI: [0, 0.042]Likelihood ratio test
Comparison: Null Hypothesis 02: LEN/bHIV\>= 0.8; Null hypothesis was to be rejected if HIV-1 incidence in LEN was significantly and at least 20% lower than bHIV.p-value: <0.000195% CI: [0, 0.042]Likelihood ratio test
Comparison: Null Hypothesis 03: F/TAF/bHIV\>= 1; Null hypothesis was to be rejected if HIV-1 incidence in F/TAF was significantly lower than bHIV.p-value: 0.2069795% CI: [0.55, 1.279]Wald test
Comparison: Null Hypothesis 04: F/TAF/bHIV\>= 0.8; Null hypothesis was to be rejected if HIV-1 incidence in F/TAF was significantly and at least 20% lower than bHIV.p-value: 0.5867495% CI: [0.55, 1.279]Wald test
Secondary

Randomized Blinded Phase: HIV-1 Incidence Among Participants Adherent to LEN

A participant was defined as adherent to LEN if they have received all per-protocol administrations of LEN within 28 weeks since the previous administration. The incidence of HIV-1 infection per 100 PY calculation is defined in outcome measure #2.

Time frame: When at least 50% of the participants completed 52 weeks of follow-up after randomization or permanently discontinued from the study (maximum 143 weeks)

Population: Participants in the Full Analysis Set who were adherent to LEN were analyzed.

ArmMeasureValue (NUMBER)
Participants Screened for HIV-1 in Incidence PhaseRandomized Blinded Phase: HIV-1 Incidence Among Participants Adherent to LEN0.000 HIV-1 events per 100 person-years
Secondary

Randomized Blinded Phase: HIV-1 Incidence Reported Per 100 PY for LEN, F/TAF and F/TDF

HIV-1 incidence per 100 PY was calculated as the number of participants who acquired HIV-1 divided by the total of a) for participants not diagnosed with HIV-1, sum of all duration of follow-up time in years, while at risk of HIV-1 infection (where a year is 365.25 days) and b) for participants diagnosed with HIV-1, sum of all duration of follow-up time up to confirmed HIV-1 diagnoses. HIV-1 diagnosis was determined by an HIV adjudication committee who reviewed potential HIV-1 infection events in the randomized participants. The committee, in a blinded, consistent, and unbiased manner, determined whether HIV test results confirmed HIV-1 infection and determined the date of diagnosis for each case, defined as the date of the earliest study visit with evidence of HIV infection considering both prospective HIV testing and back-testing of archived samples.

Time frame: When at least 50% of the participants completed 52 weeks of follow-up after randomization or permanently discontinued from the study (maximum 143 weeks)

Population: Participants in the Full Analysis Set were analyzed.

ArmMeasureValue (NUMBER)
Participants Screened for HIV-1 in Incidence PhaseRandomized Blinded Phase: HIV-1 Incidence Reported Per 100 PY for LEN, F/TAF and F/TDF0.000 HIV-1 events per 100 person-years
Randomized Blinded Phase: F/TAFRandomized Blinded Phase: HIV-1 Incidence Reported Per 100 PY for LEN, F/TAF and F/TDF2.018 HIV-1 events per 100 person-years
Incidence Phase: All Screened Participants With Non-missing HIV-1 DiagnosisRandomized Blinded Phase: HIV-1 Incidence Reported Per 100 PY for LEN, F/TAF and F/TDF1.685 HIV-1 events per 100 person-years
p-value: <0.000195% CI: [0, 0.101]Poisson model
p-value: 0.728295% CI: [0.669, 2.143]Poisson model
p-value: <0.000195% CI: [-2.737, -0.939]Hybrid approach
p-value: 0.20995% CI: [-0.869, 1.367]Hybrid approach
Secondary

Randomized Blinded Phase: Percentage of Participants Adherent to F/TAF in HIV-1 Diagnosed Participants and Their Matched Controls

A participant's adherence to F/TAF was measured by tenofovir diphosphate (TFV-DP) in dried blood spot (DBS) samples, where \<450 fmol/punch associates with an adherence of \<2 days per week. The data is reported in two categories: low adherence (\<2 days per week) and not low adherence (\>= 2 days per week).

Time frame: When at least 50% of the participants completed 52 weeks of follow-up after randomization or permanently discontinued from the study (maximum 143 weeks)

Population: The dried blood spot (DBS) Case-Control Analysis Set included all randomized participants who took at least 1 dose of study drug, were diagnosed with HIV-1 or were selected as a matched control (with no diagnosis of HIV-1) for a participant with HIV-1 and have at least 1 non-missing DBS concentration value reported by the DBS laboratory.~Per pre-specified analysis, the data is reported in a subset of participants in the F/TAF arm with and without HIV-1 diagnosis.

ArmMeasureGroupValue (NUMBER)
Participants Screened for HIV-1 in Incidence PhaseRandomized Blinded Phase: Percentage of Participants Adherent to F/TAF in HIV-1 Diagnosed Participants and Their Matched ControlsLow (< 2 days/Week)91.9 percentage of participants
Participants Screened for HIV-1 in Incidence PhaseRandomized Blinded Phase: Percentage of Participants Adherent to F/TAF in HIV-1 Diagnosed Participants and Their Matched ControlsNot Low (>= 2 days/Week)8.1 percentage of participants
Randomized Blinded Phase: F/TAFRandomized Blinded Phase: Percentage of Participants Adherent to F/TAF in HIV-1 Diagnosed Participants and Their Matched ControlsLow (< 2 days/Week)65.9 percentage of participants
Randomized Blinded Phase: F/TAFRandomized Blinded Phase: Percentage of Participants Adherent to F/TAF in HIV-1 Diagnosed Participants and Their Matched ControlsNot Low (>= 2 days/Week)34.1 percentage of participants
p-value: 0.000695% CI: [2.06, 83.36]ExactConditionalLogisticRegressionModel
Secondary

Randomized Blinded Phase: Percentage of Participants Experiencing Clinically Significant Laboratory Abnormalities

Treatment-emergent laboratory abnormalities were defined as values that increased at least 1 toxicity grade from baseline at any post-baseline visit, up to and including the last exposure date for participants who permanently discontinued study drug, or the last available date in the database snapshot for participants who were still on treatment at the time of an analysis.

Time frame: When all participants have a minimum of 52 weeks of exposure to study drug or permanent discontinuation, whichever occurs first (maximum approximately 3 years)

Secondary

Randomized Blinded Phase: Percentage of Participants Experiencing Treatment-Emergent Adverse Events (TEAEs)

TEAEs are defined as 1 or both of the following: * Any adverse events (AEs) leading to premature discontinuation of study drug, or * Any AEs with an onset date on or after the study drug start date and no later than the last exposure date after permanent discontinuation of the study drug. An AE was any untoward medical occurrence in a clinical study participant administered a study drug that did not necessarily had a causal relationship with the treatment.

Time frame: When all participants have a minimum of 52 weeks of exposure to study drug or permanent discontinuation, whichever occurs first (maximum approximately 3 years)

Source: ClinicalTrials.gov · Data processed: Mar 31, 2026