Breastfeeding, Antiretroviral, and Nutrition Study
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This is a comparative clinical trial among HIV-infected women and their infants to determine:
- the benefit of nutritional supplementation given to women during breastfeeding
- the benefit and safety of antiretroviral (ARV) medications given either to infants or to their mothers to prevent HIV transmission during breastfeeding
- the feasibility of exclusive breastfeeding followed by early, rapid breastfeeding cessation
Condition | Intervention | Phase |
---|---|---|
HIV Infections |
Drug: Maternal zidovudine/lamivudine/lopinavir-ritonavir Drug: Infant nevirapine Dietary Supplement: Maternal protein and calorie supplement |
Phase 3 |
Study Type: | Interventional |
Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Factorial Assignment Masking: Open Label Primary Purpose: Prevention |
Official Title: | HIV Infection and Breastfeeding: Interventions for Maternal and Infant Health |
- Postpartum weight loss between delivery and 28 weeks [ Time Frame: between delivery and 28 weeks ] [ Designated as safety issue: Yes ]
- Infant HIV status at 28 weeks. (Infants found to have HIV at birth or 2 weeks after delivery will have been disenrolled.) [ Time Frame: birth to 28 weeks ] [ Designated as safety issue: No ]
- Exclusive breastfeeding and breastfeeding cessation by 28 weeks [ Time Frame: birth to 28 weeks ] [ Designated as safety issue: No ]
- Duration of exclusive breastfeeding [ Time Frame: birth to 28 weeks ] [ Designated as safety issue: No ]
- Infant HIV status through 48 weeks [ Time Frame: birth to 48 weeks ] [ Designated as safety issue: No ]
- Maternal adherence to ARV, maternal CD4 count, and clinical assessment of opportunistic infection status through 48 weeks [ Time Frame: delivery to 48 weeks ] [ Designated as safety issue: No ]
Enrollment: | 2369 |
Study Start Date: | March 2004 |
Study Completion Date: | January 2010 |
Primary Completion Date: | January 2010 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
---|---|
Active Comparator: Maternal ARVs & Nutrition Supplement
Extended maternal ARVs for prophylaxis (for the infant) & daily nutritional supplement given to the mother
|
Drug: Maternal zidovudine/lamivudine/lopinavir-ritonavir
Total daily dose: zidovudine 600mg, lamivudine 300mg, (taken as Combivir 1 tab twice a day with food). Lopinavir/ritonavir 400/100mg (taken as 2 tabs twice a day). Commencing after delivery and through to 28 weeks.
Other Names:
Dietary Supplement: Maternal protein and calorie supplement
High energy, nutrient-dense, micronutrient fortified nutritional supplement. Daily: Energy 700kcal, Protein 20g, 100% of recommended dietary allowance for all micronutrients during the 6 months of lactation. Vitamin A is excluded.
Other Name: Produced by Nutriset. Daily dose: 2 sachets.
|
Active Comparator: Infant NVP & Nutrition Supplement
Extended infant nevirapine for prophylaxis & daily nutritional supplment given to the mother
|
Drug: Infant nevirapine
Nevirapine suspension once daily dose. 0-14days: 10mg; 3-18weeks: 20mg; 19-28weeks: 30mg. To 28 weeks while breastfeeding. Other Name: Viramune (Nevirapine) suspension 50mg/5ml
Dietary Supplement: Maternal protein and calorie supplement
High energy, nutrient-dense, micronutrient fortified nutritional supplement. Daily: Energy 700kcal, Protein 20g, 100% of recommended dietary allowance for all micronutrients during the 6 months of lactation. Vitamin A is excluded.
Other Name: Produced by Nutriset. Daily dose: 2 sachets.
|
Active Comparator: Maternal ARVs & No Nutrition Supplement
Extended maternal ARVs for prophylaxis (for the infant) & no nutritional supplement given to the mother
|
Drug: Maternal zidovudine/lamivudine/lopinavir-ritonavir
Total daily dose: zidovudine 600mg, lamivudine 300mg, (taken as Combivir 1 tab twice a day with food). Lopinavir/ritonavir 400/100mg (taken as 2 tabs twice a day). Commencing after delivery and through to 28 weeks.
Other Names:
|
Active Comparator: Infant NVP & No Nutrition Supplement
Extended infant nevirapine for prophylaxis & no nutritional supplment given to the mother
|
Drug: Infant nevirapine
Nevirapine suspension once daily dose. 0-14days: 10mg; 3-18weeks: 20mg; 19-28weeks: 30mg. To 28 weeks while breastfeeding. Other Name: Viramune (Nevirapine) suspension 50mg/5ml
|
Active Comparator: No Drugs & Nutrition Supplement
No extended maternal ARV prophylaxis nor infant nevirapine prophylaxis & daily nutritional supplement given to the mother. Note: As of March 2008, the third arm of the antiretroviral intervention, in which neither mother nor infant received drugs beyond enhanced standard of care, was stopped based on recommendations of a Data and Safety Monitoring Board review of interim efficacy results and safety data after 77% participants had received treatment assignment. |
Dietary Supplement: Maternal protein and calorie supplement
High energy, nutrient-dense, micronutrient fortified nutritional supplement. Daily: Energy 700kcal, Protein 20g, 100% of recommended dietary allowance for all micronutrients during the 6 months of lactation. Vitamin A is excluded.
Other Name: Produced by Nutriset. Daily dose: 2 sachets.
|
No Intervention: No Drugs & No Nutrition Supplement
No extended maternal ARV prophylaxis nor infant nevirapine prophylaxis & no nutritional supplement given to the mother. Note: As of March 2008, the third arm of the antiretroviral intervention, in which neither mother nor infant received drugs beyond enhanced standard of care, was stopped based on recommendations of a Data and Safety Monitoring Board review of interim efficacy results and safety data after 77% participants had received treatment assignment. |
Detailed Description:
This study addresses the complex issues of HIV related maternal morbidity, mortality, and postnatal HIV transmission during breastfeeding and weaning in resource-poor countries. Objectives include assessment of mortality and morbidity among HIV-infected women; evaluation of interventions to reduce HIV transmission to infants exposed by breast milk; and assessment of early weaning as a risk-reduction strategy for infants of HIV-infected mothers.
The study will evaluate the following:
- The efficacy of a high-density caloric/micronutrient nutritional supplement given to HIV-infected women who breastfeed in preventing maternal depletion (weight loss and micronutrient status).
- The safety and efficacy of maternal or infant antiretroviral regimens, taken for up to 6 months during breastfeeding, in reducing infant HIV infection rates at 48 weeks.
- The feasibility of exclusive breastfeeding for 6 months followed by rapid weaning.
Additional study objectives are to evaluate the feasibility of delivering these interventions in resource poor settings and to identify maternal, infant, and virologic factors associated with HIV transmission during breastfeeding.
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Ages Eligible for Study: | 14 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
Recruitment and primary eligibility criteria:
- Age > 14 years.
- Ability to give informed assent or consent.
- Evidence of HIV infection, as documented by 2 positive ELISA antibody tests; or 1 positive ELISA, and 1 Western Blot; or 2 separate concurrent rapid tests.
- Currently pregnant (with a single or multiple fetuses).
- Gestation < 30 weeks at referral from 'Call to Action' Program
- No serious current complications of pregnancy.
- Intention to breastfeed.
- Intention to deliver at the institution at which the study is based.
- Not previously enrolled in this study for an earlier pregnancy.
- Other than HIV, no active serious infection, such as tuberculosis or other potentially serious illnesses.
- No previous use of antiretrovirals including the HIVNET 012 regimen.
- Mother's CD4 count > 250 cells/uL determined in the antenatal clinic.
- Mother's ALT < 2.5 x ULN (upper limit of normal) determined in the antenatal clinic
Secondary eligibility criteria and treatment assignment:
- Mother who delivers outside of the institution at which the study is based must present with her infant to the study site within 36 hours of delivery.
- Mother accepts nevirapine and zidovudine+lamivudine 7-day regimen for herself and her infant.
- Infant birth weight > 2000 g.
- No severe congenital malformations or other condition(s) not compatible with life.
- Based on clinical assessment, no maternal condition which would preclude the start of the study intervention.
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Malawi | |
Kamuzu Central Hospital, Bottom Hospital | |
Lilongwe, Malawi |
Study Chair: | Charles van der Horst, MD | University of North Carolina, Chapel Hill |
Principal Investigator: | Denise J Jamieson, MD, MPH | CDC, Atlanta, GA |
Principal Investigator: | Peter Kazembe, MB ChB | Kamuzu Central Hospital, Lilongwe, Malawi |
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No publications provided by Centers for Disease Control and Prevention
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: | Dr. Denise Jamieson, CDC |
ClinicalTrials.gov Identifier: | NCT00164736 History of Changes |
Other Study ID Numbers: | CDC-NCCDPHP-3946, U48CCU409660, PA 04003 SIP 26-04 |
Study First Received: | September 13, 2005 |
Last Updated: | April 22, 2010 |
Health Authority: | United States: Federal Government United States: Institutional Review Board Malawi: National Health Sciences Research Committee |
Keywords provided by Centers for Disease Control and Prevention:
HIV Clinical trial breastfeeding |
mother-to-child-transmission nutrition HIV Seronegativity |
Additional relevant MeSH terms:
HIV Infections Acquired Immunodeficiency Syndrome Lentivirus Infections Retroviridae Infections RNA Virus Infections Virus Diseases Sexually Transmitted Diseases, Viral Sexually Transmitted Diseases Immunologic Deficiency Syndromes Immune System Diseases Slow Virus Diseases Zidovudine Nevirapine Lamivudine Lamivudine, zidovudine drug combination |
Ritonavir Lopinavir Antimetabolites Molecular Mechanisms of Pharmacological Action Pharmacologic Actions Reverse Transcriptase Inhibitors Nucleic Acid Synthesis Inhibitors Enzyme Inhibitors Anti-Retroviral Agents Antiviral Agents Anti-Infective Agents Therapeutic Uses Anti-HIV Agents HIV Protease Inhibitors Protease Inhibitors |
ClinicalTrials.gov processed this record on March 14, 2013