ARVs to Prevent Breastmilk HIV:Viral and Immune Responses

Summary

Identifying new approaches for preventing breastmilk transmission of HIV-1 is an important research priority. To this end, clinical trials are underway to evaluate the efficacy of HAART (zidovudine, lamivudine, nevirapine) during late pregnancy/lactation versus zidovudine/nevirapine peripartum for prevention of breastmilk HIV-1 transmission. It is important to understand the mechanism of effect of these antiretroviral (ARV) strategies on prevention of breastmilk HIV-1 transmission.

This phase II trial will compare HAART vs peripartum zidovudine/nevirapine for effect on breastmilk HIV-1, breastmilk HIV-1 specific immune responses, and infant HIV-1 specific immune responses.

100 pregnant HIV-1 seropositive women in Nairobi with CD4 counts between 200 to 500 who have chosen to breastfeed will receive either ARV regimen. Mother-infant pairs will be followed for 1 year after delivery. Home visits will be conducted in the first month (\~10 visits) to collect 2-5 mls of breastmilk per visit. Mother-infant pairs will be seen in the study clinic with maternal blood and breastmilk and infant blood collected at months 1, 3, and 6 for HIV-1 and HIV-1 Elispot assays. Breastmilk HIV-1 RNA and DNA levels will be quantified in Dr. Overbaugh's laboratory in Seattle and Elispot assays conducted in Nairobi with validation of a subset in Dr. Rowland-Jones laboratory in Oxford. Viral loads, decay curves, half-life, and re-population following ARV cessation will be estimated for each regimen and regimens compared. These studies will provide insight into the viral and immune responses to ARV regimens proposed for prevention of breastfeeding HIV-1 transmission and will be important for rational design of future interventions. After taking into account, estimated loss to follow-up, the targeted sample size with outcome data was 80 women, 40 in each trial arm, estimating undetectable breast milk HIV-1 RNA levels in the HAART arm and median breast milk HIV-1 RNA levels of 3.0 log10 in women receiving ZDV/NVP.

Conditions

• HIV Infections

Interventions

DRUG

Combined short-course zidovudine/nevirapine

300 mg of ZDV was given twice daily from 34 weeks gestation until labor then every 3 hours until delivery; 200 mg of NVP was given as a single oral dose at the onset of labor; and a single 2 mg/kg (6 mg if birthweight \> 2.5 kg) oral dose of NVP suspension was administered to the infant within 72 hours of delivery.

DRUG

HAART

300 mg of zidovudine (ZDV), 150 mg of lamivudine, and 200 mg nevirapine (NVP) was given twice daily from 34 weeks gestation until six months after delivery.

Sponsors & Collaborators

• Elizabeth Glaser Pediatric AIDS Foundation

  collaborator OTHER

• University of Washington

  lead OTHER

Principal Investigators

• Grace C. John-Stewart, MD, PhD · University of Washington

• Carey Farquhar, MD, MPH · University of Washington

• Dorothy Mbori-Ngacha, MBChB,MPH · University of Nairobi

• Ruth Nduati, MBChB,MPH · University of Nairobi

• James Kiarie, MBChB, MPH · University of Nairobi

• Michael Chung, MD, MPH · University of Washington

• Julie Overbaugh, PhD · Fred Hutchinson Cancer Center

• John Kinuthia, MBChB, MMed · University of Nairobi

• Barbra Richardson, PhD · University of Washington

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

50 Years

Sex

FEMALE

Healthy Volunteers

No

Timeline & Regulatory

Start

2003-11-03

Primary Completion

2005-03-31

Completion

2006-04-30

Countries

• Kenya

Study Locations