Very Early Intensive Treatment of Infants Living With HIV to Achieve HIV Remission: A Phase I/II Proof of Concept Study

Who is this study for? Infants infected with HIV
Status: Recruiting
Location: See all (50) locations...
Intervention Type: Drug
Study Type: Interventional
Study Phase: Phase 1/Phase 2
SUMMARY

The study will explore the effects of early intensive antiretroviral therapy (ART) with or without a broadly neutralizing antibody (bNAb) on achieving HIV remission (HIV RNA below the limit of detection of the assay) among infants living with HIV.

Eligibility
Participation Requirements
Sex: All
Maximum Age: 2 days
Healthy Volunteers: f
View:

• Presumed or confirmed maternal HIV infection:

‣ Mothers will be eligible to enroll with EITHER:

• Presumed HIV infection defined as at least one positive rapid HIV antibody-based test result from a sample collected in the peripartum period. Presumed infection must be confirmed within 10 business days of enrollment OR

∙ Confirmed HIV infection defined as positive results from two samples collected at different timepoints

• Willing and able to provide written informed consent for participation of herself and her infant. The mother must be of legal age or circumstance to provide independent informed consent as determined by site standard operating procedures (SOPs) and consistent with IRB/EC policies and procedures. Otherwise, informed consent must be obtained from a legal guardian and the mother must provide written assent.

• Was not previously enrolled in this study with another infant.

• Did not receive ARVs during the current pregnancy.

• Infant is eligible per inclusion criteria.

• Less than or equal to 48 hours of age.

• Greater than or equal to 36 weeks gestational age at birth (assessment of gestational age will be based on the best clinical estimate determined by date of last menstrual period, antenatal ultrasound, fundal height, or Ballard Score).

• Greater than or equal to 2 kilograms (kg) at birth.

• Able to take ARVs by mouth, nasogastric tube, or gastrostomy tube.

• Has no clinically significant diseases (other than HIV infection) or clinically significant findings during review of medical history or physical examination prior to entry that, in the site investigator's opinion, would interfere with study participation or interpretation.

• Mother is eligible per inclusion criteria.

• Enrolled in Step 1.

• Confirmed in utero HIV infection.

• Able to take ARVs by mouth, nasogastric tube, or gastrostomy tube.

• Has no clinically significant diseases (other than HIV infection) or clinically significant findings during review of medical history or physical examination prior to entry that, in the site investigator's opinion, would interfere with study participation or interpretation.

• Mother (or legal guardian if applicable) is willing and able to provide written informed consent for child's participation in Step 2.

• Enrolled in Step 2.

• Has reached Step 2 Week 96.

• Has the following results based on testing:

‣ No confirmed plasma HIV RNA ≥200 copies/mL at Step 2 Week 24 and up to but excluding Step 2 Week 48.

⁃ No plasma HIV RNA detected at Step 2 Week 48 and thereafter, with two possible exceptions

• (i) First possible exception: If HIV RNA is detected at or after Step 2 Week 48 with a result \<200 copies/mL, testing will be repeated within three weeks (specimen collection for the confirmatory test must occur within three weeks of specimen collection for the initial test).

∙ If no HIV RNA is detected on the confirmatory test, or if HIV RNA is detected with a result \<200 copies/mL, the infant will be potentially eligible for Step 3 after an additional 48 weeks of follow-up in Step 2, provided no HIV RNA is detected on any subsequent tests in Step 2.

∙ If HIV RNA is detected on the confirmatory test with a result ≥200 copies/mL, the infant will not be eligible for Step 3.

∙ (ii) Second possible exception: If HIV RNA is detected after Step 2 Week 48 with a result \<LOD, the infant will be potentially eligible for Step 3 after an additional 48 weeks of follow-up in Step 2 with no RNA detected. There is no limit on the number of times HIV RNA may be detected with a result \<LOD after Week 48. However, infants with detectable RNA with a result \<LOD after Week 48 will not be considered for entry into Step 3 until after an additional 48 weeks of no RNA detected.

∙ Participants may experience either or both exceptions at different timepoints during follow-up in Step 2.

• If breastfed, must have permanently ceased breastfeeding, with no exposure to breast milk for at least six weeks prior to specimen collection for the testing specified in the criterion (#5) below.

• Has met ALL of the following additional criteria while in Step 2, based on testing between Step 2 Week 84 and Step 2 Week 192 (inclusive):

‣ Two consecutive negative HIV antibody tests by fourth generation ELISA at least eight weeks apart.

⁃ Two consecutive HIV DNA tests with no DNA detected in at least 850,000 PBMCs assayed at least eight weeks apart.

⁃ CD4 cell percentage greater than or equal to 25% and CD4 cell absolute count greater than or equal to the lower limit of normal for age (≥1000 cells/mL if 2 to less than 3 years of age; ≥750 cells/mL if 3 to less than 5 years of age; ≥500 cells/mL if 5 years of age or older).

⁃ Infant assessed by the site investigator or designee as expected to adhere to the Step 3 Schedule of Evaluations.

⁃ Mother (or legal guardian if applicable) willing and able to provide written informed consent for child's participation in Step 3 and Step 4.

• No plasma HIV RNA detected by testing after criteria have been confirmed, with specimen collection for the assay within 14 days prior to Step 3 Entry.

• Enrolled in Step 3.

• Has met at least one of the following:

‣ Plasma HIV RNA ≥LOD based on two assays.

⁃ Plasma HIV RNA ≥1000 copies/mL in the presence of fever or other sign or symptom of acute retroviral syndrome.

⁃ Confirmed or suspected diagnosis of acute retroviral syndrome.

⁃ Confirmed or suspected diagnosis of a new WHO Clinical Stage 3 or 4 condition.

⁃ Confirmed CD4 cell percentage less than 25% and CD4 cell absolute count less than the lower limit of normal for age (\<1000 cells/mL if 2 to less than 3 years of age; \<750 cells/mL if 3 to less than 5 years of age; \<500 cells/mL if 5 years of age or older).

⁃ Otherwise assessed by the site investigator or designee, in consultation with the Clinical Management Committee (CMC), as having an indication to re-initiate treatment.

Locations
United States
California
4601, University of California, San Diego Clinical Research Site
COMPLETED
La Jolla
5048, University of Southern California Clinical Research Site
RECRUITING
Los Angeles
5112, David Geffen School of Medicine at UCLA Clinical Research Site
RECRUITING
Los Angeles
Colorado
5052, University of Colorado, Denver Clinical Research Site
RECRUITING
Aurora
Florida
5055, South Florida CDTC Fort Lauderdale Clinical Research Site
COMPLETED
Fort Lauderdale
5051, University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES) Clinical Research Site
RECRUITING
Jacksonville
5127, Pediatric Perinatal HIV Clinical Research Site
RECRUITING
Miami
University of Miami CRS
COMPLETED
Miami
Georgia
Emory University School of Medicine NICHD CRS
WITHDRAWN
Atlanta
Illinois
4001, Lurie Children's Hospital of Chicago Clinical Research Site
RECRUITING
Chicago
5083, Rush University Cook County Hospital Clinical Research Site
RECRUITING
Chicago
Massachusetts
Boston Medical Center Ped. HIV Program NICHD CRS
WITHDRAWN
Boston
Maryland
5092, Johns Hopkins Clinical Research Site
RECRUITING
Baltimore
New York
5040, SUNY Stony Brook Clinical Research Site
WITHDRAWN
Stony Brook
5013, Jacobi Medical Center Clinical Research Site
RECRUITING
The Bronx
5114, Bronx Lebanon Hospital Center Clinical Research Site
RECRUITING
The Bronx
Pennsylvania
Philadelphia IMPAACT Unit CRS
WITHDRAWN
Philadelphia
Tennessee
6501, St Jude Children's Research Hospital Clinical Research Site
RECRUITING
Memphis
Texas
5128, Baylor College of Medicine/Texas Children's Hospital Clinical Research Site
RECRUITING
Houston
Texas Children's Hospital CRS
WITHDRAWN
Houston
Washington
Seattle Children's Research Institute CRS
WITHDRAWN
Seattle
Univ. of Washington NICHD CRS
WITHDRAWN
Seattle
Other Locations
Argentina
Hosp. General de Agudos Buenos Aires Argentina NICHD CRS
WITHDRAWN
Buenos Aires
Brazil
5073, School of Medicine Federal University Minas Gerais Clinical Research Site
RECRUITING
Minas Gerais
Hospital Nossa Senhora da Conceicao NICHD CRS
COMPLETED
Porto Alegre
5071, Instituto de Puericultura e Pediatria Martagao Gesteira Clinical Research Site
RECRUITING
Rio De Janeiro
5072, Hospital Federal dose Servidores do Estado Clinical Research Site
COMPLETED
Rio De Janeiro
5097, Hospital Geral de Nova Igaucu Clinical Research Site
RECRUITING
Rio De Janeiro
5074, University of Sao Paulo Clinical Research Site
RECRUITING
São Paulo
Haiti
30022, Les Centres GHESKIO Clinical Research Site
RECRUITING
Port-au-prince
Kenya
5121, Kenya Medical Research Institute/Walter Reed Project Clinical Research Center Kericho Clinical Research Site
RECRUITING
Kericho
Malawi
30301, Blantyre Clinical Research Site
RECRUITING
Blantyre
12001, Malawi Clinical Research Site
RECRUITING
Lilongwe
Puerto Rico
5129, University of Puerto Rico Gamma Project Clinical Research Site
RECRUITING
San Juan
San Juan City Hosp. PR NICHD CRS
WITHDRAWN
San Juan
University of Puerto Rico Pediatric HIV/AIDS Research Program CRS
WITHDRAWN
San Juan
South Africa
30300, Umlazi Clinical Research Site
RECRUITING
Durban
Soweto IMPAACT CRS
COMPLETED
Johannesburg
Wits RHI Shandukani Research Centre CRS
COMPLETED
Johannesburg
8950, FAMCRU Clinical Research Site
RECRUITING
Tygerberg
Thailand
5115, Siriraj Hospital Mahidol University Clinical Research Site
RECRUITING
Bangkok
5116, Chiangrai Prachanukroh Hospital Clinical Research Site
RECRUITING
Chiang Mai
Uganda
31798, Baylor-Uganda Clinical Research Site
RECRUITING
Kampala
MU-JHU Care Limited CRS
COMPLETED
Kampala
MU-JHU Research Collaboration (MUJHU CARE LTD) CRS
WITHDRAWN
Kampala
United Republic of Tanzania
5118, Kilimanjaro Christian Medical Centre Clinical Research Site
RECRUITING
Moshi
Zambia
George CRS
COMPLETED
Lusaka
Zimbabwe
30303, Saint Mary's Clinical Research Site
RECRUITING
Chitungwiza
30306, Seke North Clinical Research Site
RECRUITING
Chitungwiza
31890, Harare Family Care Clinical Research Site
RECRUITING
Harare
Contact Information
Primary
Anne Coletti, MS
acoletti@fhi360.org
919-627-6445
Time Frame
Start Date: 2015-01-23
Estimated Completion Date: 2031-12-31
Participants
Target number of participants: 1120
Treatments
Experimental: Cohort 1, Regimen 1L: 2 NRTIs + NVP + LPV/r
Participants will receive 2 NRTIs + NVP + LPV/r.
Experimental: Cohort 2, Regimen 1L: 2 NRTIs + NVP + LPV/r
Participants will receive 2 NRTIs + NVP + LPV/r.
Experimental: Cohort 1, Regimen 2R: 2 NRTIs + NVP + RAL
Participants will receive 2 NRTIs + NVP + RAL.
Experimental: Cohort 2, Regimen 2R: 2 NRTIs + NVP + RAL
Participants will receive 2 NRTIs + NVP + RAL.
Experimental: Cohort 1, Regimen 2RV: 2 NRTIs + NVP + RAL + VRC01
Participants will receive 2 NRTIs + NVP + RAL + VRC01.
Experimental: Cohort 1, Regimen 3RD: 2 NRTIs + NVP + RAL switch to 2 NRTIs + DTG
Participants will receive 2 NRTIs + NVP + RAL with subsequent switch to 2 NRTIs + DTG upon reaching 28 days of age and 3 kg body weight.
Experimental: Cohort 1, Regimen 3RDV7: 2 NRTIs + NVP + RAL + VRC07-523LS switch to 2 NRTIs + DTG + VRC07-523LS
Participants will receive 2 NRTIs + NVP + RAL + VRC07-523LS with subsequent switch to 2 NRTIs + DTG + VRC07-523LS upon reaching 28 days of age and 3 kg body weight.
Related Therapeutic Areas
Sponsors
Leads: National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators: National Institute of Mental Health (NIMH), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

This content was sourced from clinicaltrials.gov