Safety and Effectiveness of Tenofovir Gel in the Prevention of Human Immunodeficiency Virus (HIV-1) Infection in Women and the Effects of Tenofovir Gel on the Incidence of Herpes Simplex Virus (HSV-2) Infection

HIV Prevention Clinical Trial

Official title:

A Phase III, Multi-Centre, Randomized Controlled Trial to Assess the Safety and Effectiveness of the Vaginal Microbicide 1% Tenofovir Gel in the Prevention of Human Immunodeficiency Virus Type 1 Infection in Women, and to Examine Effects of the Microbicide on the Incidence of Herpes Simplex Virus Type 2 Infection

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01386294
• Other study ID #: FACTS 001
• Status: Completed
• Phase: Phase 3
• First received: June 28, 2011
• Last updated: April 16, 2015
• Start date: October 2011
• Est. completion date: August 2014

Study information

• Verified date: April 2015
• Source: CONRAD
• Contact: n/a
• Is FDA regulated: No
• Health authority: South Africa: Medicines Control CouncilUnited States: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

The purpose of the study is to assess the safety and effectiveness of intravaginal 1% tenofovir gel in preventing Human Immunodeficiency Virus (HIV-1) infection and Herpes Simplex Virus (HSV-2) infection in sexually active women.

Description:

This is a phase III, multicenter trial to assess the safety and effectiveness of 1% tenofovir gel, administered vaginally by approximately 2900 sexually active women at high risk for sexually transmitted HIV. Approximately 2600 women aged 18-30 years old will be enrolled to achieve the required number of endpoints to show an effect on HIV-1 infection, while up to 300 additional women aged 31-40 years old will be enrolled to collect more safety information in this age group.

This is an event driven study that plans to randomize seronegative women. Participants will be randomized to a 1:1 ratio to receive 1% tenofovir gel or placebo gel. Each will be asked to insert a dose of the assigned study product within 12 hours prior to a coital event and another dose as soon as possible within 12 hours after a coital event. Participants will be advised to use only two doses of gel in a 24 hour period.

All women will be evaluated for the rates of adverse events and the rate of HIV seroconversion. In addition, the study will evaluate several secondary endpoints that bear directly on potential risks and benefits of vaginal tenofovir gel use.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 2059
• Est. completion date: August 2014
• Est. primary completion date: August 2014
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Female
• Age group: 18 Years to 40 Years

Eligibility

Inclusion Criteria:

• Confirmed age 18-40 years (inclusive)

• Able and willing to provide written informed consent

• Able and willing to provide adequate locator information for study retention and safety purposes

• Sexually active, defined as having had vaginal intercourse at least twice in the past 30 days prior to screening

• HIV negative on two rapid tests performed by study staff within 30 days of enrolment (see algorithm in Appendix 3).

• No evidence of glycosuria

• No evidence of proteinuria greater than trace*

• No history of pathological bone fractures

• Have a negative pregnancy test

• Women currently breastfeeding may be enrolled in the study

• Agree to use a study-approved effective non-barrier form of contraception

• Agree to adhere to study visits and procedures

• Willing to use study gel as advised

• Not using or taking any of the following groups of medications:

• Nephrotoxic agents

• Drugs that slow renal excretion

• Immune system modulators

• Other antiretrovirals

Exclusion Criteria:

• History of adverse reaction to latex.

• Plans any of the following during the study period

• To travel away from the study site for more than 30 consecutive days.

• To relocate away from the study site.

• To become pregnant.

• To enrol in any other study of an investigational product or behaviour modification related to HIV prevention.

• If in the opinion of the examining clinician, is not sexually active

• Inadequate renal function (serum creatinine greater than 1.5mg/dl and creatinine clearance less than 50ml/min, as estimated using the method of Cockcroft and Gault96 )

• Grade 3 and above ALT and AST at screening or any clinical sign of liver disease ( e.g. ascites, hepatomegaly, jaundice)

• Abnormal serum phosphate levels (Grade 3 and above)

• Has a clinically apparent finding on speculum pelvic examination (observed by study staff) involving deep epithelial disruption. Otherwise eligible participants with speculum pelvic examination findings involving deep epithelial disruption may proceed with enrolment after the findings have resolved and the inclusion/exclusion are met.

• Received previously or receiving an experimental HIV vaccine

• Currently participating in another HIV prevention intervention study or participation in any other clinical trial with a biomedical intervention in the last six months

• Has current STI symptoms and/or other reproductive tract infection requiring treatment, as assessed by study staff. Otherwise eligible participants diagnosed during screening with infection(s) requiring treatment may be enrolled provided that treatment has been completed.

• Any clinical evidence of untreated cervical abnormalities

• Has any other condition that, based on the opinion of the Investigator or designee, would preclude provision of informed consent, make participation in the study unsafe, complicate interpretation of study outcome data, or otherwise interfere with achieving the study objectives.

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Prevention

Related Conditions & MeSH terms

• Acquired Immunodeficiency Syndrome
• Herpes Simplex
• HIV Infections
• HIV Prevention
• Immunologic Deficiency Syndromes

Intervention

Drug:
• Tenofovir gel
Tenofovir gel is a clear, transparent, viscous gel at concentrations of 1% formulated in purified water with edentate disodium, citric acid, glycerin, methylparaben, propylparaben, HEC, and pH adjusted to 4-5. Tenofovir gel will be supplies in a 4 ml single use applicator containing approximately 4 grams of gel, equivalent to approximately 40mg of tenofovir.
• Universal placebo gel
The placebo gel is an inert gel containing HEC as the gelling agent, purified water, sodium chloride, sorbic acid and sodium hydroxide. Each applicator contains approximately 4ml of placebo gel

Locations

Country	Name	City	State
South Africa	Desmond Tutu HIV Centre / University of Cape Town	Cape Town
South Africa	Perinatal HIV Research Unit / University of the Witwatersrand	Diepkloof
South Africa	Wits Reproductive Health and HIV Institute / University of the Witwatersrand	Hillbrow
South Africa	Qhakaza Mbokodo Research Clinic	Ladysmith
South Africa	MatCH Edendale Research Center	Pietermaritzburg	Kwa-Zulu NAtal
South Africa	Medunsa Clinical Research Unit / Ga-Ra	Pretoria
South Africa	The Aurum Institute (Rustenburg)	Rustenburg
South Africa	Setshaba Research Centre	Soshanguve
South Africa	The Aurum Institute, Tembisa Hospital	Tembisa

Sponsors (3)

Lead Sponsor	Collaborator
CONRAD	Follow-on African Consortium for Tenofovir Studies (FACTS), United States Agency for International Development (USAID)

Country where clinical trial is conducted

South Africa, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Effectiveness	Incidence of HIV-1 infection: HIV incidence will be determine by detection of HIV antibodies using two HIV rapid tests (of which one will be FDA approved) according to algorithm in protocol. One of the rapid tests will detect both HIV-1 and HIV-2; the other will be specific for HIV-1. All endpoints will be reviewed by an expert committee (the Endpoint Adjudication Committee). In carrying out this review, the Committee will use guidelines prepared by the protocol committee for this purpose and recorded in the Manual of Procedures	30 months	No
Primary	Safety	Grade 2, 3, and 4 clinical and laboratory adverse events as defined by the DAIDS toxicity table	30 months	Yes
Secondary	Incidence of HSV-2 infection	HSV-2 status will be established at enrollment according to a testing algorithm in the protocol. At product discontinuation samples of all those that were HSV-2 seronegative at enrollment will be tested. To identify and confirm incident HSV-2 infections and the timing of these infections, blood samples that were stored will be tested to determine the earliest equivocal or positive result. These samples will be then be tested by HSV Western blot. Samples positive on HSV Western blot will be deemed to be incident HSV-2 infections.	30 months	No
Secondary	Pregnancy	Incidence of pregnancy loss, prematurity, low birth weight, and major and minor congenital anomalies will be determined	30 months	No
Secondary	Gel and condom use		30 months	No
Secondary	HIV-1 incidence after product withdrawal	HIV testing will be conducted 3 months after product discontinuation and if HIV positive, the last stored sample will be tested to ascertain timing of infection and viral tenofovir resistance testing will be performed	3 months after product withdrawal	No