Nevirapine Dosing in Neonates for Prophylaxis of Mother-to-Child-Transmission (MTCT) of HIV Infection

HIV Clinical Trial

Official title:

Nevirapine Dosing in Neonates for Prophylaxis of Mother-to-Child-Transmission (MTCT) of HIV Infection

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02166502
• Other study ID #: 1000029134
• Status: Completed
• Phase: Phase 3
• First received: June 5, 2014
• Last updated: November 17, 2015
• Start date: February 2012
• Est. completion date: November 2015

Study information

• Verified date: November 2015
• Source: The Hospital for Sick Children
• Contact: n/a
• Is FDA regulated: No
• Health authority: Canada: Health Canada
• Study type: Observational

Clinical Trial Summary

The purpose of this study is to determine whether the current dose of nevirapine recommended in the Ontario Ministry of Health vertical transmission prevention protocol achieves therapeutic drug levels in newborn infants at high risk of HIV infection.

Description:

Although nevirapine (NVP) is often given as part of combination antiretroviral therapy (cART) at our institutions for prevention of vertical transmission (VT) in high risk infants, the optimal prophylactic dose of nevirapine is unknown. The National Institute of Health (NIH) guidelines currently recommend a single 2 mg/kg dose of nevirapine given to the infant within 72 hours of birth, however, this dose is not being used in practice given the controversies previously described with single-dose nevirapine. In the absence of any guidance to inform the multiple daily dosing of nevirapine for prophylaxis of VT, we are currently using the treatment dose for infants >15 days of age of 150 mg/m2 once daily for 14 days, then increasing to 150 mg/m2 twice daily for 14 days. This is analogous to the treatment dosing of triple antiretrovirals (ARVs) that is given for occupational post-exposure prophylaxis. Nevirapine is given for 4 weeks total with zidovudine (AZT) and lamivudine (3TC), followed by 2 additional weeks of AZT and 3TC to prevent the development of nevirapine resistance from its long half life. Stopping all 3 drugs simultaneously would result in a period of functional NVP monotherapy, resulting in a risk of NVP resistance should the infant become infected despite prophylaxis. Since the dose of nevirapine being used in our clinic populations for prevention of VT is higher than has been previously studied in neonates, it is important to evaluate the safety and efficacy of this dosing regimen, using therapeutic drug monitoring.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 27
• Est. completion date: November 2015
• Est. primary completion date: May 2015
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Both
• Age group: N/A to 72 Hours

Eligibility

Inclusion Criteria:

• Newborn infants prescribed combination antiretroviral treatment with nevirapine for prevention of mother-to-child HIV transmission. These infants are routinely referred to the Hospital for Sick Children (SickKids) and Children's Hospital of Eastern Ontario (CHEO) HIV clinics in Toronto and Ottawa, respectively, for ongoing management. The majority of referrals are from Mount Sinai Hospital and St. Michael's Hospital in Toronto, and the Ottawa General Hospital in Ottawa.

• Voluntary informed consent by the legal guardian

Exclusion Criteria:

• Infants born prior to 32 weeks gestational age;

• Infants with life-threatening medical conditions;

• Infants unable to take oral medication;

• Infants born to women considered at high risk of harboring nevirapine resistance mutations in whom Kaletra (lopinavir/ritonavir) is a therapeutic option (e.g. term neonates) will be excluded and prescribed Kaletra rather than nevirapine

Study Design

Observational Model: Case-Only, Time Perspective: Prospective

Related Conditions & MeSH terms

• Acquired Immunodeficiency Syndrome
• HIV
• HIV Infections
• Human Immunodeficiency Virus
• Immunologic Deficiency Syndromes
• Infection
• Vertical Infection Transmission

Locations

Country	Name	City	State
Canada	Children's Hospital of Eastern Ontario	Ottawa	Ontario
Canada	The Hospital for Sick Children	Toronto	Ontario

Sponsors (5)

Lead Sponsor	Collaborator
The Hospital for Sick Children	Canadian Foundation for AIDS Research (CANFAR), Children's Hospital of Eastern Ontario, Mount Sinai Hospital, Canada, St. Michael's Hospital, Toronto

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Proportion of nevirapine trough (Cmin) plasma levels that are above or below the target range for prophylaxis		Weeks 1, 2, and 4	No
Secondary	Final dose of nevirapine	Final dose of nevirapine required to achieve target plasma trough concentrations at week 4	Week 4	No
Secondary	Derived pharmacokinetic parameters	Derived pharmacokinetic parameters volume of distribution (Vd)(L/kg), elimination rate (ke), clearance (mL/kg/hr), Cmin (ug/L), Cmax (ug/L), Tmax (hrs), and Area under the Curve (AUC)	Week 4	No
Secondary	Association between nevirapine levels and incidence of adverse effects	Number of adverse events among patients with therapeutic vs. supratherapeutic nevirapine levels	Weeks 1, 2 and 4	Yes
Secondary	Association between patient characteristics and differences in nevirapine levels	Patient characteristics that may explain differences in nevirapine levels including chronologic and gestational age, weight, and ethnic background.	Baseline, Week 1, 2 and 4	No
Secondary	Rate of vertical transmission of HIV		18 months	No