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A Study of Zidovudine in Infants Exposed to the HIV Before or Soon After Birth

Primary Purpose

HIV Infections

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Zidovudine
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infections focused on measuring Pregnancy, Pregnancy Complications, Infectious, Infant, Newborn, Diseases, Infusions, Intravenous, Drug Evaluation, Administration, Oral, Acquired Immunodeficiency Syndrome, Zidovudine

Eligibility Criteria

1 Day - 3 Months (Child)All SexesAccepts Healthy Volunteers

Inclusion Criteria Infant gestation period must have been = or > 36 weeks and birthweight must = or > 2000 grams. Active infection must not be present at the time of entry into the study although an HIV culture or P24 serum antigen determination must be obtained prior to study entry. The child must have a life expectancy greater than 3 months. Parents or guardian must be available to give informed consent. Prior Medication: Allowed on a case-by-case basis: Some essential supportive therapies including antibiotics. Exclusion Criteria Co-existing Condition: Patients with the following conditions or symptoms are excluded: Any of the following laboratory findings within 2 weeks of study entry. A total bilirubin > 2 times age-adjusted upper limit of normal. Liver transaminase values > 3 x upper limit of normal. Serum creatinine > 1.5 x upper limit of normal. Total granulocyte count < 1500 cells/mm3. Hemoglobin < 10 g/dl or hemoglobinopathy. A urine toxicology screen positive for any drug or chemical. Infants must not have hemoglobinopathy or active infection at entry. Prior Medication: Excluded within 2 months of study entry: Antiretroviral agents. Excluded within 4 weeks of study entry: Immunomodulating agents including steroids, interferon, isoprinosine, and interleukin. Immunoglobulin. Excluded within 2 weeks of study entry: Any other experimental therapy, drugs which cause prolonged neutropenia or significant nephrotoxicity, or rifampin / rifampin derivatives. Some essential supportive therapies including antibiotics may have infrequent or transient effects. These drugs will be considered on a case-by-case basis. Prior Treatment: Excluded within 2 weeks of study entry: Red blood cells or whole blood transfusion. Excluded within 4 weeks of study entry: Lymphocyte transfusions for immune reconstitution. Infants may not be entered into the study during the first 2 weeks of life if their mother received methadone therapy during the last trimester of her pregnancy or used any known illicit drug. A maternal urine toxicology screen may be optionally performed prior to entry of the child, and children whose mothers have a screen which is positive for any drugs or chemicals may not be enrolled within 2 weeks of the positive screen.

Sites / Locations

  • Univ of Alabama at Birmingham
  • Stanford Univ School of Medicine
  • Johns Hopkins Hosp - Pediatric
  • Johns Hopkins Hosp
  • Boston Med Ctr
  • Duke Univ Med Ctr

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
November 2, 1999
Last Updated
July 11, 2008
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
Glaxo Wellcome
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1. Study Identification

Unique Protocol Identification Number
NCT00001007
Brief Title
A Study of Zidovudine in Infants Exposed to the HIV Before or Soon After Birth
Official Title
A Multicenter Phase I Trial To Evaluate the Safety and Pharmacokinetics of Intravenous and Oral Zidovudine in Infants With Perinatal Human Immunodeficiency Virus (HIV) Exposure
Study Type
Interventional

2. Study Status

Record Verification Date
January 2003
Overall Recruitment Status
Completed
Study Start Date
undefined (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
Glaxo Wellcome

4. Oversight

5. Study Description

Brief Summary
To determine if intravenous (IV) and oral zidovudine (AZT) can be safely given to children aged 1 day to 3 months who were born to mothers with an HIV infection. Also to determine the correct dose of AZT for young children. Of a total of 908 pediatric AIDS cases, 78 percent have acquired HIV infection from a mother with HIV infection or at high risk for acquisition of HIV, and the number of cases in children is expected to increase over the next several years. AZT therapy may be effective in altering the course of the disease and decreasing the high mortality in these children. It is also possible that early intervention with AZT may prevent the establishment of HIV contracted before, during, or just after birth.
Detailed Description
Of a total of 908 pediatric AIDS cases, 78 percent have acquired HIV infection from a mother with HIV infection or at high risk for acquisition of HIV, and the number of cases in children is expected to increase over the next several years. AZT therapy may be effective in altering the course of the disease and decreasing the high mortality in these children. It is also possible that early intervention with AZT may prevent the establishment of HIV contracted before, during, or just after birth. The children entered in this study receive oral and IV AZT. The first 6 children receive 2 IV doses and 2 oral doses over a 2-week period, then 4 weeks of continuous oral dosing (4 doses per day). The remaining 12 children receive 1 IV dose and 1 oral dose followed by 6 weeks of oral AZT (4 doses per day) and a second IV dose at the end of the study. Each child is under the care of a specialist in pediatrics and has a physical examination and laboratory tests before starting AZT and 6 times while taking AZT to make sure the drug is not having a toxic effect on the child. A single cerebrospinal fluid (CSF) sample is taken from the last 12 children entering the study, so that the level of the AZT reaching the brain can be measured. The child returns to the hospital or clinic 4 weeks after the end of therapy to make sure that there are no delayed toxic effects.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections
Keywords
Pregnancy, Pregnancy Complications, Infectious, Infant, Newborn, Diseases, Infusions, Intravenous, Drug Evaluation, Administration, Oral, Acquired Immunodeficiency Syndrome, Zidovudine

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Masking
None (Open Label)
Enrollment
18 (false)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Zidovudine

10. Eligibility

Sex
All
Minimum Age & Unit of Time
1 Day
Maximum Age & Unit of Time
3 Months
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria Infant gestation period must have been = or > 36 weeks and birthweight must = or > 2000 grams. Active infection must not be present at the time of entry into the study although an HIV culture or P24 serum antigen determination must be obtained prior to study entry. The child must have a life expectancy greater than 3 months. Parents or guardian must be available to give informed consent. Prior Medication: Allowed on a case-by-case basis: Some essential supportive therapies including antibiotics. Exclusion Criteria Co-existing Condition: Patients with the following conditions or symptoms are excluded: Any of the following laboratory findings within 2 weeks of study entry. A total bilirubin > 2 times age-adjusted upper limit of normal. Liver transaminase values > 3 x upper limit of normal. Serum creatinine > 1.5 x upper limit of normal. Total granulocyte count < 1500 cells/mm3. Hemoglobin < 10 g/dl or hemoglobinopathy. A urine toxicology screen positive for any drug or chemical. Infants must not have hemoglobinopathy or active infection at entry. Prior Medication: Excluded within 2 months of study entry: Antiretroviral agents. Excluded within 4 weeks of study entry: Immunomodulating agents including steroids, interferon, isoprinosine, and interleukin. Immunoglobulin. Excluded within 2 weeks of study entry: Any other experimental therapy, drugs which cause prolonged neutropenia or significant nephrotoxicity, or rifampin / rifampin derivatives. Some essential supportive therapies including antibiotics may have infrequent or transient effects. These drugs will be considered on a case-by-case basis. Prior Treatment: Excluded within 2 weeks of study entry: Red blood cells or whole blood transfusion. Excluded within 4 weeks of study entry: Lymphocyte transfusions for immune reconstitution. Infants may not be entered into the study during the first 2 weeks of life if their mother received methadone therapy during the last trimester of her pregnancy or used any known illicit drug. A maternal urine toxicology screen may be optionally performed prior to entry of the child, and children whose mothers have a screen which is positive for any drugs or chemicals may not be enrolled within 2 weeks of the positive screen.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Modlin J
Official's Role
Study Chair
Facility Information:
Facility Name
Univ of Alabama at Birmingham
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35294
Country
United States
Facility Name
Stanford Univ School of Medicine
City
Stanford
State/Province
California
ZIP/Postal Code
94305
Country
United States
Facility Name
Johns Hopkins Hosp - Pediatric
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
212874933
Country
United States
Facility Name
Johns Hopkins Hosp
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States
Facility Name
Boston Med Ctr
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02118
Country
United States
Facility Name
Duke Univ Med Ctr
City
Durham
State/Province
North Carolina
ZIP/Postal Code
277103499
Country
United States

12. IPD Sharing Statement

Citations:
Citation
Vance E, Guzman J, Bitar M, Kazanjian P. Clarithromycin and zidovudine pharmacokinetic study. Int Conf AIDS. 1994 Aug 7-12;10(2):201 (abstract no PB0816)
Results Reference
background
PubMed Identifier
7574530
Citation
Vance E, Watson-Bitar M, Gustavson L, Kazanjian P. Pharmacokinetics of clarithromycin and zidovudine in patients with AIDS. Antimicrob Agents Chemother. 1995 Jun;39(6):1355-60. doi: 10.1128/AAC.39.6.1355.
Results Reference
background
PubMed Identifier
8419601
Citation
Boucher FD, Modlin JF, Weller S, Ruff A, Mirochnick M, Pelton S, Wilfert C, McKinney R Jr, Crain MJ, Elkins MM, et al. Phase I evaluation of zidovudine administered to infants exposed at birth to the human immunodeficiency virus. J Pediatr. 1993 Jan;122(1):137-44. doi: 10.1016/s0022-3476(05)83507-3.
Results Reference
background
PubMed Identifier
1483365
Citation
Collart L, Blaschke TF, Boucher F, Prober CG. Potential of population pharmacokinetics to reduce the frequency of blood sampling required for estimating kinetic parameters in neonates. Dev Pharmacol Ther. 1992;18(1-2):71-80.
Results Reference
background
PubMed Identifier
9257746
Citation
Polis MA, Piscitelli SC, Vogel S, Witebsky FG, Conville PS, Petty B, Kovacs JA, Davey RT Jr, Walker RE, Falloon J, Metcalf JA, Craft C, Lane HC, Masur H. Clarithromycin lowers plasma zidovudine levels in persons with human immunodeficiency virus infection. Antimicrob Agents Chemother. 1997 Aug;41(8):1709-14. doi: 10.1128/AAC.41.8.1709.
Results Reference
background
PubMed Identifier
2715903
Citation
Balis FM, Pizzo PA, Eddy J, Wilfert C, McKinney R, Scott G, Murphy RF, Jarosinski PF, Falloon J, Poplack DG. Pharmacokinetics of zidovudine administered intravenously and orally in children with human immunodeficiency virus infection. J Pediatr. 1989 May;114(5):880-4. doi: 10.1016/s0022-3476(89)80158-1.
Results Reference
background

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A Study of Zidovudine in Infants Exposed to the HIV Before or Soon After Birth

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