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FEM-PrEP (Truvada®): Study to Assess the Role of Truvada® in Preventing HIV Acquisition in Women

Primary Purpose

HIV Infections

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Truvada
Placebo
Sponsored by
FHI 360
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for HIV Infections focused on measuring Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), HIV, HIV Prevention, Oral PrEP, Truvada, women, Tenofovir, TDF, FTC, emtricitabine, hepatitis, Pre-exposure Prophylaxis (PrEP), HIV Seronegativity

Eligibility Criteria

18 Years - 35 Years (Adult)FemaleAccepts Healthy Volunteers

Inclusion Criteria:

  1. Willing and able (see criterion 2) to provide written informed consent to be screened for and to participate in the trial
  2. Able to answer a percentage of informed consent screening (75%) and enrollment (100%) comprehension quiz questions correctly
  3. Between 18-35 years old, inclusive
  4. At higher risk of becoming HIV infected
  5. Have a final negative result according to the site-specific screening HIV testing algorithm and a final negative result at enrollment according to the study HIV testing algorithm
  6. Willing to participate in all aspects of the study and to comply with study procedures, for up to 60 weeks, including:

    • Be randomized
    • Use study product as directed
    • Adhere to follow-up schedule and willing to be contacted by site staff between study visits (by phone and/or in person)
    • Use a study-approved effective non-barrier method of contraception for the duration of the study
    • Take study product, as evidenced by swallowing a vitamin tablet that is similar in size to the study product at enrollment
    • Provide contact information and agrees to some form of contact method throughout the study
  7. Not intending to relocate out of the area for the duration of the study participation and does not have a job or other obligations that may require long absences from the area ( > 1 month at a time)
  8. In general good health and have no condition (social or medical) which, in the opinion of the Site Investigator, would make study participation unsafe or complicate data interpretation
  9. Not pregnant or breastfeeding, and does not anticipate a desire for pregnancy during the 52 weeks of on-product participation
  10. Medically eligible at screening including:

    • Adequate renal function (serum creatinine ≤ upper limit of normal (ULN) of local range and creatinine clearance ≥ 60ml/min estimated by the Cockcroft-Gault Creatinine Clearance Formula
    • Adequate hepatic function (hepatic transaminases ALT and AST < 2x ULN [according to local normal ranges])
    • HBsAg negative
    • Serum phosphorus levels above the lower limit of the local normal range (according to local normal ranges - grade 3 & 4 hypophosphatemia will be excluded even if within normal local ranges)
  11. Not received or receiving an experimental HIV vaccine, participating in another HIV prevention study or participating in any other clinical trial with a biomedical intervention
  12. No clinical signs of liver disease (e.g., ascites, spider angiomata, hepatomegaly, jaundice)
  13. No definite evidence of glycosuria or proteinuria (i.e., no repeated positive [ ≥ + 1 ] urine dipstick). If a urine dipstick is positive for either glucose and/or protein at the first test, a second urine sample will be tested.
  14. No history of pathological bone fractures
  15. No history of adverse reaction to latex
  16. Not taking any of the following medications: nephrotoxic agents; aminoglycoside antibiotics (including gentamicin); intravenous (IV) amphotericin B; cidofovir; cisplatin; foscarnet; IV pentamidine; oral or IV vancomycin; oral or IV gancyclovir; other agents with significant nephrotoxic potential; drugs that slow renal excretion; probenecid; immune system modulators; systemic chemotherapeutic agents (i.e. cancer treatment medications); systemic corticosteroids; interleukin-2 (IL-2); immunomodulators; interferon (alpha, beta, or gamma); other antiretrovirals (including nucleoside analogs, non-nucleoside reverse transcriptase inhibitors, protease inhibitors or investigational antiretroviral agents)

Sites / Locations

  • Bondo Clinic, Bondo District Hospital
  • Setshaba Research Centre
  • Josha Research Center
  • Arusha Clinic, Levolosi Health Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Truvada Arm

Placebo Arm

Arm Description

Daily single oral tablet of Truvada (TDF/FTC), a fixed-dose combination of emtricitabine (FTC; 200 mg) and tenofovir disoproxil fumarate (TDF; 300 mg).

Daily single oral tablet of Placebo. Tablets are identical to Truvada tablets in taste and appearance; however, they contain no active ingredients.

Outcomes

Primary Outcome Measures

HIV Infection
HIV Seroconversion, with time to infection refined based on PCR results obtained from stored specimens.
Confirmed Grade 2 or Higher Serum Creatinine Toxicity
Repeat specimens were collected to confirm chemistry toxicities. Grade 2 or higher serum creatinine toxicity was defined as ≥1.4 times the upper limit of normal
Frequency of Adverse Events (AEs) During and Within 4 Weeks After Study Product Administration
The total number of adverse events in the placebo and Truvada arms during and within 4 weeks after study product administration.
Confirmed Grade 3 or Higher Reduction in Phosphorus
Repeat specimens were collected to confirm chemistry toxicities. Grade 3 phosphorus reduction was defined as ≤2.4mg/dL
Confirmed Grade 3 or Higher ALT Elevation
Grade 3 or higher ALT elevation was defined as ≥ 2.6 times the upper limit of normal
Confirmed Grade 3 or Higher AST Elevation
Grade 3 or higher AST elevation was defined as ≥ 2.6 times the upper limit of normal

Secondary Outcome Measures

Plasma HIV RNA Level (HIV-1 Viral Load)
Viral load at the time of HIV detection, HIV conversion and through 16 weeks
CD4+ T-cell Count
CD4+ T-cell Count at the Time of HIV Seroconversion through 16 weeks
FTC and/or Tenofovir Resistance
Genotypic resistance to FTC and/or tenofovir at the time of HIV diagnosis and 4 weeks later. If resistance was present, testing was repeated at weeks 12, 24, 36 and 52 as necessary (resistance testing will stop if no resistance is detected). participants were classified as having resistance if they had one or more visits in which resistance was detected, even if the resistance became undetectable over time.
Pregnancy Complications
Reported complications during pregnancy, including spontaneous abortion, vaginal or uterine bleeding, emergency c-section and other complications
Pill Counts and Participant Report of Adherence to Once-daily Pill Taking
Pill counts and participant report of adherence to once-daily pill taking reported as mean days study product could have been used according to pill counts
Participant Report of Change in Number of Sexual Partners
Difference in mean number of reported sexual partners between final study visit and enrollment visit

Full Information

First Posted
February 19, 2008
Last Updated
June 28, 2018
Sponsor
FHI 360
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1. Study Identification

Unique Protocol Identification Number
NCT00625404
Brief Title
FEM-PrEP (Truvada®): Study to Assess the Role of Truvada® in Preventing HIV Acquisition in Women
Official Title
Phase 3, Multi-center, Double-blind, Randomized, Placebo-controlled Effectiveness and Safety Study to Assess the Role of Truvada® in Preventing HIV Acquisition in Women
Study Type
Interventional

2. Study Status

Record Verification Date
June 2018
Overall Recruitment Status
Completed
Study Start Date
May 2009 (undefined)
Primary Completion Date
August 2012 (Actual)
Study Completion Date
January 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
FHI 360

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This Phase III, double-blind, randomized, placebo-controlled trial enrolled HIV-negative women from 4 sites in 3 countries (Kenya, Tanzania, South Africa). The study's purpose was to investigate the safety and effectiveness of a once-daily Truvada® pill (compared with placebo) in preventing HIV among HIV-uninfected women at risk of becoming infected through sexual intercourse. The study population included HIV-antibody-negative women between the ages of 18-35 who were at risk of HIV acquisition through sexual intercourse. Each participant was randomized to take either a daily single oral tablet of Truvada®, which is a fixed-dose combination of emtricitabine (FTC; 200 mg) and tenofovir disoproxil fumarate (TDF; 300 mg), or an identical placebo. After enrollment, each participant was followed every four weeks. All participants were followed for an additional eight weeks after study drug was stopped. Incidence rates of HIV infection were compared between the two groups (active drug and placebo) using the intent-to-treat principle.
Detailed Description
This Phase III, double-blind, randomized, placebo-controlled trial enrolled HIV-negative women from 4 sites in 3 countries (Kenya, Tanzania, South Africa). The study's purpose was to investigate the safety and effectiveness of a once-daily Truvada® pill (compared with placebo) in preventing HIV among HIV-uninfected women at risk of becoming infected through sexual intercourse. The study population included HIV-antibody-negative women between the ages of 18-35 who were at risk of HIV acquisition through sexual intercourse. Each participant was randomized to take either a daily single oral tablet of Truvada®, which is a fixed-dose combination of emtricitabine (FTC; 200 mg) and tenofovir disoproxil fumarate (TDF; 300 mg), or an identical placebo. All participants received risk reduction counseling and condoms. Women had to be using a study-approved effective non-barrier contraceptive method at the time of enrollment and were asked to do so for the whole period they were on study drug. They received contraceptive counseling throughout the study. Any diagnosed, treatable sexually transmitted infection was treated free of charge. After enrollment, each participant was followed every four weeks. All participants were followed for an additional eight weeks after study drug was stopped. Participants at risk for Hepatitis B Virus (HBV) flare were followed every four weeks for 12 weeks after stopping study product. Participants who acquired HIV infection during the study stopped taking the study drug at the time of HIV diagnosis, and will be followed for 52 weeks post diagnosis and were referred for care and treatment. Participants who became pregnant stopped taking the study drug but continued follow-up visits. Incidence rates of HIV infection were compared between the two groups (active drug and placebo) using the intent-to-treat principle.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections
Keywords
Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), HIV, HIV Prevention, Oral PrEP, Truvada, women, Tenofovir, TDF, FTC, emtricitabine, hepatitis, Pre-exposure Prophylaxis (PrEP), HIV Seronegativity

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
2120 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Truvada Arm
Arm Type
Experimental
Arm Description
Daily single oral tablet of Truvada (TDF/FTC), a fixed-dose combination of emtricitabine (FTC; 200 mg) and tenofovir disoproxil fumarate (TDF; 300 mg).
Arm Title
Placebo Arm
Arm Type
Placebo Comparator
Arm Description
Daily single oral tablet of Placebo. Tablets are identical to Truvada tablets in taste and appearance; however, they contain no active ingredients.
Intervention Type
Drug
Intervention Name(s)
Truvada
Other Intervention Name(s)
TDF/FTC - emtricitabine and tenofovir disoproxil fumarate
Intervention Description
Daily single oral tablet of Truvada - a fixed-dose combination of emtricitabine (FTC; 200 mg) and tenofovir disoproxil fumarate (TDF; 300 mg).
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Daily single oral tablet of Placebo. Tablets are identical to Truvada tablets in taste and appearance; however, they contain no active ingredients.
Primary Outcome Measure Information:
Title
HIV Infection
Description
HIV Seroconversion, with time to infection refined based on PCR results obtained from stored specimens.
Time Frame
Cumulative HIV infection between enrollment and 52 weeks
Title
Confirmed Grade 2 or Higher Serum Creatinine Toxicity
Description
Repeat specimens were collected to confirm chemistry toxicities. Grade 2 or higher serum creatinine toxicity was defined as ≥1.4 times the upper limit of normal
Time Frame
cumulative toxicity through 52 weeks of product use and 4 weeks post product
Title
Frequency of Adverse Events (AEs) During and Within 4 Weeks After Study Product Administration
Description
The total number of adverse events in the placebo and Truvada arms during and within 4 weeks after study product administration.
Time Frame
10-26 months per site
Title
Confirmed Grade 3 or Higher Reduction in Phosphorus
Description
Repeat specimens were collected to confirm chemistry toxicities. Grade 3 phosphorus reduction was defined as ≤2.4mg/dL
Time Frame
Through 52 weeks on product and 4 weeks post-product
Title
Confirmed Grade 3 or Higher ALT Elevation
Description
Grade 3 or higher ALT elevation was defined as ≥ 2.6 times the upper limit of normal
Time Frame
Through 52 weeks on product and 4 weeks post-product
Title
Confirmed Grade 3 or Higher AST Elevation
Description
Grade 3 or higher AST elevation was defined as ≥ 2.6 times the upper limit of normal
Time Frame
Through 52 weeks on product and 4 weeks post-product
Secondary Outcome Measure Information:
Title
Plasma HIV RNA Level (HIV-1 Viral Load)
Description
Viral load at the time of HIV detection, HIV conversion and through 16 weeks
Time Frame
up to 16 weeks
Title
CD4+ T-cell Count
Description
CD4+ T-cell Count at the Time of HIV Seroconversion through 16 weeks
Time Frame
Up to 16 weeks
Title
FTC and/or Tenofovir Resistance
Description
Genotypic resistance to FTC and/or tenofovir at the time of HIV diagnosis and 4 weeks later. If resistance was present, testing was repeated at weeks 12, 24, 36 and 52 as necessary (resistance testing will stop if no resistance is detected). participants were classified as having resistance if they had one or more visits in which resistance was detected, even if the resistance became undetectable over time.
Time Frame
up to 52 weeks
Title
Pregnancy Complications
Description
Reported complications during pregnancy, including spontaneous abortion, vaginal or uterine bleeding, emergency c-section and other complications
Time Frame
up to 60 weeks
Title
Pill Counts and Participant Report of Adherence to Once-daily Pill Taking
Description
Pill counts and participant report of adherence to once-daily pill taking reported as mean days study product could have been used according to pill counts
Time Frame
Up to 52 weeks
Title
Participant Report of Change in Number of Sexual Partners
Description
Difference in mean number of reported sexual partners between final study visit and enrollment visit
Time Frame
Up to 52 weeks

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
35 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Willing and able (see criterion 2) to provide written informed consent to be screened for and to participate in the trial Able to answer a percentage of informed consent screening (75%) and enrollment (100%) comprehension quiz questions correctly Between 18-35 years old, inclusive At higher risk of becoming HIV infected Have a final negative result according to the site-specific screening HIV testing algorithm and a final negative result at enrollment according to the study HIV testing algorithm Willing to participate in all aspects of the study and to comply with study procedures, for up to 60 weeks, including: Be randomized Use study product as directed Adhere to follow-up schedule and willing to be contacted by site staff between study visits (by phone and/or in person) Use a study-approved effective non-barrier method of contraception for the duration of the study Take study product, as evidenced by swallowing a vitamin tablet that is similar in size to the study product at enrollment Provide contact information and agrees to some form of contact method throughout the study Not intending to relocate out of the area for the duration of the study participation and does not have a job or other obligations that may require long absences from the area ( > 1 month at a time) In general good health and have no condition (social or medical) which, in the opinion of the Site Investigator, would make study participation unsafe or complicate data interpretation Not pregnant or breastfeeding, and does not anticipate a desire for pregnancy during the 52 weeks of on-product participation Medically eligible at screening including: Adequate renal function (serum creatinine ≤ upper limit of normal (ULN) of local range and creatinine clearance ≥ 60ml/min estimated by the Cockcroft-Gault Creatinine Clearance Formula Adequate hepatic function (hepatic transaminases ALT and AST < 2x ULN [according to local normal ranges]) HBsAg negative Serum phosphorus levels above the lower limit of the local normal range (according to local normal ranges - grade 3 & 4 hypophosphatemia will be excluded even if within normal local ranges) Not received or receiving an experimental HIV vaccine, participating in another HIV prevention study or participating in any other clinical trial with a biomedical intervention No clinical signs of liver disease (e.g., ascites, spider angiomata, hepatomegaly, jaundice) No definite evidence of glycosuria or proteinuria (i.e., no repeated positive [ ≥ + 1 ] urine dipstick). If a urine dipstick is positive for either glucose and/or protein at the first test, a second urine sample will be tested. No history of pathological bone fractures No history of adverse reaction to latex Not taking any of the following medications: nephrotoxic agents; aminoglycoside antibiotics (including gentamicin); intravenous (IV) amphotericin B; cidofovir; cisplatin; foscarnet; IV pentamidine; oral or IV vancomycin; oral or IV gancyclovir; other agents with significant nephrotoxic potential; drugs that slow renal excretion; probenecid; immune system modulators; systemic chemotherapeutic agents (i.e. cancer treatment medications); systemic corticosteroids; interleukin-2 (IL-2); immunomodulators; interferon (alpha, beta, or gamma); other antiretrovirals (including nucleoside analogs, non-nucleoside reverse transcriptase inhibitors, protease inhibitors or investigational antiretroviral agents)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lut Van Damme, MD, MS, PhD
Organizational Affiliation
FHI 360
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Amy Corneli, PhD, MPH
Organizational Affiliation
FHI 360
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Jennifer Deese, MPH
Organizational Affiliation
FHI 360
Official's Role
Study Director
Facility Information:
Facility Name
Bondo Clinic, Bondo District Hospital
City
Bondo
State/Province
Nyanza
Country
Kenya
Facility Name
Setshaba Research Centre
City
Pretoria
State/Province
Gauteng
Country
South Africa
Facility Name
Josha Research Center
City
Bloemfontein
Country
South Africa
Facility Name
Arusha Clinic, Levolosi Health Center
City
Arusha
Country
Tanzania

12. IPD Sharing Statement

Citations:
PubMed Identifier
22784040
Citation
Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, Malahleha M, Owino F, Manongi R, Onyango J, Temu L, Monedi MC, Mak'Oketch P, Makanda M, Reblin I, Makatu SE, Saylor L, Kiernan H, Kirkendale S, Wong C, Grant R, Kashuba A, Nanda K, Mandala J, Fransen K, Deese J, Crucitti T, Mastro TD, Taylor D; FEM-PrEP Study Group. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012 Aug 2;367(5):411-22. doi: 10.1056/NEJMoa1202614. Epub 2012 Jul 11.
Results Reference
result
PubMed Identifier
25539648
Citation
Mandala J, Nanda K, Wang M, De Baetselier I, Deese J, Lombaard J, Owino F, Malahleha M, Manongi R, Taylor D, Van Damme L. Liver and renal safety of tenofovir disoproxil fumarate in combination with emtricitabine among African women in a pre-exposure prophylaxis trial. BMC Pharmacol Toxicol. 2014 Dec 24;15:77. doi: 10.1186/2050-6511-15-77.
Results Reference
derived
PubMed Identifier
25503265
Citation
Grant RM, Liegler T, Defechereux P, Kashuba AD, Taylor D, Abdel-Mohsen M, Deese J, Fransen K, De Baetselier I, Crucitti T, Bentley G, Agingu W, Ahmed K, Damme LV. Drug resistance and plasma viral RNA level after ineffective use of oral pre-exposure prophylaxis in women. AIDS. 2015 Jan 28;29(3):331-7. doi: 10.1097/QAD.0000000000000556.
Results Reference
derived
PubMed Identifier
25459097
Citation
Todd CS, Deese J, Wang M, Hubacher D, Steiner MJ, Otunga S, Van Damme L; FEM-PrEP Study Group. Sino-implant (II)(R) continuation and effect of concomitant tenofovir disoproxil fumarate-emtricitabine use on plasma levonorgestrel concentrations among women in Bondo, Kenya. Contraception. 2015 Mar;91(3):248-52. doi: 10.1016/j.contraception.2014.10.008. Epub 2014 Oct 22.
Results Reference
derived
Links:
URL
http://ghr.nlm.nih.gov/condition/complement-factor-i-deficiency
Description
Genetics Home Reference for complement factor I deficiency
URL
http://www.nlm.nih.gov/medlineplus/hivaids.html
Description
MedlinePlus: AIDS
URL
http://www.nlm.nih.gov/medlineplus/hepatitis.html
Description
MedlinePlus: Hepatitis
URL
http://druginfo.nlm.nih.gov/drugportal/ProxyServlet?mergeData=true&objectHandle=DBMaint&APPLICATION_NAME=drugportal&actionHandle=default&nextPage=jsp/drugportal/ResultScreen.jsp&TXTSUPERLISTID=0000057114&QV1=N-OCTADECANOIC+ACID
Description
Drug Information: n-Octadecanoic acid
URL
http://druginfo.nlm.nih.gov/drugportal/ProxyServlet?mergeData=true&objectHandle=DBMaint&APPLICATION_NAME=drugportal&actionHandle=default&nextPage=jsp/drugportal/ResultScreen.jsp&TXTSUPERLISTID=0001592230&QV1=CALCIUM+STEARATE
Description
Drug Information: Calcium stearate
URL
http://druginfo.nlm.nih.gov/drugportal/ProxyServlet?mergeData=true&objectHandle=DBMaint&APPLICATION_NAME=drugportal&actionHandle=default&nextPage=jsp/drugportal/ResultScreen.jsp&TXTSUPERLISTID=0007047849&QV1=ALUMINUM+MONOSTEARATE
Description
Drug Information : Aluminum monostearate
URL
http://clinicaltrials.gov/ct2/info/fdalinks
Description
U.S. FDA Resources

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FEM-PrEP (Truvada®): Study to Assess the Role of Truvada® in Preventing HIV Acquisition in Women

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