Safety, Tolerability and Acceptability of Long-Acting Cabotegravir (CAB LA) for the Prevention of HIV Among Adolescent Males - A Sub-study of HPTN 083
Primary Purpose
HIV Infections
Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Cabotegravir (CAB) tablet
CAB LA
Tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) tablet
Sponsored by

About this trial
This is an interventional prevention trial for HIV Infections focused on measuring Pre-Exposure Prophylaxis, PrEP
Eligibility Criteria
Inclusion Criteria:
- Assigned male at birth (includes MSM, TGW, and gender non-conforming people)
- At enrollment, aged below 18 years
- At enrollment, body weight ≥ 35 kg (77 lbs.)
- Willing to provide informed consent for the study
- Self-reported sexual activity with a male in the past 12 months
In general, good health, as evidenced by the following laboratory values
- Non-reactive/negative HIV test results
- Absolute neutrophil count > 799 cells/mm3
- Platelet count ≥ 100,000 cells/mm3
- Hemoglobin ≥ 11g/dL
- Calculated creatinine clearance ≥ 60 mL/minute using modified Schwartz equation (≤ grade 2)
- Alanine aminotransferase (ALT) < 2.0 times the upper limit of normal (ULN) and total bilirubin (Tbili) ≤ 2.5 x ULN
- Hepatitis B virus (HBV) surface antigen (HBsAg) negative and accepts vaccination
- Hepatitis C virus (HCV) Antibody negative
- Willing to undergo all required study procedures
- If currently on pre-exposure prophylaxis (PrEP) from a non-study source, willing to stop said PrEP prior to enrollment and agree to switch to oral CAB for the lead-in period and CAB LA injections.
Exclusion Criteria:
- Co-enrollment in any other HIV interventional research study or other concurrent studies which may interfere with this study (as provided by self-report or other available documentation)
- Past or current participation in HIV vaccine trial with exception for participants who can provide documentation of receipt of placebo
- Exclusively had sex with biological females in lifetime
- In the last 6 months (at the time of screening): active or planned use of any substance which would, in the opinion of the site investigator, would hinder study participation (including herbal remedies), as described in the Investigator's Brochure (IB) or listed in the Study Specific Procedures (SSP), and/ or Protocol Section 4.4
- Known history of clinically significant cardiovascular disease, as defined by history/evidence of symptomatic arrhythmia, angina/ischemia, coronary artery bypass grafting (CABG) surgery or percutaneous transluminal coronary angioplasty (PTCA) or any clinically significant cardiac disease
- Inflammatory skin conditions that compromise the safety of intramuscular (IM) injections
- Tattoo or other dermatological condition overlying the buttock region that may interfere with interpretation of injection site reactions
- Current or chronic history of liver disease (e.g., non-alcoholic or alcoholic steatohepatitis) or known hepatic or biliary abnormalities (with the exception of Gilbert's syndrome, asymptomatic gallstones, or cholecystectomy)
- Known history of clinically significant bleeding
- Surgically-placed or injected buttock implants or fillers, per self-report. Contact the CMC for guidance regarding questions about individual cases
- A history of seizure disorder, per self-report
- Medical, social, or other condition that, in the opinion of the site investigator, would interfere with the conduct of the study or the safety of the participant (e.g., provided by self-report, or found upon medical history and examination or in available medical records)
- Plans to move out of the geographic area within the next 18 months or otherwise unable to participate in study visits, according to the site investigator.
Sites / Locations
- University of Colorado Denver ATN CRS
- John H. Stroger Jr. Hosp. of Cook County ATN CRS
- The Fenway Institute ATN CRS
- St. Jude Children's Research Hosp. ATN CRS
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
CAB LA
Arm Description
In Step 1, participants will receive one CAB tablet orally every day for 5 weeks. In Step 2, participants will receive an intramuscular (IM) injection of CAB LA at Weeks 5, 9, 17, 25, and 33. In Step 3, participants will receive a TDF/FTC tablet orally every day for 48 weeks or may be offered the opportunity to join an open label CAB study instead, if such a study is being implemented in their area at the time.
Outcomes
Primary Outcome Measures
Safety endpoint: Proportion of participants experiencing any Grade 2 or higher clinical adverse events (AEs) and laboratory abnormalities among participants who receive at least one injection of CAB LA.
Tolerability endpoint: Proportion of participants who receive at least 1 injection and who discontinue receiving injections prior to the full course of injections due to intolerability of injection, frequency of injections or burden of study procedures.
Acceptability endpoint: Proportion of participants who complete all scheduled injections and proportion of participants who receive at least one injection whom would consider using CAB LA for HIV prevention in the future.
Secondary Outcome Measures
Plasma CAB Drug Measurements
CAB drug concentrations will be measured in plasma to generate CAB-LA concentration-time profiles among study participants. Measurements will occur at study visits during the injection phase of the study as well as during the pharmacologic "tail" phase.
Proportion of participant-study visits above the protein-adjusted inhibitor concentration (90%; PA-IC₉₀)
CAB drug concentrations will be measured throughout the study, to determine the proportion of visits in which a participant remains above the 1x (0.166 mcg/mL), 4x (0.664 mcg/mL) and 8x (1.33 mcg/mL) PA-IC₉₀. Concentrations above the 3 PA-IC₉₀ are associated with rectal protection in a non-human primate study, and concentrations above the 8x PA-IC₉₀ are expected to be associated with protection in humans.
Measurement of pharmacokinetic parameters, mean and median drug concentrations at each injection visit.
CAB drug concentrations will be measured throughout the study, and the study team will characterize variability in concentrations at each visit by determining mean and median concentrations, as well as associated deviations and %CVs.
Terminal half-life estimates for CAB-LA.
CAB drug concentrations will be measured during the tail phase of the study, up to one year after a participant's last visit. This will allow the study team to estimate the terminal half-life of CAB-LA.
Characterize CAB drug concentrations in individuals who acquire HIV.
CAB drug measurements will be conducted in all participants, including those who acquire HIV; these data will be used to determine the CAB drug concentration at the first HIV positive visit, and serve as a possible explanatory variable in potential HIV acquisition. Drug concentrations will be evaluated within the context of CAB's PA-IC₉₀.
Full Information
NCT ID
NCT04692077
First Posted
December 22, 2020
Last Updated
August 15, 2023
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
1. Study Identification
Unique Protocol Identification Number
NCT04692077
Brief Title
Safety, Tolerability and Acceptability of Long-Acting Cabotegravir (CAB LA) for the Prevention of HIV Among Adolescent Males - A Sub-study of HPTN 083
Official Title
Safety, Tolerability and Acceptability of Long-Acting Cabotegravir (CAB LA) for the Prevention of HIV Among Adolescent Males - A Sub-study of HPTN 083
Study Type
Interventional
2. Study Status
Record Verification Date
November 2022
Overall Recruitment Status
Completed
Study Start Date
February 19, 2020 (Actual)
Primary Completion Date
July 7, 2023 (Actual)
Study Completion Date
July 7, 2023 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This study will establish the minimum safety, tolerability and acceptability data needed to support the use of cabotegravir long-acting injection (CAB LA) in an adolescent population, potentially transforming the field of HIV prevention for young people.
Detailed Description
The purpose of this study is to establish the minimum safety, tolerability and acceptability data needed to support the use of cabotegravir long-acting injection (CAB LA) in an adolescent population, potentially transforming the field of HIV prevention for young people.
This study will enroll healthy, HIV-uninfected adolescents assigned male at birth, including men who have sex with men (MSM), transgender women (TGW), and gender non-conforming people. The total participant commitment for the entire study is approximately 1.5 years.
This study will take place in three steps. In Step 1, participants will receive daily oral CAB tablets for 5 weeks. In Step 2, participants will receive a series of five intramuscular (IM) injections of CAB LA, administered at 8-week intervals after a 4-week loading dose (injections at Weeks 5, 9, 17, 25 & 33). A safety visit will follow each injection to ascertain safety data, including injection site reactions. In Step 3, all participants who have received at least one injection will be followed quarterly (every 3 months) for 48 weeks after their last injection. Participants will receive oral TDF/FTC for daily use for 48 weeks or may be provided the opportunity to enroll in a local open label study of CAB, if available.
Participants will attend about 18 study visits throughout the study. Visits may include physical examinations, blood collection, urine collection, rectal and oral pharyngeal swab collection, risk reduction and adherence counseling, and behavioral or acceptability assessments.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections
Keywords
Pre-Exposure Prophylaxis, PrEP
7. Study Design
Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
9 (Actual)
8. Arms, Groups, and Interventions
Arm Title
CAB LA
Arm Type
Experimental
Arm Description
In Step 1, participants will receive one CAB tablet orally every day for 5 weeks. In Step 2, participants will receive an intramuscular (IM) injection of CAB LA at Weeks 5, 9, 17, 25, and 33. In Step 3, participants will receive a TDF/FTC tablet orally every day for 48 weeks or may be offered the opportunity to join an open label CAB study instead, if such a study is being implemented in their area at the time.
Intervention Type
Drug
Intervention Name(s)
Cabotegravir (CAB) tablet
Intervention Description
30 mg tablets
Intervention Type
Drug
Intervention Name(s)
CAB LA
Intervention Description
Administered as one 3 mL (600 mg) IM injection in the gluteal muscle at two time points 4 weeks apart and every 8 weeks thereafter.
Intervention Type
Drug
Intervention Name(s)
Tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) tablet
Intervention Description
300 mg/200 mg fixed-dose combination tablets
Primary Outcome Measure Information:
Title
Safety endpoint: Proportion of participants experiencing any Grade 2 or higher clinical adverse events (AEs) and laboratory abnormalities among participants who receive at least one injection of CAB LA.
Time Frame
Measured through participant's last study visit, up to 1.5 years after study entry.
Title
Tolerability endpoint: Proportion of participants who receive at least 1 injection and who discontinue receiving injections prior to the full course of injections due to intolerability of injection, frequency of injections or burden of study procedures.
Time Frame
Measured through participant's last study visit, up to 1.5 years after study entry.
Title
Acceptability endpoint: Proportion of participants who complete all scheduled injections and proportion of participants who receive at least one injection whom would consider using CAB LA for HIV prevention in the future.
Time Frame
Measured through participant's last study visit, up to 1.5 years after study entry.
Secondary Outcome Measure Information:
Title
Plasma CAB Drug Measurements
Description
CAB drug concentrations will be measured in plasma to generate CAB-LA concentration-time profiles among study participants. Measurements will occur at study visits during the injection phase of the study as well as during the pharmacologic "tail" phase.
Time Frame
Measured through participant's last study visit, up to 1.5 years after study entry.
Title
Proportion of participant-study visits above the protein-adjusted inhibitor concentration (90%; PA-IC₉₀)
Description
CAB drug concentrations will be measured throughout the study, to determine the proportion of visits in which a participant remains above the 1x (0.166 mcg/mL), 4x (0.664 mcg/mL) and 8x (1.33 mcg/mL) PA-IC₉₀. Concentrations above the 3 PA-IC₉₀ are associated with rectal protection in a non-human primate study, and concentrations above the 8x PA-IC₉₀ are expected to be associated with protection in humans.
Time Frame
Measured through participant's last study visit, up to 1.5 years after study entry.
Title
Measurement of pharmacokinetic parameters, mean and median drug concentrations at each injection visit.
Description
CAB drug concentrations will be measured throughout the study, and the study team will characterize variability in concentrations at each visit by determining mean and median concentrations, as well as associated deviations and %CVs.
Time Frame
Measured from the initial injection through Week 33.
Title
Terminal half-life estimates for CAB-LA.
Description
CAB drug concentrations will be measured during the tail phase of the study, up to one year after a participant's last visit. This will allow the study team to estimate the terminal half-life of CAB-LA.
Time Frame
Measured through participant's last study visit, up to 1.5 years after study entry.
Title
Characterize CAB drug concentrations in individuals who acquire HIV.
Description
CAB drug measurements will be conducted in all participants, including those who acquire HIV; these data will be used to determine the CAB drug concentration at the first HIV positive visit, and serve as a possible explanatory variable in potential HIV acquisition. Drug concentrations will be evaluated within the context of CAB's PA-IC₉₀.
Time Frame
Measured through participant's last study visit, up to 1.5 years after study entry.
10. Eligibility
Sex
Male
Gender Based
Yes
Gender Eligibility Description
Assigned male at birth (includes MSM, TGW, and gender non-conforming people)
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
Assigned male at birth (includes MSM, TGW, and gender non-conforming people)
At enrollment, aged below 18 years
At enrollment, body weight ≥ 35 kg (77 lbs.)
Willing to provide informed consent for the study
Self-reported sexual activity with a male in the past 12 months
In general, good health, as evidenced by the following laboratory values
Non-reactive/negative HIV test results
Absolute neutrophil count > 799 cells/mm3
Platelet count ≥ 100,000 cells/mm3
Hemoglobin ≥ 11g/dL
Calculated creatinine clearance ≥ 60 mL/minute using modified Schwartz equation (≤ grade 2)
Alanine aminotransferase (ALT) < 2.0 times the upper limit of normal (ULN) and total bilirubin (Tbili) ≤ 2.5 x ULN
Hepatitis B virus (HBV) surface antigen (HBsAg) negative and accepts vaccination
Hepatitis C virus (HCV) Antibody negative
Willing to undergo all required study procedures
If currently on pre-exposure prophylaxis (PrEP) from a non-study source, willing to stop said PrEP prior to enrollment and agree to switch to oral CAB for the lead-in period and CAB LA injections.
Exclusion Criteria:
Co-enrollment in any other HIV interventional research study or other concurrent studies which may interfere with this study (as provided by self-report or other available documentation)
Past or current participation in HIV vaccine trial with exception for participants who can provide documentation of receipt of placebo
Exclusively had sex with biological females in lifetime
In the last 6 months (at the time of screening): active or planned use of any substance which would, in the opinion of the site investigator, would hinder study participation (including herbal remedies), as described in the Investigator's Brochure (IB) or listed in the Study Specific Procedures (SSP), and/ or Protocol Section 4.4
Known history of clinically significant cardiovascular disease, as defined by history/evidence of symptomatic arrhythmia, angina/ischemia, coronary artery bypass grafting (CABG) surgery or percutaneous transluminal coronary angioplasty (PTCA) or any clinically significant cardiac disease
Inflammatory skin conditions that compromise the safety of intramuscular (IM) injections
Tattoo or other dermatological condition overlying the buttock region that may interfere with interpretation of injection site reactions
Current or chronic history of liver disease (e.g., non-alcoholic or alcoholic steatohepatitis) or known hepatic or biliary abnormalities (with the exception of Gilbert's syndrome, asymptomatic gallstones, or cholecystectomy)
Known history of clinically significant bleeding
Surgically-placed or injected buttock implants or fillers, per self-report. Contact the CMC for guidance regarding questions about individual cases
A history of seizure disorder, per self-report
Medical, social, or other condition that, in the opinion of the site investigator, would interfere with the conduct of the study or the safety of the participant (e.g., provided by self-report, or found upon medical history and examination or in available medical records)
Plans to move out of the geographic area within the next 18 months or otherwise unable to participate in study visits, according to the site investigator.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sybil Hosek, PhD
Organizational Affiliation
Stroger Hospital of Cook County
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Lynda Stranix-Chibanda, MBChB, MMED
Organizational Affiliation
University of Zimbabwe College of Health Sciences
Official's Role
Study Chair
Facility Information:
Facility Name
University of Colorado Denver ATN CRS
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
John H. Stroger Jr. Hosp. of Cook County ATN CRS
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
Facility Name
The Fenway Institute ATN CRS
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Facility Name
St. Jude Children's Research Hosp. ATN CRS
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38105
Country
United States
12. IPD Sharing Statement
Learn more about this trial
Safety, Tolerability and Acceptability of Long-Acting Cabotegravir (CAB LA) for the Prevention of HIV Among Adolescent Males - A Sub-study of HPTN 083
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