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Safety, Tolerability and Acceptability of Long-Acting Cabotegravir (CAB LA) for the Prevention of HIV Among Adolescent Females - A Sub-study of HPTN 084

Primary Purpose

HIV Infections

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Oral cabotegravir (CAB)
CAB LA
Oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC)
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for HIV Infections

Eligibility Criteria

undefined - 17 Years (Child)FemaleAccepts Healthy Volunteers

Inclusion Criteria:

  • Assigned female at birth
  • At enrollment, below 18 years of age
  • At enrollment, body weight ≥ 35 kg (77 lbs.)
  • Willing and able to provide informed assent/consent for the study and/or able to obtain written parental/guardian informed consent
  • Self-reported sexual activity with a male (oral, anal or vaginal) in the past 12 months
  • Willing and able to undergo all study procedures
  • 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/mm3,
    • Hemoglobin ≥ 11g/dL,
    • Calculated creatinine clearance ≥ 60 mL/minute using the modified Schwartz equation,
    • Alanine aminotransferase (ALT) < 2.0 times the upper limit of normal (ULN) (≤ grade 1) 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
  • Must have a negative beta human chorionic gonadotropin (βHCG) pregnancy test (sensitivity of ≤ 25 mIU/mL) performed (and results known) on the same day as Enrollment and before initiating study product
  • Must agree to use a reliable form of long acting contraception, during the trial and for 48 weeks after stopping the long acting injectable, or 30 days after stopping oral study product, from the list below:

    • Intrauterine device (IUD) or intrauterine system (IUS) that meets <1% failure rate as stated in the product label
    • Hormone-based contraceptive that meets <1% failure rate when used consistently and correctly as stated in the product label (implants or injectables only; this excludes combined oral contraception)
  • If currently on 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.
  • HIV-uninfected, based on HIV test results obtained at Screening and at the Enrollment visit. All HIV test results from the Screening visit must be obtained and must all be negative/non-reactive. This includes testing for acute HIV infection, which must be performed within 14 days of Enrollment. Individuals who have one or more reactive or positive HIV test result(s) will not be enrolled, even if subsequent confirmatory testing indicates that they are not HIV-infected (see SSP Manual).

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 use which would, in the opinion of the site investigator, interfere with 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
  • 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 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
  • Pregnant or currently breastfeeding at the time of screening or intends to become pregnant and/or breastfeed while on study

Sites / Locations

  • Ward 21 CRS
  • MU-JHU Research Collaboration (MUJHU CARE LTD) CRS
  • Spilhaus 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 join an open-label extension CAB study in their area, if available.

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 injection 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.
TFV and TFV-DP may be measured to evaluate oral PrEP use (F/TDF, F/TAF) in cases of incident infection after cessation of study product

Full Information

First Posted
January 6, 2021
Last Updated
June 20, 2023
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT04824131
Brief Title
Safety, Tolerability and Acceptability of Long-Acting Cabotegravir (CAB LA) for the Prevention of HIV Among Adolescent Females - A Sub-study of HPTN 084
Official Title
Safety, Tolerability and Acceptability of Long-Acting Cabotegravir (CAB LA) for the Prevention of HIV Among Adolescent Females - A Sub-study of HPTN 084
Study Type
Interventional

2. Study Status

Record Verification Date
December 2022
Overall Recruitment Status
Completed
Study Start Date
November 4, 2020 (Actual)
Primary Completion Date
January 10, 2023 (Actual)
Study Completion Date
January 10, 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
This study will enroll sexually-active, healthy, HIV-uninfected adolescents assigned female sex at birth. 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 join and open-label extension CAB study in their area, if available. Participants will attend about 18 study visits throughout the study. Visits may include physical examinations, blood collection, urine collection, vaginal 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

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
50 (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 join an open-label extension CAB study in their area, if available.
Intervention Type
Drug
Intervention Name(s)
Oral cabotegravir (CAB)
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)
Oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC)
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 approximately 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 approximately 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 approximately 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 approximately 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 approximately 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 through participant's last study visit, up to approximately 1.5 years after study entry.
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 injection 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 approximately 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 approximately 1.5 years after study entry.
Title
TFV and TFV-DP may be measured to evaluate oral PrEP use (F/TDF, F/TAF) in cases of incident infection after cessation of study product
Time Frame
Measured through participant's last study visit, up to approximately 1.5 years after study entry.

10. Eligibility

Sex
Female
Gender Based
Yes
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Assigned female at birth At enrollment, below 18 years of age At enrollment, body weight ≥ 35 kg (77 lbs.) Willing and able to provide informed assent/consent for the study and/or able to obtain written parental/guardian informed consent Self-reported sexual activity with a male (oral, anal or vaginal) in the past 12 months Willing and able to undergo all study procedures 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/mm3, Hemoglobin ≥ 11g/dL, Calculated creatinine clearance ≥ 60 mL/minute using the modified Schwartz equation, Alanine aminotransferase (ALT) < 2.0 times the upper limit of normal (ULN) (≤ grade 1) 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 Must have a negative beta human chorionic gonadotropin (βHCG) pregnancy test (sensitivity of ≤ 25 mIU/mL) performed (and results known) on the same day as Enrollment and before initiating study product Must agree to use a reliable form of long acting contraception, during the trial and for 48 weeks after stopping the long acting injectable, or 30 days after stopping oral study product, from the list below: Intrauterine device (IUD) or intrauterine system (IUS) that meets <1% failure rate as stated in the product label Hormone-based contraceptive that meets <1% failure rate when used consistently and correctly as stated in the product label (implants or injectables only; this excludes combined oral contraception) If currently on 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. HIV-uninfected, based on HIV test results obtained at Screening and at the Enrollment visit. All HIV test results from the Screening visit must be obtained and must all be negative/non-reactive. This includes testing for acute HIV infection, which must be performed within 14 days of Enrollment. Individuals who have one or more reactive or positive HIV test result(s) will not be enrolled, even if subsequent confirmatory testing indicates that they are not HIV-infected (see SSP Manual). 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 use which would, in the opinion of the site investigator, interfere with 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 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 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 Pregnant or currently breastfeeding at the time of screening or intends to become pregnant and/or breastfeed while on study
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
Ward 21 CRS
City
Johannesburg
State/Province
Gauteng
ZIP/Postal Code
2001
Country
South Africa
Facility Name
MU-JHU Research Collaboration (MUJHU CARE LTD) CRS
City
Kampala
ZIP/Postal Code
23491
Country
Uganda
Facility Name
Spilhaus CRS
City
Harare
Country
Zimbabwe

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 Females - A Sub-study of HPTN 084

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