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Safety and Acceptability of Cabotegravir in HIV Uninfected Women in KwaZulu-Natal, South Africa (CAPRISA014)

Primary Purpose

Human Immunodeficiency Virus

Status
Withdrawn
Phase
Phase 2
Locations
South Africa
Study Type
Interventional
Intervention
cabotegravir
Placebo
Sponsored by
Centre for the AIDS Programme of Research in South Africa
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Human Immunodeficiency Virus focused on measuring Cabotegravir, safety, long-acting injectable, HIV prevention, acceptability

Eligibility Criteria

18 Years - 30 Years (Adult)FemaleAccepts Healthy Volunteers

Inclusion Criteria:

  • Able and willing to provide written informed consent to be screened for, and to enrol in, the study.
  • Able and willing to provide adequate locator information for study retention purposes.
  • Sexually active, defined as having had vaginal intercourse at least once in the past 30 days prior to screening.
  • HIV negative on testing performed by study staff
  • Have a negative pregnancy test performed by study staff
  • Agree to use a non-barrier form of contraceptive
  • Agree to adhere to study visits and procedures.
  • Haemoglobin > 11 g/dL,
  • ALT < ULN
  • AST < ULN
  • Total bilirubin < Grade 1
  • Direct bilirubin < ULN
  • Creatinine clearance ≥60 mL/min
  • Hepatitis B surface antigen (HBsAg) negative
  • Hepatitis C Ab negative
  • In general good health, as assessed clinically

Exclusion Criteria:

  • Past or current participation in any other HIV interventional research study or other concurrent studies which may interfere with this study.
  • Clinically significant cardiovascular disease, including:
  • ECG with:
  • heart rate <50 or >100 beats per minute (one repeat ECG is allowed during screening; can be performed on the same day)
  • QRS duration >120 msec
  • QTc interval (B or F) > 450 msec
  • evidence of previous myocardial infarction (pathologic Q waves, S-T segment changes (except early repolarization)
  • any conduction abnormality (including but not specific to left or right complete bundle branch block, Atrioventricular block [2nd degree (type II) or higher], Wolf Parkinson White syndrome)
  • sinus pauses > 3 seconds
  • any significant arrhythmia which, in the opinion of the Principal Investigator or designee, will interfere with the safety for the individual participant
  • history of non-sustained (3 consecutive ventricular ectopic beats on ECG at screening or entry) or sustained ventricular tachycardia
  • History/evidence of symptomatic arrhythmia, angina/ischemia, coronary artery bypass grafting surgery or percutaneous transluminal coronary angioplasty or any clinically significant cardiac disease
  • Underlying skin disease or currently active skin disorder (e.g., infection, inflammation, dermatitis, eczema, psoriasis, urticaria). Mild cases of localized disease or other mild skin condition may not be exclusionary at the discretion of the Principal Investigator or designee.
  • Has a tattoo or other dermatological condition overlying the buttock region which in the opinion of the Principal Investigator or designee, may interfere with interpretation of injection site reactions.
  • History of acute or chronic 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).
  • Coagulopathy (primary or iatrogenic) which would contraindicate IM injection.
  • Active or planned use of prohibited medications as described in the SSP manual (updated regularly from the Investigator's Brochure).
  • Pregnant or currently breastfeeding, or intends to become pregnant and/or breastfeed during the study.
  • Known Hypersensitivity to egg, soya or peanut protein.
  • Has any other condition that, based on the opinion of the Principal Investigator or designee, would preclude provision of informed consent, make participation in the study unsafe, complicate interpretation of study outcome data, or otherwise interfere with achieving the study objectives.

Sites / Locations

  • CAPRISA eThekwini Research Clinic
  • CAPRISA Vulindlela Research Clinic

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Cabotegravir

Placebo

Arm Description

Women randomised to the cabotegravir arm will receive daily oral cabotegravir (30 mg tablets) for approximately 30 days and thereafter will receive intra-muscular gluteal injections of cabotegravir LA (800 mg, administered as two 400 mg injections) every 12 weeks

Women randomised to the placebo arm will receive daily oral tablets (30 mg tablets) for approximately 30 days and thereafter will receive intra-muscular gluteal injections of Intralipid® 20% every 12 weeks

Outcomes

Primary Outcome Measures

Number of participants with adverse events
The incidence of increase in graded AEs and in particular liver enzymes (AST/ALT) at the level of Grade 3 or higher.

Secondary Outcome Measures

Acceptability of study injections and oral tablets
Participant's opinions on the injections and tablets will be obtained through structured interviews.
Incidence of sexually transmitted infections
Incidence of HIV, HSV-2, HPV, gonorrhoea, chlamydia and trichomonas infections in women
Area under the plasma concentration versus time curve (AUC) of cabotegravir
Cabotegravir concentrations will be measured throughout the study
Impact on pregnancy
The incidence of pregnancy and pregnancy outcomes in women assigned to cabotegravir and placebo will be compared
Resistance to antiretroviral drugs
Viruses from HIV seroconverters will be sequenced and assessed for resistance mutations
HIV viral load in women who acquire HIV
HIV viral load (copies/ml) will be measured and compared between the cabotegravir and placebo arms

Full Information

First Posted
May 27, 2015
Last Updated
November 4, 2015
Sponsor
Centre for the AIDS Programme of Research in South Africa
Collaborators
ViiV Healthcare
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1. Study Identification

Unique Protocol Identification Number
NCT02462772
Brief Title
Safety and Acceptability of Cabotegravir in HIV Uninfected Women in KwaZulu-Natal, South Africa
Acronym
CAPRISA014
Official Title
Phase II Trial to Assess the Safety and Acceptability of the Long-acting Injectable HIV Integrase Inhibitor, Cabotegravir (GSK1265744), in HIV Uninfected Women in KwaZulu-Natal, South Africa
Study Type
Interventional

2. Study Status

Record Verification Date
November 2015
Overall Recruitment Status
Withdrawn
Study Start Date
October 2015 (undefined)
Primary Completion Date
September 2018 (Anticipated)
Study Completion Date
September 2018 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Centre for the AIDS Programme of Research in South Africa
Collaborators
ViiV Healthcare

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The CAPRISA 014 trial aims to assess the safety and acceptability of the long-acting (LA) injectable antiretroviral agent, cabotegravir LA (GSK1265744), in HIV uninfected women in KwaZulu-Natal, South Africa.
Detailed Description
The CAPRISA 014 trial is designed to establish the safety and acceptability of cabotegravir LA in sexually active, at-risk HIV-uninfected women. A total of 632 HIV uninfected women (18 to 30 years) from two sites in KwaZulu-Natal, South Africa will be enrolled. The trial will be approximately 24 months, with an additional 12 months post-trial safety observation. The study is divided into three periods: Period 1 - Clinical trial oral lead-in (up to 34 days) - Consenting participants will be randomized to receive daily oral cabotegravir (30mg tablets) or daily oral placebo for approximately 30 days, to assess safety and tolerability prior to exposure to the LA injectable formulation. Period 2 - Clinical trial follow-up with injectable (approximately 48-96 weeks) - Participants who have successfully completed Period 1 will receive intra-muscular (IM) gluteal injections of cabotegravir LA (800 mg, administered as two 400 mg injections) or placebo every 12 weeks. The end of Period 2 marks the completion of clinical trial follow-up. Period 3 - Post-trial safety follow-up off-product (approximately 12 months) - During this post-trial safety observation period, participants will be followed up (off product) for approximately 12 months after completion of period 2.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Human Immunodeficiency Virus
Keywords
Cabotegravir, safety, long-acting injectable, HIV prevention, acceptability

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cabotegravir
Arm Type
Experimental
Arm Description
Women randomised to the cabotegravir arm will receive daily oral cabotegravir (30 mg tablets) for approximately 30 days and thereafter will receive intra-muscular gluteal injections of cabotegravir LA (800 mg, administered as two 400 mg injections) every 12 weeks
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Women randomised to the placebo arm will receive daily oral tablets (30 mg tablets) for approximately 30 days and thereafter will receive intra-muscular gluteal injections of Intralipid® 20% every 12 weeks
Intervention Type
Drug
Intervention Name(s)
cabotegravir
Other Intervention Name(s)
GSK1265744
Intervention Description
Cabotegravir 30 mg tablets are formulated as white to almost white oval-shaped coated tablets for oral administration. The cabotegravir LA is formulated as a sterile white to slightly coloured suspension containing 400mg/2mL of cabotegravir LA for administration by IM injection.
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
Intralipid® 20%
Intervention Description
Placebo tablets for cabotegravir are formulated as white to almost white oval-shaped coated tablets to visually match the active cabotegravir tablets. Placebo for cabotegravir injectable suspension is Intralipid® 20%. Intralipid® is a fat emulsion with no pharmacological action. It is a white, milky emulsion, consisting of purified soyabean oil, purified egg phospholipids and anhydrous glycerol. Intralipid® 20% is supplied in infusion bags.
Primary Outcome Measure Information:
Title
Number of participants with adverse events
Description
The incidence of increase in graded AEs and in particular liver enzymes (AST/ALT) at the level of Grade 3 or higher.
Time Frame
36 months
Secondary Outcome Measure Information:
Title
Acceptability of study injections and oral tablets
Description
Participant's opinions on the injections and tablets will be obtained through structured interviews.
Time Frame
24 months
Title
Incidence of sexually transmitted infections
Description
Incidence of HIV, HSV-2, HPV, gonorrhoea, chlamydia and trichomonas infections in women
Time Frame
36 months
Title
Area under the plasma concentration versus time curve (AUC) of cabotegravir
Description
Cabotegravir concentrations will be measured throughout the study
Time Frame
36 months
Title
Impact on pregnancy
Description
The incidence of pregnancy and pregnancy outcomes in women assigned to cabotegravir and placebo will be compared
Time Frame
36 months
Title
Resistance to antiretroviral drugs
Description
Viruses from HIV seroconverters will be sequenced and assessed for resistance mutations
Time Frame
36 months
Title
HIV viral load in women who acquire HIV
Description
HIV viral load (copies/ml) will be measured and compared between the cabotegravir and placebo arms
Time Frame
36 months
Other Pre-specified Outcome Measures:
Title
Pharmacogenomics of cabotegravir
Description
The impact of genetic polymorphisms on response to cabotagravir LA will be assessed
Time Frame
36 months
Title
Impact of contraception on area under the plasma concentration versus time curve (AUC) of cabotegravir
Description
Cabotegravir concentrations in women on DMPA will be compared to women on other forms of contraception
Time Frame
36 months

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
30 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Able and willing to provide written informed consent to be screened for, and to enrol in, the study. Able and willing to provide adequate locator information for study retention purposes. Sexually active, defined as having had vaginal intercourse at least once in the past 30 days prior to screening. HIV negative on testing performed by study staff Have a negative pregnancy test performed by study staff Agree to use a non-barrier form of contraceptive Agree to adhere to study visits and procedures. Haemoglobin > 11 g/dL, ALT < ULN AST < ULN Total bilirubin < Grade 1 Direct bilirubin < ULN Creatinine clearance ≥60 mL/min Hepatitis B surface antigen (HBsAg) negative Hepatitis C Ab negative In general good health, as assessed clinically Exclusion Criteria: Past or current participation in any other HIV interventional research study or other concurrent studies which may interfere with this study. Clinically significant cardiovascular disease, including: ECG with: heart rate <50 or >100 beats per minute (one repeat ECG is allowed during screening; can be performed on the same day) QRS duration >120 msec QTc interval (B or F) > 450 msec evidence of previous myocardial infarction (pathologic Q waves, S-T segment changes (except early repolarization) any conduction abnormality (including but not specific to left or right complete bundle branch block, Atrioventricular block [2nd degree (type II) or higher], Wolf Parkinson White syndrome) sinus pauses > 3 seconds any significant arrhythmia which, in the opinion of the Principal Investigator or designee, will interfere with the safety for the individual participant history of non-sustained (3 consecutive ventricular ectopic beats on ECG at screening or entry) or sustained ventricular tachycardia History/evidence of symptomatic arrhythmia, angina/ischemia, coronary artery bypass grafting surgery or percutaneous transluminal coronary angioplasty or any clinically significant cardiac disease Underlying skin disease or currently active skin disorder (e.g., infection, inflammation, dermatitis, eczema, psoriasis, urticaria). Mild cases of localized disease or other mild skin condition may not be exclusionary at the discretion of the Principal Investigator or designee. Has a tattoo or other dermatological condition overlying the buttock region which in the opinion of the Principal Investigator or designee, may interfere with interpretation of injection site reactions. History of acute or chronic 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). Coagulopathy (primary or iatrogenic) which would contraindicate IM injection. Active or planned use of prohibited medications as described in the SSP manual (updated regularly from the Investigator's Brochure). Pregnant or currently breastfeeding, or intends to become pregnant and/or breastfeed during the study. Known Hypersensitivity to egg, soya or peanut protein. Has any other condition that, based on the opinion of the Principal Investigator or designee, would preclude provision of informed consent, make participation in the study unsafe, complicate interpretation of study outcome data, or otherwise interfere with achieving the study objectives.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Salim S Abdool Karim, MBCHB, PhD
Organizational Affiliation
Centre for the AIDS Programme of Research in South Africa
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Quarraisha Abdool Karim, PhD
Organizational Affiliation
Centre for the AIDS Programme of Research in South Africa
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Leila E Mansoor, PhD
Organizational Affiliation
Centre for the AIDS Programme of Research in South Africa
Official's Role
Principal Investigator
Facility Information:
Facility Name
CAPRISA eThekwini Research Clinic
City
Durban
State/Province
KwaZulu-Natal
ZIP/Postal Code
4001
Country
South Africa
Facility Name
CAPRISA Vulindlela Research Clinic
City
Mafakatini
State/Province
KwaZulu-Natal
ZIP/Postal Code
3290
Country
South Africa

12. IPD Sharing Statement

Citations:
PubMed Identifier
25589631
Citation
Radzio J, Spreen W, Yueh YL, Mitchell J, Jenkins L, Garcia-Lerma JG, Heneine W. The long-acting integrase inhibitor GSK744 protects macaques from repeated intravaginal SHIV challenge. Sci Transl Med. 2015 Jan 14;7(270):270ra5. doi: 10.1126/scitranslmed.3010297.
Results Reference
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PubMed Identifier
24100877
Citation
Spreen WR, Margolis DA, Pottage JC Jr. Long-acting injectable antiretrovirals for HIV treatment and prevention. Curr Opin HIV AIDS. 2013 Nov;8(6):565-71. doi: 10.1097/COH.0000000000000002.
Results Reference
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Safety and Acceptability of Cabotegravir in HIV Uninfected Women in KwaZulu-Natal, South Africa

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