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| ID | Type | Description | Link |
|---|---|---|---|
| U01AI068632 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute of Allergy and Infectious Diseases (NIAID) | NIH |
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This study will examine drug and body interactions in children receiving anti-HIV treatment regimens using new medications. Drug regimens to be examined will feature the medications raltegravir (RAL), maraviroc (MVC), and etravirine (ETV). These drugs will not be provided through the study.
Antiretroviral (ARV) medication regimens for children, adolescents and young adults are often prescribed based on drug resistance because of previous treatment history. In order to find an effective regimen, clinicians must often turn to newer drugs before they have been fully tested in adolescent or pediatric clinical trials. One of the first steps in testing these drugs is to assess the drug pharmacokinetics (PK), or interaction between drugs and body. This study, a follow-on protocol to the International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) P1058 study, will test children, adolescents and young adults who have already been prescribed treatment regimens with new drugs. The study will examine the PK of medication combinations featuring raltegravir, a new drug in the new ARV class of entry inhibitors (EIs); maraviroc, a new drug in the new class of fusion inhibitors (FIs); and etravirine, a new drug in the class of non-nucleoside reverse transcriptase inhibitors (NNRTIs). Older medications may also be used to complete these regimens.
Participation in this study will last between 1 and 7 weeks and involve at least two clinic visits. The first is a screening and entry visit at which a medical history will be taken and a physical exam and blood test will be completed. The second visit will measure PK of the medications. During this visit, participants will complete the same measures as before-medical history, physical exam, blood test-and then be given a dose of their anti-HIV medication regimen. After receiving the medications, participants will be monitored and give blood samples after 1, 2, 4, 6, 8, and 12 hours. For Groups G, H, I, J, K and L an intensive 12-hour PK study will be scheduled after at least 30 days on the combination of interest. For all Groups, the intensive 12-hour PK study should be performed within 35 days (5 weeks) of screening/entry evaluations. Medications will not be provided through this study.
Results of the 12-hour medication monitoring tests will be delivered to participants' physicians within 6 weeks. If, based on these results, a physician decides to change the dosage of a participant's medication, that participant may be asked to complete a second PK visit. Participants must have received the revised dose for at least 14 days before the PK study can be repeated.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group G | Participants will receive a medication regimen including RAL + ATV + RTV. |
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| Group H | Participants will receive a medication regimen including RAL + TDF. |
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| Group I | Participants will receive a medication regimen including ETV + DRV + RTV. |
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| Group J | Participants will receive a medication regimen including MVC + ATV + RTV. |
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| Group K | Participants will receive a medication regimen including MVC + LPV + RTV. |
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| Group L |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Raltegravir (RAL) | Drug | 400 mg twice daily (BID) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Steady state pharmacokinetics (PK) of raltegravir administered in combination with atazanavir/ritonavir or tenofovir or maraviroc/etravirine to older children, adolescents and young adults | Measured at baseline and 1, 2, 4, 6, 8, and 12 hours after dosing | |
| Steady state PK of etravirine administered to older children, adolescents and young adults | Measured at baseline and 1, 2, 4, 6, 8, and 12 hours after dosing | |
| Steady state PK of maraviroc administered in combination with atazanavir/ritonavir or lopinavir/ritonavir to older children, adolescents and young adults | Measured at baseline and 1, 2, 4, 6, 8, and 12 hours after dosing | |
| Steady state PK of maraviroc (600 mg twice daily [BID]) given in combination with raltegravir and etravirine (a protease inhibitor [PI]-sparing regimen) to older children, adolescents and young adults | Measured at baseline and 1, 2, 4, 6, 8, and 12 hours after dosing |
| Measure | Description | Time Frame |
|---|---|---|
| Relationship between Tanner stage and the PK of the regimens of interest in children and adolescents | Measured at baseline and 1, 2, 4, 6, 8, and 12 hours after dosing | |
| Relationships between the PK parameters and polymorphisms that may affect the antiretrovirals (ARVs) of interest in older children, adolescents and young adults |
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Inclusion Criteria:
Exclusion Criteria:
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HIV infected children, adolescents and young adults who are receiving a regimen of antiretroviral drugs prescribed by their physician that includes one of the target combinations.
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| Name | Affiliation | Role |
|---|---|---|
| Jennifer R. King, PharmD | University of Alabama at Birmingham | Study Chair |
| Ram Yogev, MD | Northwestern University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Univ. of Alabama Birmingham NICHD CRS (5096) | Birmingham | Alabama | 35294 | United States | ||
| Miller Children's Hospital Long Beach, CA NICHD CRS (5093) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 9572665 | Background | Guidelines for the use of antiretroviral agents in pediatric HIV infection. Center for Disease Control and Prevention. MMWR Recomm Rep. 1998 Apr 17;47(RR-4):1-43. | |
| 18838589 | Background | Iwamoto M, Wenning LA, Petry AS, Laethem M, De Smet M, Kost JT, Breidinger SA, Mangin EC, Azrolan N, Greenberg HE, Haazen W, Stone JA, Gottesdiener KM, Wagner JA. Minimal effects of ritonavir and efavirenz on the pharmacokinetics of raltegravir. Antimicrob Agents Chemother. 2008 Dec;52(12):4338-43. doi: 10.1128/AAC.01543-07. Epub 2008 Oct 6. |
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Blood samples
Participants will receive a medication regimen including MVC + RAL + ETV. |
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| Arm M | Participants will receive a medication regimen of DRV |
| Arm N | Participants will receive a medication regimen of DRV |
| Arm O | Participants will receive a medication regimen of unboosted ATV |
| Arm P | Participants will receive a medication regimen of RPV |
| Arm Q | Participants will receive a medication regimen of RPV |
| Atazanavir (ATV) | Drug | 300 mg daily |
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| Ritonavir (RTV) | Drug | 100 mg daily, dosing by weight in Group I |
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| Tenofovir (TDF) | Drug | 300 mg daily |
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| Etravirine (ETV) | Drug | 200 mg BID |
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| Darunavir (DRV) | Drug | Dosing by weight |
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| Maraviroc (MVC) | Drug | 150 mg BID in groups J and K; 600 mg BID in group L |
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| Lopinavir/ritonavir (LPV/r) | Drug | Coformulation of 400 mg lopinavir and 100 mg ritonavir, taken twice daily |
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| Measured at baseline and 1, 2, 4, 6, 8, and 12 hours after dosing |
| Adverse events associated with the ARVs of interest | Measured throughout |
| Steady state PK of darunavir/ritonavir administered to older children, adolescents and young adults | Measured at baseline and 1, 2, 4, 6, 8, and 12 hours after dosing |
| Long Beach |
| California |
| 90806 |
| United States |
| Usc La Nichd Crs (5048) | Los Angeles | California | 90033 | United States |
| UCSD Mother, Child & Adolescent HIV Program(4601) | San Diego | California | 92103 | United States |
| Univ. of California San Francisco NICHD CRS (5091) | San Francisco | California | 94117 | United States |
| Harbor (UCLA) Medical Center NICHD CRS (5045) | Torrance | California | 90509 | United States |
| Harbor Univeristy of California, Los Angeles (UCLA) Medical Center (603) | Torrance | California | 90509 | United States |
| Childrens Hospital (U. Colorado, Denver) NICHD CRS (5052) | Denver | Colorado | 80218-1088 | United States |
| Children's National Medical Center (5015) | Washington D.C. | District of Columbia | 20010 | United States |
| South Florida CDC Ft Lauderdale NICHD CRS (5055) | Fort Lauderdale | Florida | 33316 | United States |
| University of Miami Pediatric Perinatal HIV/AIDS CRS (4201) | Miami | Florida | 33136 | United States |
| University of South Florida Tampa (5018) | Tampa | Florida | 33620 | United States |
| Rush University Cook County (5083) | Chicago | Illinois | 60612 | United States |
| Chicago Children's CRS (4001) | Chicago | Illinois | 60614 | United States |
| University of Maryland NICHD CRS (5094) | Baltimore | Maryland | 21201 | United States |
| Johns Hopkins University NICHD CRS (5092) | Baltimore | Maryland | 21287 | United States |
| Children's Hospital of Boston NICHD CRS (5009) | Boston | Massachusetts | 02115 | United States |
| Boston Medical Center Ped. HIV Program NICHD CRS (5011) | Boston | Massachusetts | 02118 | United States |
| WNE Maternal Pediatric Adolescent AIDS CRS (7301) | Worcester | Massachusetts | 01605 | United States |
| New Jersey Medical School (NJ) (2802) | Newark | New Jersey | 07103 | United States |
| New York University NY (5012) | New York | New York | 10016 | United States |
| Metropolitan Hospital (5003) | New York | New York | 10029 | United States |
| Columbia IMPAACT CRS (4101) | New York | New York | 10032 | United States |
| SUNY Stony Brook NICHD CRS (5040) | Stony Brook | New York | 11794 | United States |
| Bronx-Lebanon Hospital (6901) | The Bronx | New York | 10457 | United States |
| Jacobi Medical Center Bronx (5013) | The Bronx | New York | 10461 | United States |
| Duke University Medical Center (DUMC) (4701) | Durham | North Carolina | 27710 | United States |
| The Children's Hosp. of Philadelphia IMPAACT CRS (6701) | Philadelphia | Pennsylvania | 19104 | United States |
| St. Jude/UTHSC CRS (6501) | Memphis | Tennessee | 38105 | United States |
| Texas Children's Hosp. CRS (3801) | Houston | Texas | 77030 | United States |
| Harborview Medical Center NICHD CRS (5027) | Seattle | Washington | 98105 | United States |
| Univ of Washington Children's Hospital Seattle (5017) | Seattle | Washington | 98105 | United States |
| University of Washington NICHD CRS (5029) | Seattle | Washington | 98105 | United States |
| San Juan City Hosp. PR NICHD CRS (5031) | San Juan | 00927 | Puerto Rico |
| University of Puerto Rico Pediatric HIV/AIDS Research (6601) | San Juan | 00936-5067 | Puerto Rico |
| 18625763 | Background | Wenning LA, Friedman EJ, Kost JT, Breidinger SA, Stek JE, Lasseter KC, Gottesdiener KM, Chen J, Teppler H, Wagner JA, Stone JA, Iwamoto M. Lack of a significant drug interaction between raltegravir and tenofovir. Antimicrob Agents Chemother. 2008 Sep;52(9):3253-8. doi: 10.1128/AAC.00005-08. Epub 2008 Jul 14. |
| 27583590 | Derived | Cressey TR, Hazra R, Wiznia A, Foca M, Jean-Philippe P, Graham B, King JR, Britto P, Carey VJ, Acosta EP, Yogev R; IMPAACT P1058A Team. Pharmacokinetics of Unboosted Atazanavir in Treatment-experienced HIV-infected Children, Adolescents and Young Adults. Pediatr Infect Dis J. 2016 Dec;35(12):1333-1335. doi: 10.1097/INF.0000000000001320. |
| ID | Term |
|---|---|
| D015658 | HIV Infections |
| ID | Term |
|---|---|
| D000086982 | Blood-Borne Infections |
| D003141 | Communicable Diseases |
| D007239 | Infections |
| D015229 | Sexually Transmitted Diseases, Viral |
| D012749 | Sexually Transmitted Diseases |
| D016180 | Lentivirus Infections |
| D012192 | Retroviridae Infections |
| D012327 | RNA Virus Infections |
| D014777 | Virus Diseases |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D007153 | Immunologic Deficiency Syndromes |
| D007154 | Immune System Diseases |
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| ID | Term |
|---|---|
| D000068898 | Raltegravir Potassium |
| D000069446 | Atazanavir Sulfate |
| D019438 | Ritonavir |
| D000068698 | Tenofovir |
| C451734 | etravirine |
| D000069454 | Darunavir |
| D000077592 | Maraviroc |
| D061466 | Lopinavir |
| C558899 | lopinavir-ritonavir drug combination |
| ID | Term |
|---|---|
| D011760 | Pyrrolidinones |
| D011759 | Pyrrolidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D011725 | Pyridines |
| D009842 | Oligopeptides |
| D010455 | Peptides |
| D000602 | Amino Acids, Peptides, and Proteins |
| D013844 | Thiazoles |
| D013457 | Sulfur Compounds |
| D009930 | Organic Chemicals |
| D001393 | Azoles |
| D063065 | Organophosphonates |
| D009943 | Organophosphorus Compounds |
| D000225 | Adenine |
| D011687 | Purines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D013449 | Sulfonamides |
| D000577 | Amides |
| D002219 | Carbamates |
| D000144 | Acids, Acyclic |
| D002264 | Carboxylic Acids |
| D013450 | Sulfones |
| D005663 | Furans |
| D003510 | Cyclohexanes |
| D003516 | Cycloparaffins |
| D006840 | Hydrocarbons, Alicyclic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D014230 | Triazoles |
| D011744 | Pyrimidinones |
| D011743 | Pyrimidines |
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