Purpose

More than 3 billion people worldwide are at risk of acquiring malaria and pregnant women living with HIV in Africa are at particular risk. An effective prophylaxis regimen capable of preventing malaria and other common perinatal infections would have great potential to improve adverse birth outcomes. The purpose of this randomized controlled trial is to evaluate a new combination prophylaxis regimen in pregnant women with HIV in Cameroon to determine its efficacy and safety.

Conditions

Eligibility

Eligible Ages
Between 16 Years and 55 Years
Eligible Genders
Female
Accepts Healthy Volunteers
No

Inclusion Criteria

  • Confirmed HIV-infection (documented in medical record) - Age ≥16 years - Confirmed pregnancy, <28 weeks estimated gestational age (by best obstetric estimate which may include ultrasound or fundal height and LMP) - Live singleton pregnancy - Receiving prenatal care at Mboppi Hospital or Mutengene Hospital - Plan to receive follow up prenatal care and deliver at study facility - Capable of providing written informed consent - Able and agree to come to facility for febrile episodes or acute illness during pregnancy (with reimbursement of transportation costs). - Agree to avoid antimalarial medications outside of study protocol.

Exclusion Criteria

  • Severe anemia (last hemoglobin <6) - History of severe adverse reaction to co-trimoxazole or azithromycin - Active medical problem requiring inpatient evaluation at the time of screening - Intention of moving far away from the facility during pregnancy or not likely to return for follow up care or delivery - Signs or symptoms of early or active labor - History of severe cardiac disease (including congestive heart failure, severe valvular disease or arrhythmias).

Study Design

Phase
Phase 2
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Primary Purpose
Prevention
Masking
Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

Arm Groups

ArmDescriptionAssigned Intervention
Active Comparator
Azithromycin/TMPS
Azithromycin 1 gm po daily x 3 days at enrollment and at each 4 week follow up visit. TMPS double strength 1 tablet po daily.
  • Drug: Azithromycin/TMPS
    2 tabs po daily x 3 days at enrollment and at each monthly follow up visit
    Other names:
    • Cotrimoxazole
Placebo Comparator
Placebo/TMPS
Azithromycin placebo 1 gm po daily x 3 days at enrollment and at each 4 week follow up visit. TMPS double strength 1 tablet po daily.
  • Drug: Placebo/TMPS
    2 tabs po daily x 3 days at enrollment and at each monthly follow up visit
    Other names:
    • Co-Trimoxazole

More Details

Status
Completed
Sponsor
University of Alabama at Birmingham

Study Contact

Detailed Description

The World Health Organization (WHO) recommends malaria prophylaxis for all pregnant women living in endemic areas in order to reduce maternal anemia, low birth weight and perinatal mortality by 25-45%. The most commonly used regimen is intermittently dosed sulfadoxine-pyrimethamine (SP).Unfortunately, SP prophylaxis is contraindicated for HIV-infected pregnant women since co-administration with TMPS (trimethoprim-sulfamethoxazole) causes serious adverse events. TMPS (Bactrim or Cotrimoxazole) is an effective, well-tolerated, low-cost antibiotic that is used as prophylaxis in HIV-patients with low CD4 counts. It has anti-malarial activity with prophylactic efficacy that is comparable to SP (30-90%). Daily TMPS is recommended as malaria prophylaxis in pregnant women with HIV in many African countries (including Cameroon) but malaria infection rates are high even when medication compliance is excellent; thus, new and improved options are urgently needed. Azithromycin (AZ) is a macrolide antibiotic with activity against malaria, a good safety profile in pregnancy and proven utility as a part of combination malaria prevention regimens (such as SP-AZ). It also has activity against sexually transmitted infections (STI) and perinatal pathogens, including chlamydia (CT), gonorrhea (GC), syphilis and GBS (Streptococcus agalactiae or Group B Streptococcus), a potential but understudied contributor to high rates of newborn sepsis and death in Africa. SP-AZ prophylaxis in HIV-uninfected pregnant women has been reported to reduce prevalence of low birth weight (RR 0.74, 95% confidence interval (CI) 0.6-0.9) and preterm delivery (RR 0.66, 95% CI 0.48-0.91) compared to SP alone. Thus, the central hypothesis is that a TMPS-AZ combination will be more effective than standard TMPS malaria prophylaxis in pregnant women with HIV, and that it will also decrease STI coinfection. Investigators plan a test-of-concept of the central hypothesis by conducting a double blinded, Phase II randomized controlled trial (RCT).

Notice

Study information shown on this site is derived from ClinicalTrials.gov (a public registry operated by the National Institutes of Health). The listing of studies provided is not certain to be all studies for which you might be eligible. Furthermore, study eligibility requirements can be difficult to understand and may change over time, so it is wise to speak with your medical care provider and individual research study teams when making decisions related to participation.