The purpose of this study was to see if antiretroviral therapy (ART) is safe and works at getting rid of malaria in blood and to see whether one type of ART is better than another. This study may offer information for further research in looking at whether ART plays a role in the prevention and treatment of malaria.
A5297 was a Phase I/II, open-label, proof of concept, two-step, two-arm, randomized controlled clinical trial (RCT) to test the superiority of lopinavir/ritonavir (LPV/r)-based antiretroviral therapy (ART) to non-nucleoside reverse transcriptase (nNRTI)-based ART for clearance of Plasmodium falciparum (Pf) subclinical parasitemia (SCP). The study consisted of two steps. At study Step 1 entry, participants were randomized 1:1 to either LPV/r-based ART or nNRTI-based ART for 15 days. In study Step 2, all participants received nNRTI-based ART and TMP/SMX prophylaxis for 15 days. The total study duration was 30 days. Study visits occurred every 3 days in Step 1, and every 5 days in Step 2. At each study visit, 2 samples were taken for measurement of parasite density, except day 15 and day 30 at which 3 samples were taken. Adverse events which occurred after randomization were also recorded. Signs/symptoms and diagnoses were evaluated at each visit, while safety labs (including Hemoglobin, hematocrit, white blood cell count (WBC), differential WBC, platelet count, and absolute neutrophil count (ANC), glucose, electrolytes (sodium, potassium, chloride, bicarbonate), total bilirubin, AST (SGOT), ALT (SGPT), albumin, alkaline phosphatase, and creatinine) were taken at day 15 and day 30, or if indicated at other study visits.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
52
Participants received two 200 mg/50 mg tablets of lopinavir/ritonavir orally twice daily.
Participants received one 200 mg/300 mg tablet of Emtricitabine/tenofovir disoproxil fumarate orally once daily.
Participants received one 600 mg tablet of efavirenz orally once daily.
AMPATH at Moi Univ. Teaching Hosp. Eldoret CRS (12601)
Eldoret, Kenya
Walter Reed Project - Kenya Med. Research Institute Kericho CRS (12501)
Kericho, Kenya
Kisumu Crs (31460)
Kisumu, Kenya
College of Med. JHU CRS (30301)
Blantyre, Malawi
Proportion of Participants With Plasmodium Falciparum (Pf) Subclinical Parasitemia (SCP) Clearance
Pf SCP clearance defined by polymerase chain reaction (PCR) \< 10 parasites/µL on three consecutive occasions within a 24-hour period. If a participant had missing data on day 15, they were considered as not having clearance.
Time frame: Day 15 (3 samples collected, separated by at least 5 hours and all three collected within 24-hours)
Time to First Pf SCP Clearance
Time to clearance is defined by time to first measurement with PCR \< 10 parasites/µL, and is evaluated as the point estimate and 95% CI for the day when 50% of participants cleared parasite.
Time frame: From study entry up to day 30
Log10(Pf Parasite Density)
Pf parasite density was determined by PCR. If parasite density equals 0, the value is set to 0.01 before log10 transformation. The value 0.01 was chosen based on the smallest observed parasite density value of 0.017.
Time frame: Entry, days 3, 6, 9, 12, 15, 20, 25, 30
Change in log10(Pf Parasite Density) From Entry to Day 30
Change is evaluated as log10(Pf parasite density) at day 30 minus log10(Pf parasite density) at entry. Change is evaluated in four groups: * Randomized to nNRTI-based ART with continued Pf SCP at day 15 * Randomized to nNRTI-based ART with clearance of Pf SCP at day 15 * Randomized to LPV/r-based ART with continued Pf SCP at day 15 * Randomized to LPV/r-based ART with clearance of Pf SCP at day 15
Time frame: Entry, Day 30
Number of Participants With Uncomplicated Clinical Malaria
Uncomplicated clinical malaria is defined as the presence of non-severe fever/symptoms and parasitemia without organ complication.
Time frame: From study entry to day 30
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If unable to take efavirenz, participants received on 200 mg tablet of nevirapine orally once daily.
Participants received one 160 mg/800 mg tablet of trimethoprim/sulfamethoxazole orally once daily.
Joint Clinical Research Centre (JCRC) (12401)
Kampala, Uganda
Number of Participants With Detectable Pf Gametocyte Density
Number of participants with detectable Pf gametocyte density as determined by PCR. Due to the large number of undetectable results, this outcome was measured as dichotomous.
Time frame: Entry, days 3, 6, 9, 12, 15, 20, 25, 30
Change in log10(Pf Gametocyte Density) From Entry to Day 30
Change in log10(Pf gametocyte density) as evaluated using a Hodges-Lehmann estimate from entry to day 30 is evaluated in two groups: * Randomized to nNRTI-based ART with continued Pf SCP at day 15 * Randomized to LPV/r-based ART with continued Pf SCP at day 15 Analysis was not conducted in either group with clearance at day 15 due to the small sample size and high number of undetectable samples in both clearance groups at entry and day 30.
Time frame: Entry, Day 30