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Pharmacokinetics of Emtricitabine/Tenofovir/Efavirenz in HIV-infected Patients With Tuberculosis

Information source: African Poverty Related Infection Oriented Research Initiative
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Tuberculosis; HIV Infections

Intervention: Emtricitabine/tenofovir/efavirenz (Drug)

Phase: Phase 2

Status: Recruiting

Sponsored by: African Poverty Related Infection Oriented Research Initiative

Official(s) and/or principal investigator(s):
Martin Boeree, MD, PhD, Principal Investigator, Affiliation: University Lungcentre Dekkerswald, Groesbeek / University Medical Centre Nijmegen, the Netherlands
David Burger, PharmD, PhD, Principal Investigator, Affiliation: University Medical Centre Nijmegen, the Netherlands
Gibson Kibiki, MMed, PhD, Principal Investigator, Affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania

Overall contact:
Gibson Kibiki, MMed, PhD, Phone: +255 754 572767, Email: gkibiki@gmail.com

Summary

In this pilot study the pharmacokinetics and safety of the antiretroviral combination of co-formulated emtricitabine/tenofovir/efavirenz will be studied in HIV-positive patients with pulmonary tuberculosis (TB) who are concomitantly treated with a standard rifampin-containing tuberculostatic regimen. It is expected that this antiretroviral combination causes minimal drug interactions with the rifampin-containing anti-tuberculosis medication.

Clinical Details

Official title: The Pharmacokinetics of Co-formulated Emtricitabine/Tenofovir/Efavirenz in HIV-infected Patients With Smear-positive Pulmonary Tuberculosis in the Kilimanjaro Region, Tanzania

Study design: Endpoint Classification: Pharmacokinetics/Dynamics Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome:

Pharmacokinetic parameters of emtricitabine, tenofovir and efavirenz

Pharmacokinetic parameters of the tuberculostatic agents

Secondary outcome:

Biochemistry and haematology samples for safety

Questioning about occurrence of adverse events

CD4 count and HIV-1 RNA

Sputum staining and culture

Detailed description: The primary objectives of this pilot study in 30 patients are: 1. To determine the effect of rifampin-containing tuberculostatic treatment on the pharmacokinetic profile of emtricitabine+tenofovir+efavirenz, when co-formulated in one tablet, in HIV-infected patients with smear-positive pulmonary tuberculosis in Tanzania. 2. To determine the effect of the emtricitabine+tenofovir+efavirenz regimen on the pharmacokinetics of tuberculostatics in the same population. The secondary objectives are: 1. To determine the safety of co-administration of emtricitabine+tenofovir+efavirenz with treatment for smear-positive pulmonary tuberculosis. 2. To determine the short-term (24 weeks) virological efficacy on HIV of an emtricitabine+tenofovir+efavirenz regimen in patients with smear-positive pulmonary tuberculosis. 3. To determine the short-term bacteriological efficacy on smear-positive tuberculosis of the co-administration of a standard regimen for tuberculosis and an emtricitabine+tenofovir+efavirenz regimen.

Eligibility

Minimum age: 18 Years. Maximum age: 65 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- A smear-positive pulmonary tuberculosis, based on positive smear of at least two

sputum samples with Ziehl-Neelsen (ZN) staining.

- HIV-infected as documented by positive HIV antibody test.

- Subject is at least 18 years of age at the day of the first dosing of study

medication.

- Subject is able and willing to sign the Informed Consent Form prior to screening

evaluations.

- CD4 cell count > 50 copies/mm3.

- Karnofsky score > 40.

- Willing and able to regularly attend the Kibung'oto National Tuberculosis Hospital

(KNTH) clinic. Exclusion Criteria:

- History of sensitivity/idiosyncrasy to the drug or chemically related compounds or

excipients, which may be employed in the trial.

- Previously treated for HIV infection with antiretroviral agents.

- Pregnant or breastfeeding.

- Relevant history or current condition that might interfere with drug absorption,

distribution, metabolism or excretion.

- A history of severe psychiatric disease such as psychosis, schizophrenia, etc.

- Inability to understand the nature and extent of the trial and the procedures

required.

- Abnormal serum transaminases or creatinine, determined as levels being > 5 times

upper limit of normal.

- Active hepatobiliary or hepatic disease (Non B Chronic Hepatitis B/C co-infection is

allowed).

- CD4 cell count > 350 cells/mm3.

Locations and Contacts

Gibson Kibiki, MMed, PhD, Phone: +255 754 572767, Email: gkibiki@gmail.com

Kibong'oto National Tuberculosis Hospital, Moshi, Kilimanjaro Region P.O. Box 12, Tanzania; Recruiting
Liberate Mleoh, MD, Phone: 027 2756194, Email: lmleoh@yahoo.com
Gibson Kibiki, MMed, PhD, Principal Investigator
Elton Kisanga, B-Pharm, PhD, Sub-Investigator
Liberate Mleoh, MD, Sub-Investigator
Jossy van den Boogaard, MD, Sub-Investigator
Hadija Semvua, B-Pharm, MPH, Sub-Investigator
Charles Mtabho, MD, MPH, Sub-Investigator
Additional Information

Related publications:

Bowen EF, Rice PS, Cooke NT, Whitfield RJ, Rayner CF. HIV seroprevalence by anonymous testing in patients with Mycobacterium tuberculosis and in tuberculosis contacts. Lancet. 2000 Oct 28;356(9240):1488-9.

Msamanga GI, Fawzi WW. The double burden of HIV infection and tuberculosis in sub-Saharan Africa. N Engl J Med. 1997 Sep 18;337(12):849-51.

Dean GL, Edwards SG, Ives NJ, Matthews G, Fox EF, Navaratne L, Fisher M, Taylor GP, Miller R, Taylor CB, de Ruiter A, Pozniak AL. Treatment of tuberculosis in HIV-infected persons in the era of highly active antiretroviral therapy. AIDS. 2002 Jan 4;16(1):75-83.

Burman WJ, Gallicano K, Peloquin C. Comparative pharmacokinetics and pharmacodynamics of the rifamycin antibacterials. Clin Pharmacokinet. 2001;40(5):327-41. Review.

Finch CK, Chrisman CR, Baciewicz AM, Self TH. Rifampin and rifabutin drug interactions: an update. Arch Intern Med. 2002 May 13;162(9):985-92. Review.

López-Cortés LF, Ruiz-Valderas R, Viciana P, Alarcón-González A, Gómez-Mateos J, León-Jimenez E, Sarasanacenta M, López-Pua Y, Pachón J. Pharmacokinetic interactions between efavirenz and rifampicin in HIV-infected patients with tuberculosis. Clin Pharmacokinet. 2002;41(9):681-90.

Burger DM, Meenhorst PL, Koks CH, Beijnen JH. Pharmacokinetic interaction between rifampin and zidovudine. Antimicrob Agents Chemother. 1993 Jul;37(7):1426-31.

Gallicano KD, Sahai J, Shukla VK, Seguin I, Pakuts A, Kwok D, Foster BC, Cameron DW. Induction of zidovudine glucuronidation and amination pathways by rifampicin in HIV-infected patients. Br J Clin Pharmacol. 1999 Aug;48(2):168-79.

Friedland G, Abdool Karim S, Abdool Karim Q, Lalloo U, Jack C, Gandhi N, El Sadr W. Utility of tuberculosis directly observed therapy programs as sites for access to and provision of antiretroviral therapy in resource-limited countries. Clin Infect Dis. 2004 Jun 1;38 Suppl 5:S421-8.

Droste JA, Aarnoutse RE, Koopmans PP, Hekster YA, Burger DM. Evaluation of antiretroviral drug measurements by an interlaboratory quality control program. J Acquir Immune Defic Syndr. 2003 Mar 1;32(3):287-91.

Holland DT, DiFrancesco R, Stone J, Hamzeh F, Connor JD, Morse GD; Adult and Pediatric AIDS Clinical Trials Group Pharmacology Laboratory Committees, Pediatric AIDS Clinical Trials Group. Quality assurance program for clinical measurement of antiretrovirals: AIDS clinical trials group proficiency testing program for pediatric and adult pharmacology laboratories. Antimicrob Agents Chemother. 2004 Mar;48(3):824-31.

Marzolini C, Telenti A, Decosterd LA, Greub G, Biollaz J, Buclin T. Efavirenz plasma levels can predict treatment failure and central nervous system side effects in HIV-1-infected patients. AIDS. 2001 Jan 5;15(1):71-5.

Starting date: November 2008
Last updated: December 16, 2010

Page last updated: August 23, 2015

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