Tuberculosis Preventive Therapy Among Latent Tuberculosis Infection in HIV-infected Individuals

  • STATUS
    Recruiting
  • End date
    Mar 13, 2023
  • participants needed
    2500
  • sponsor
    The HIV Netherlands Australia Thailand Research Collaboration
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Updated on 13 April 2022
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Summary

The investigators want to know if ultra-short, effective treatment for latent tuberculosis (TB) infection (LTBI) could dramatically reduce the global incidence of active TB or not. The investigators hypothesize that short-course (4-week) daily isoniazid/rifapentine (INH/RPT) (1HP) is not inferior to standard -course (12 weeks) INH/RPT weekly regimen (3HP) for the prevention of TB in human immunodeficiency virus (HIV)-infected individuals.

Description

This study is a multicenter, randomized, open-label, phase III clinical trial comparing a 4-week daily INH/RPT regimen (1HP) to a 12-weekly INH/RPT (3HP) for the treatment of LTBI in HIV-infected participants without evidence of active TB. The primary objective will be efficacy of active TB prevention. The study will also assess safety and tolerability of the regimens, adherence to the treatments, and patterns of antibiotic resistance among Mycobacterium tuberculosis (MTB) isolates in participants who fail on these prophylactic regimens.

Under this study, there is one substudy entitled, "Pharmacokinetic study of rifapentine, dolutegravir, and tenofovir alafenamide in HIV-infected individual with latent tubersulosis infection". There will be a subgroup of patients who will participate in this pharmacokinetic study of rifapentine and dolutegravir (DTG) / tenofovir alafenamide (TAF). Randomization is based on cluster of differentiation 4 (CD4) categories : < 200, 200-350, > 500 cells/mm3 and VL <50 or >50 copies/ml.

Details
Condition HIV-infected Participants With Latent TB Infection in High TB Burden Country
Treatment Isoniazid/Rifapentine daily (4 weeks) plus pyridoxine (vitamin B6), Isoniazid/Rifapentine 12-weekly plus pyridoxine (vitamin B6)
Clinical Study IdentifierNCT03785106
SponsorThe HIV Netherlands Australia Thailand Research Collaboration
Last Modified on13 April 2022

Eligibility

 Yes No Not Sure

Inclusion Criteria

Documented HIV-1 infection by standard HIV test or plasma HIV-1 RNA viral load and received ART within 12 months. Participants received ART more than 12 months would be allowed if CD4 cell counts is less than 350 cells/mm3
18 years and older
Evidence of latent TB infection, either by TST ≥5 mm or positive interferon gamma release assay (IGRA) or history of close contact with active pulmonary TB _within 3 months prior entry visit or residing in a high TB burden area_ NOTE close contact is referred to person living/sharing in the same room with active pulmonary TB participants for > 4 hours/day
high TB burden areas are defined as areas with an estimated or reported TB
prevalence of 100 to 300/100,000, according to the WHO. Thailand is included
in high TB burden areas
Laboratory values obtained within 30 days prior to entry
Absolute neutrophil count (ANC) >750 cells/mm3
Hemoglobin >7.4 g/dL
Platelet count >50,000/mm3
Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) <3x upper limit of normal (ULN)
Total bilirubin <2.5 X ULN
Chest radiograph or chest computed tomography (CT) scan without evidence of active
tuberculosis, unless one has been performed within 90 days prior to entry
Female participants who are participating in sexual activity that could lead to pregnancy must agree to use one reliable non-hormonal form of contraceptive (i.e., condoms, IUD, diaphragm) during RPT treatment and contraception should be remain to 6 weeks post RPT NOTE Female participants who are not of reproductive potential or whose male partner(s) have undergone successful vasectomy with documented azoospermia or have documented azoospermia are eligible without requiring the use of contraceptives. Participant-reported history is acceptable documentation of menopause, hysterectomy, or bilateral oophorectomy or bilateral tubal ligation
All participants must agree not to participate in a conception process (e.g., active attempt to become pregnant or to impregnate, donate sperm, in vitro fertilization) while receiving RPT and for 6 weeks after stopping this drug
Body weight > 40 kg
Ability and willingness of participant to provide informed consent

Exclusion Criteria

Treatment for active or latent TB (pulmonary or extrapulmonary) within 2 years prior to study entry or presence of any confirmed or probable active TB at screening
History of Isoniazid (INH) or Rifampicin (RIF)/Rifabutin (RFB) resistant TB at any time prior to study entry or known exposure to INH or RIF/RFB resistant TB (e.g., household member of a person with MDR or XDR TB) at any time prior to study entry
Treatment for >14 consecutive days with a rifamycin or >30 consecutive days with INH at any time during the 2 years prior to enrollment
Current or planned use of protease inhibitor-based ART
Currently on a salvage ART regimen, defined as a regimen started due to confirmed HIV virologic failure on a prior ART regimen or due to known HIV drug resistance
History of liver cirrhosis at any time prior to study entry
Evidence of acute hepatitis, such as abdominal pain, jaundice, dark urine, and/or light stools within 90 days prior to entry
Diagnosis of porphyria at any time prior to study entry
Known allergy/sensitivity or any hypersensitivity to components of study drug(s) or their formulation
Active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements
Acute or serious illness requiring systemic treatment and/or hospitalization within 30 days prior to entry
Pregnancy or breastfeeding
Peripheral neuropathy ≥Grade 2 according to the Division of AIDS (DAIDS) Toxicity Table, within 90 days prior to study entry
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