Safety and Tolerability of Maraviroc-Containing Regimens to Prevent HIV Infection in Women: A Phase 2 Randomized Trial.

Abstract

BACKGROUND:

Maraviroc (MVC) is a candidate drug for HIV preexposure prophylaxis (PrEP).

OBJECTIVE:

To assess the safety and tolerability of MVC-containing PrEP over 48 weeks in U.S. women at risk for HIV infection.

DESIGN:

Phase 2 randomized, controlled, double-blinded study of 4 antiretroviral regimens used as PrEP. (ClinicalTrials.gov: NCT01505114).

SETTING:

12 clinical research sites of the HIV Prevention Trials Network and AIDS Clinical Trials Group.

PARTICIPANTS:

HIV-uninfected women reporting condomless vaginal or anal intercourse with at least 1 man with HIV infection or unknown serostatus within 90 days.

INTERVENTION:

MVC only, MVC-emtricitabine (FTC), MVC-tenofovir disoproxil fumarate (TDF), and TDF-FTC (control).

MEASUREMENTS:

At each visit, clinical and laboratory (including HIV) assessments were done. Primary outcomes were grade 3 and 4 adverse events and time to permanent discontinuation of the study regimen. All randomly assigned participants were analyzed according to their original assignment.

RESULTS:

Among 188 participants, 85% completed follow-up, 11% withdrew early, and 4% were lost to follow-up; 19% discontinued their regimen prematurely. The number discontinuing and the time to discontinuation did not differ among regimens. Grade 3 or 4 adverse events occurred in 5 (MVC), 13 (MVC-FTC), 9 (MVC-TDF), and 8 (TDF-FTC) participants; rates did not differ among regimens. One death (by suicide) occurred in the MVC-TDF group but was judged not to be related to study drugs. Of available plasma samples at week 48 (n = 126), 60% showed detectable drug concentrations. No new HIV infections occurred.

LIMITATIONS:

Participants were not necessarily at high risk for HIV infection. The regimen comprised 3 pills taken daily. The study was not powered for efficacy.

CONCLUSION:

Maraviroc-containing PrEP regimens were safe and well-tolerated compared with TDF-FTC in U.S. women. No new HIV infections occurred, although whether this was due to study drugs or low risk in the population is uncertain. Maraviroc-containing PrEP for women may warrant further study.

PRIMARY FUNDING SOURCE:

National Institutes of Health.

• Authors: Roy M Gulick, Timothy J Wilkin, Ying Q Chen, Raphael J Landovitz, K Rivet Amico, Alicia M Young, Paul Richardson, Mark A Marzinke, Craig W Hendrix, Susan H Eshleman, Ian McGowan, Leslie M Cottle, Adriana Andrade, Cheryl Marcus, Karin L Klingman, Wairimu Chege, Alex R Rinehart, James F Rooney, Philip Andrew, Robert A Salata, Marc Siegel, Yukari C Manabe, Ian Frank, Ken Ho, Jorge Santana, Joanne D Stekler, Shobha Swaminathan, Marybeth McCauley, Sally Hodder, Kenneth H Mayer
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 167 Issue 6 Pg. 384-393 (Sep 19 2017) ISSN: 1539-3704 [Electronic] United States
• PMID: 28828489 (Publication Type: Clinical Trial, Phase II, Journal Article, Randomized Controlled Trial)

Chemical References

• Cyclohexanes
• HIV Fusion Inhibitors
• Triazoles
• Maraviroc

Topics

• Adolescent
• Adult
• Cyclohexanes (adverse effects, therapeutic use)
• Double-Blind Method
• Female
• Follow-Up Studies
• HIV Fusion Inhibitors (adverse effects, therapeutic use)
• HIV Infections (prevention & control)
• Humans
• Maraviroc
• Middle Aged
• Patient Dropouts
• Pre-Exposure Prophylaxis
• Prospective Studies
• Treatment Outcome
• Triazoles (adverse effects, therapeutic use)
• Young Adult