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Clinical Trial
. 2017 Sep 19;167(6):384-393.
doi: 10.7326/M17-0520. Epub 2017 Aug 22.

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

Roy M Gulick  1 , Timothy J Wilkin  1 , Ying Q Chen  1 , Raphael J Landovitz  1 , K Rivet Amico  1 , Alicia M Young  1 , Paul Richardson  1 , Mark A Marzinke  1 , Craig W Hendrix  1 , Susan H Eshleman  1 , Ian McGowan  1 , Leslie M Cottle  1 , Adriana Andrade  1 , Cheryl Marcus  1 , Karin L Klingman  1 , Wairimu Chege  1 , Alex R Rinehart  1 , James F Rooney  1 , Philip Andrew  1 , Robert A Salata  1 , Marc Siegel  1 , Yukari C Manabe  1 , Ian Frank  1 , Ken Ho  1 , Jorge Santana  1 , Joanne D Stekler  1 , Shobha Swaminathan  1 , Marybeth McCauley  1 , Sally Hodder  1 , Kenneth H Mayer  1
Affiliations
Clinical Trial

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

Roy M Gulick et al. Ann Intern Med. .

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.

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Figures

FIGURE 1
FIGURE 1. STUDY FLOW DIAGRAM
Legend: MVC, maraviroc; FTC, emtricitabine; TDF, tenofovir disoproxil fumarate. * Two participants were randomized, but never started their study regimen (one randomized to MVC alone who refused further participation and one to MVC+FTC who was unable to be contacted).
FIGURE 2
FIGURE 2. TIME TO PERMANENT STUDY DISCONTINUATION
Legend: Kaplan-Meier plot. MVC, maraviroc; FTC, emtricitabine; TDF, tenofovir disoproxil fumarate.
See this image and copyright information in PMC

References

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