Pre-Exposure Prophylaxis and Timed Intercourse for HIV-Discordant Couples

NCT02572505 | Withdrawn

• 1 other identifier: IRB #2002937
• Study Type: interventional
• Target: N/A
• Locations: 1 country
• Sites: 1

Brief Summary

Human immunodeficiency virus (HIV) infection has now become a treatable disease and many infected individuals are interested in having a family. Couples in which the man is infected but the woman is HIV-negative (hereafter referred to as HIV-discordant) require medical intervention during procreation to prevent HIV transmission to the female and her child. The current view is that reducing the number of infections involving unprotected intercourse in HIV-discordant couples is a public health issue in the U.S. The safest methods for HIV-discordant couples are insemination using a sperm donor, adoption and remaining childless. However, some couples strongly desire a biologically related child. Fertility clinics in the United States have been resistant to treating HIV-discordant couples, offering only expensive, invasive techniques. This reduces access to care, leading to couples choosing unprotected intercourse to conceive a child. Pre-exposure prophylaxis (PrEP) is a treatment taken by the woman before having unprotected intercourse with an infected man. Truvada has been approved by the Food and Drug Administration (FDA) to reduce the risk of HIV-discordant couples and the Centers for Disease Control and prevention (CDC) has recommended that serodiscordant patients who wish to have a child be counseled on the availability of PrEP. When risks of transmission are minimized, including undetectable HIV in blood and use of PrEP, unprotected intercourse during the fertile period is likely to be a safe option for conceiving a child. The investigators propose to enroll HIV-discordant couples who have been counseled on the safer alternatives of donor insemination, adoption and remaining childless; have been offered referral to a clinic offering sperm washing with insemination or in vitro fertilization (IVF); have been apprised of the risks of using PrEP and one timed intercourse per cycle; and decide to proceed with this method. Couples will be from the population of HIV-discordant patients with a minimal risk of disease transmission as described above. After evaluation for normal fertility and low potential for disease transmission, the couple will receive instruction on timing of the most fertile day of the cycle, and the woman will be given a prescription for the PrEP medication. The woman and any offspring will be followed for 6 months using blood tests to check for evidence of HIV infection.

Conditions

HIV; Infertility

Keywords

HIV-Discordant; Preexposure Prophylaxis

Outcome Measures

Primary Outcomes (1)

• Proportion of women remaining HIV-seronegative for 6 months after a treatment menstrual cycle

  After having one act of unprotected intercourse at the woman's fertile period, she will be tested at 6 months by HIV Ab test. Outcome will be reported as proportion of women becoming HIV-seropositive after one cycle of treatment. It is expected that this will be zero.

  6 months after each menstrual cycle in which HIV-discordant couple has one act of unprotected intercourse

Secondary Outcomes (1)

• Proportion of couples achieving pregnancy after each treatment menstrual cycle.

  Approximately one month after unprotected intercourse

Study Arms (1)

HIV-Discordant Couple

EXPERIMENTAL

A couple in which the man is HIV-seropositive and the woman is HIV-seronegative who wish to have a biologically related child. Couple will use condoms for all sexual acts except one act of unprotected intercourse during the fertile period when the woman will be taking the drug Truvada.

Drug: Truvada

Interventions

Truvada DRUG

Female patient will take Truvada and use condoms for each act of intercourse except once at the optimal time for fertility.

Also known as: HIV-D, PrEP, Gilead Sciences, emtricitabine, tenofovir disoproxil fumarate

HIV-Discordant Couple

Eligibility Criteria

• Age: 18 Years - 40 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Woman:
• years of age
• not pregnant
• BMI 18.5-30
• nonsmoker
• no use of IV drugs
• seronegative for HIV
• negative tests for hepatitis C and hepatitis B, human T-lymphotropic virus (HTLV I\&II), syphilis, Chlamydia trachomatis and Neisseria gonorrhea
• normal fertility examination
• normal PAP smear and HPV screen
• Man:
• years of age
• nonsmoker
• no use of IV drugs
• HIV-seropositive

You may not qualify if:

• either man or woman is incarcerated
• either man or woman is unable to provide informed consent
• woman is unable to take Truvada (tenofovir/emtricitabine) medication due to contraindications or adverse reaction

Sponsors & Collaborators

• University of Missouri-Columbia: lead

Study Sites (1)

Missouri Center for Reproductive Medicine & Fertility

Columbia, Missouri, United States

Location

Related Publications (23)

• ACOG Committee Opinion no 595: Committee on Gynecologic Practice: Preexposure prophylaxis for the prevention of human immunodeficiency virus. Obstet Gynecol. 2014 May;123(5):1133-1136. doi: 10.1097/01.AOG.0000446855.78026.21.

  PMID: 24785877 BACKGROUND

• Practice Committee of American Society for Reproductive Medicine. Recommendations for reducing the risk of viral transmission during fertility treatment with the use of autologous gametes: a committee opinion. Fertil Steril. 2013 Feb;99(2):340-6. doi: 10.1016/j.fertnstert.2012.08.028. Epub 2012 Sep 10.

  PMID: 22975112 BACKGROUND

• Barreiro P, Castilla JA, Labarga P, Soriano V. Is natural conception a valid option for HIV-serodiscordant couples? Hum Reprod. 2007 Sep;22(9):2353-8. doi: 10.1093/humrep/dem226. Epub 2007 Jul 19.

  PMID: 17640945 BACKGROUND

• Daar ES, Daar JF. Human immunodeficiency virus and fertility care: embarking on a path of knowledge and access. Fertil Steril. 2006 Feb;85(2):298-300; discussion 301. doi: 10.1016/j.fertnstert.2005.08.018.

  PMID: 16595202 BACKGROUND

• De Carli G, Palummieri A, Liuzzi G, Puro V. Safe conception for human immunodeficiency virus-discordant couples: the preexposure prophylaxis for conception alternative. Am J Obstet Gynecol. 2014 Jan;210(1):90. doi: 10.1016/j.ajog.2013.08.011. Epub 2013 Aug 14. No abstract available.

  PMID: 23954529 BACKGROUND

• de Vincenzi I. A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. European Study Group on Heterosexual Transmission of HIV. N Engl J Med. 1994 Aug 11;331(6):341-6. doi: 10.1056/NEJM199408113310601.

  PMID: 8028613 BACKGROUND

• Del Romero J, Castilla J, Hernando V, Rodriguez C, Garcia S. Combined antiretroviral treatment and heterosexual transmission of HIV-1: cross sectional and prospective cohort study. BMJ. 2010 May 14;340:c2205. doi: 10.1136/bmj.c2205.

  PMID: 20472675 BACKGROUND

• Downs AM, De Vincenzi I. Probability of heterosexual transmission of HIV: relationship to the number of unprotected sexual contacts. European Study Group in Heterosexual Transmission of HIV. J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Apr 1;11(4):388-95. doi: 10.1097/00042560-199604010-00010.

  PMID: 8601226 BACKGROUND

• Frodsham LC, Boag F, Barton S, Gilling-Smith C. Human immunodeficiency virus infection and fertility care in the United Kingdom: demand and supply. Fertil Steril. 2006 Feb;85(2):285-9. doi: 10.1016/j.fertnstert.2005.07.1326.

  PMID: 16595198 BACKGROUND

• Gilling-Smith C, Nicopoullos JD, Semprini AE, Frodsham LC. HIV and reproductive care--a review of current practice. BJOG. 2006 Aug;113(8):869-78. doi: 10.1111/j.1471-0528.2006.00960.x. Epub 2006 Jun 2.

  PMID: 16753050 BACKGROUND

• Gray RH, Wawer MJ, Brookmeyer R, Sewankambo NK, Serwadda D, Wabwire-Mangen F, Lutalo T, Li X, vanCott T, Quinn TC; Rakai Project Team. Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda. Lancet. 2001 Apr 14;357(9263):1149-53. doi: 10.1016/S0140-6736(00)04331-2.

  PMID: 11323041 BACKGROUND

• Klein J, Pena JE, Thornton MH, Sauer MV. Understanding the motivations, concerns, and desires of human immunodeficiency virus 1-serodiscordant couples wishing to have children through assisted reproduction. Obstet Gynecol. 2003 May;101(5 Pt 1):987-94. doi: 10.1016/s0029-7844(03)00012-7.

  PMID: 12738162 BACKGROUND

• Lampe MA, Smith DK, Anderson GJ, Edwards AE, Nesheim SR. Achieving safe conception in HIV-discordant couples: the potential role of oral preexposure prophylaxis (PrEP) in the United States. Am J Obstet Gynecol. 2011 Jun;204(6):488.e1-8. doi: 10.1016/j.ajog.2011.02.026. Epub 2011 Mar 31.

  PMID: 21457911 BACKGROUND

• Mandelbrot L, Heard I, Henrion-Geant E, Henrion R. Natural conception in HIV-negative women with HIV-infected partners. Lancet. 1997 Mar 22;349(9055):850-1. doi: 10.1016/S0140-6736(05)61754-0. No abstract available.

  PMID: 9121267 BACKGROUND

• Mastro TD, de Vincenzi I. Probabilities of sexual HIV-1 transmission. AIDS. 1996;10 Suppl A:S75-82. doi: 10.1097/00002030-199601001-00011. No abstract available.

  PMID: 8883613 BACKGROUND

• Quinn TC, Wawer MJ, Sewankambo N, Serwadda D, Li C, Wabwire-Mangen F, Meehan MO, Lutalo T, Gray RH. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. N Engl J Med. 2000 Mar 30;342(13):921-9. doi: 10.1056/NEJM200003303421303.

  PMID: 10738050 BACKGROUND

• Royce RA, Sena A, Cates W Jr, Cohen MS. Sexual transmission of HIV. N Engl J Med. 1997 Apr 10;336(15):1072-8. doi: 10.1056/NEJM199704103361507. No abstract available.

  PMID: 9091805 BACKGROUND

• Saracco A, Veglia F, Lazzarin A. Risk of HIV-1 transmission in heterosexual stable and random couples. The Italian Partner Study. J Biol Regul Homeost Agents. 1997 Jan-Jun;11(1-2):3-6. No abstract available.

  PMID: 9418153 BACKGROUND

• Sauer MV. Sperm washing techniques address the fertility needs of HIV-seropositive men: a clinical review. Reprod Biomed Online. 2005 Jan;10(1):135-40. doi: 10.1016/s1472-6483(10)60815-2.

  PMID: 15705311 BACKGROUND

• Vernazza PL, Hollander L, Semprini AE, Anderson DJ, Duerr A. HIV-discordant couples and parenthood: how are we dealing with the risk of transmission? AIDS. 2006 Feb 28;20(4):635-6. doi: 10.1097/01.aids.0000210625.06202.c2. No abstract available.

  PMID: 16470136 BACKGROUND

• Vernazza PL, Graf I, Sonnenberg-Schwan U, Geit M, Meurer A. Preexposure prophylaxis and timed intercourse for HIV-discordant couples willing to conceive a child. AIDS. 2011 Oct 23;25(16):2005-8. doi: 10.1097/QAD.0b013e32834a36d0.

  PMID: 21716070 BACKGROUND

• Wawer MJ, Gray RH, Sewankambo NK, Serwadda D, Li X, Laeyendecker O, Kiwanuka N, Kigozi G, Kiddugavu M, Lutalo T, Nalugoda F, Wabwire-Mangen F, Meehan MP, Quinn TC. Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. J Infect Dis. 2005 May 1;191(9):1403-9. doi: 10.1086/429411. Epub 2005 Mar 30.

  PMID: 15809897 BACKGROUND

• Whetham J, Taylor S, Charlwood L, Keith T, Howell R, McInnes C, Payne E, Home J, White D, Gilleece Y. Pre-exposure prophylaxis for conception (PrEP-C) as a risk reduction strategy in HIV-positive men and HIV-negative women in the UK. AIDS Care. 2014;26(3):332-6. doi: 10.1080/09540121.2013.819406. Epub 2013 Jul 22.

  PMID: 23876052 BACKGROUND

MeSH Terms

Conditions

Infertility

Interventions

Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination; Emtricitabine; Tenofovir

Condition Hierarchy (Ancestors)

Genital Diseases; Urogenital Diseases

Intervention Hierarchy (Ancestors)

Organophosphonates; Organophosphorus Compounds; Organic Chemicals; Deoxycytidine; Cytidine; Pyrimidine Nucleosides; Pyrimidines; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Adenine; Purines; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Deoxyribonucleosides; Nucleosides; Nucleic Acids, Nucleotides, and Nucleosides; Drug Combinations; Pharmaceutical Preparations

Study Officials

• Danny J Schust, M.D.

  University of Missouri-Columbia

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professional Practice Professor

Study Record Dates

• First Submitted: October 6, 2015
• First Posted: October 9, 2015
• Study Start: November 1, 2015
• Primary Completion: September 20, 2017
• Study Completion: September 20, 2017
• Last Updated: October 6, 2017

Record last verified: 2017-10

Locations

US (1)