Evaluating the Safety and Pharmacokinetics of Maraviroc in HIV-1-Exposed Infants at Risk of Acquiring HIV-1 Infection
Evaluating the Safety and Pharmacokinetics of Maraviroc in HIV-1-Exposed Infants at Risk of Acquiring HIV-1 Infection
This study aimed to evaluate the safety, tolerability, and pharmacokinetics of maraviroc in
 infants at risk for mother-to-child HIV transmission, and to determine an appropriate dose of
 maraviroc during the first six weeks of life.
Maraviroc is a C-C Chemokine Receptor 5 (CCR5) receptor antagonist used to treat HIV
 infection in adults. Adding maraviroc to a standard of care prophylaxis regimen may also
 reduce the risk of perinatal transmission of HIV. The purpose of this study was to evaluate
 the safety, tolerability, and pharmacokinetics of maraviroc in HIV-1-exposed infants at risk
 for mother-to-child HIV transmission. This study also aimed to determine an appropriate dose
 of maraviroc during the first six weeks of life.

 The study allowed up to 72 mother-infant pairs in two cohorts to achieve a target of 36
 evaluable infants receiving the final recommended dose of maraviroc. Because maraviroc
 interacts with the antiretroviral drug efavirenz (EFV) in adults, infants in this study were
 stratified within the cohorts based on their exposure to maternal EFV. Cohort 1 was
 stratified by in utero exposure to maternal EFV, with infants in both strata receiving a
 single dose of maraviroc solution within three days of birth and another single dose at Week
 1 of life. Stratum 1A included infants without in utero exposure to maternal EFV during the
 eight weeks immediately before delivery. Stratum 1B included infants with in utero exposure
 to maternal EFV for a minimum of two weeks immediately before delivery.

 Cohort 2 was stratified by exposure to maternal EFV after birth, with infants in both strata
 receiving maraviroc oral solution twice daily starting within three days of birth and
 continuing for up to 42 days. Based on evaluation of the Cohort 1 data, the initial daily
 dose of maraviroc oral solution to be administered in Cohort 2 was 8 mg/kg dose given twice
 daily. Stratum 2A included infants without any exposure to maternal EFV either in utero
 during the eight weeks immediately before delivery or while breastfeeding. Stratum 2B
 included breastfeeding infants with exposure to maternal EFV both in utero and after birth
 while breastfeeding, for a minimum of 2 weeks immediately before delivery and while
 breastfeeding.

 Participants attended an entry visit within three days after the infant's birth. Participants
 attended five to six study visits through Week 16. Visits included medical history reviews,
 physical examinations, blood collection from the mother and/or infant, HIV testing, and
 adherence counseling.
Inclusion Criteria:

 -  Mother was of legal age to provide independent informed consent for research
 participation and was willing and able to provide written informed consent for her and
 her infant's participation in this study.

 -  Mother had confirmed HIV-1 infection based on testing of two samples collected at
 different time points. More information on this criterion can be found in the
 protocol.

 -  At entry, infant met EFV exposure requirements, based on mother's report and confirmed
 by medical records if available, as follows:

 -  For Cohort 1, Stratum 1A: Infant born to a mother who did not receive EFV during
 the eight weeks immediately prior to delivery. Note: Breastfeeding and formula
 feeding infants were eligible for this stratum.

 -  For Cohort 1, Stratum 1B: Infant born to a mother who received EFV for a minimum
 of two weeks immediately prior to delivery. Note: Breastfeeding and formula
 feeding infants were eligible for this stratum.

 -  For Cohort 2, Stratum 2A: Infants born to a mother who did not receive EFV during
 the eight weeks immediately prior to delivery and if breastfeeding, mother was
 not receiving maternal EFV. Note: Breastfeeding and formula feeding infants were
 eligible for this stratum.

 -  For Cohort 2, Stratum 2B: Breastfeeding infants born to a mother who received EFV
 for a minimum of two weeks immediately prior to delivery, intended to breastfeed
 for a minimum of six weeks and continued to receive maternal EFV while
 breastfeeding. Note: Only breastfeeding infants were eligible for this stratum.

 -  At birth, infant's estimated gestational age was at least 37 weeks. Note: If
 gestational age at birth is not documented in the infant's available birth records,
 study staff may assess gestational age at the earliest possible opportunity during the
 screening period and use this assessment for purposes of eligibility determination.

 -  At birth, infant's weight was at least 2 kg. Note: If weight at birth is not
 documented in the infant's available birth records, study staff may assess infant
 weight at the earliest possible opportunity during the screening period and use this
 assessment for purposes of eligibility determination.

 -  At entry, infant was less than or equal to 3 days old.

 -  At entry, infant had the following lab values:

 -  Grade 0 alanine transaminase (ALT) (normal)

 -  Less than or equal to Grade 1 aspartate aminotransferase (AST) and total
 bilirubin

 -  Less than or equal to Grade 2 hemoglobin, white blood cell counts, platelet
 counts

 -  At entry, infant had initiated antiretroviral prophylaxis that did not include a
 potent CYP3A4 inhibitor or inducer. See the protocol for more information.

 -  At entry, infant was assessed by the site investigator or designee as generally
 healthy based on review of available medical records, other available medical history
 information, and physical examination findings.

 -  Born after singleton delivery (not after multiple birth).

 Exclusion Criteria:

 -  Infant had any other condition that, in the opinion of the site investigator or
 designee, would make participation in the study unsafe, complicate interpretation of
 study outcome data, or otherwise interfere with achieving the study objectives; for
 example, severe congenital malformation, other medical condition, or clinically
 significant finding from physical examination.

 -  At entry, any positive infant HIV nucleic acid test result (results are not required
 to be available prior to entry but any positive results obtained prior to entry are
 exclusionary).

 -  At entry, infant or breastfeeding mother was receiving any disallowed medication
 listed in the protocol.

 -  Mother received maraviroc during pregnancy.