Pentoxifylline and Combination Antiretroviral Therapy to Improve Blood Vessel Function in HIV-Infected People

Inclusion Criteria:

• Documentation of HIV infection with a positive HIV enzyme-linked immunosorbent assay (ELISA) test and confirmatory western blot test
• Has not received any antiretroviral therapies in the 6 months before screening
• Participant is planning to initiate cART, per the primary HIV caregiver (there is no CD4 or HIV-1 RNA level criteria)

Exclusion Criteria:

• Incarceration at the time of screening or at any study visit
• Diagnosed vascular disease, including history of angina pectoris, coronary disease, peripheral vascular disease, cerebrovascular disease, aortic aneurysm, or otherwise known atherosclerotic disease
• Diagnosed disease or process, other than HIV infection, associated with increased systemic inflammation (including, but not limited to, systemic lupus erythematosis, inflammatory bowel diseases, or other collagen vascular diseases). Hepatitis B or C co-infections are NOT exclusionary.
• History of bleeding diathesis, gastrointestinal ulceration or bleeding, cerebrovascular aneurysm or bleeding, or retinal hemorrhage
• Known or suspected cancer requiring systemic treatment in the 6 months before screening
• History of American Diabetes Association (ADA)-defined diabetes mellitus. History of gestational diabetes is not exclusionary.
• History of migraine headaches
• History of Raynaud's phenomenon
• History of cardiac arrhythmias or cardiomyopathy
• History of hypothyroidism or hyperthyroidism, even if treated
• Known allergy or intolerance to pentoxifylline or other methylxanthines (e.g., theophylline, caffeine, theobromine). Use of caffeinated products, except on the mornings of the study visits, is not exclusionary.
• Known allergy or intolerance to nitroglycerin
• History of carotid bruits
• Creatinine clearance less than 50 mL/min, using the Cockcroft-Gault equation and a serum creatinine level measured in the 28 days before screening or at the screening visit
• Hemoglobin less than 9.0 mg/dL in the 28 days before screening or at the screening visit
• Alanine aminotransferase (ALT) level or aspartate aminotransferase (AST) greater than three times the upper limit of normal (ULN) in the 28 days before screening or at the screening visit
• Total bilirubin greater than 2.5 times ULN in the 28 days before screening or at the screening visit
• Fever, defined as a temperature greater than or equal to 38.0 degrees Celsius (C) in the 48 hours before screening. Fever in the 48 hours before each study visit will require postponement of that study visit until the participant's temperature has been lower than 38.0 C for at least 48 hours; fevers continuing past the allowed study visit timeframe will result in study discontinuation.
• Therapy for acute infection or other serious medical illnesses (besides HIV infection) within 14 days prior to screening.

Note: Therapy for acute infection or other serious medical illnesses that overlaps with a main study visit will result in postponement of that study visit until the course of therapy is completed; postponement outside of the allowed study visit timeframe will result in study discontinuation.

• Pregnancy or breastfeeding during the course of the study.
• Hypotension, defined as systolic blood pressure < 90mmHg, at time of screening.

Note: Hypotension noted prior to brachial artery reactivity testing on each main study visit will result in study visit postponement of at least one day until systolic pressure is ≥ 90mmHg the morning of brachial reactivity testing; postponement outside of the allowed study visit timeframe will result in study discontinuation.

• Uncontrolled hypertension, defined as a confirmed systolic blood pressure > 160mmHg at screening (regardless of use of antihypertensive medications).
• Receipt of anti-inflammatory agents (including, but not limited to, plaquenil, infliximab, etanercept, mycophenylate mofetil, sirolimus, tacrolimus, cyclosporine, pentoxifylline, thalidomide).
• Receipt of investigational agents, cytotoxic chemotherapy, systemic or topical glucocorticoids (of any dose), or anabolic steroids within 28 days of screening.

Note: Physiologic testosterone replacement therapy is not exclusionary.

• Receipt of lipid-lowering drugs, acetazolamide, anticoagulants, anticonvulsants, or thyroid replacements within 28 days prior to screening.
• Receipt of aspirin or other NSAIDS within 7 days of screening.
• Use of sildenafil, vardenafil, or tadalafil within 72 hours (before or after) of each main study visit.
• Active drug or alcohol use or dependence that, in the opinion of the investigator, would interfere with adherence to study requirements.