Therapeutic Approaches to HAART-Induced Lipodystrophy

This study is currently recruiting participants. (see Contacts and Locations)
Verified June 2013 by University of Texas Southwestern Medical Center
Sponsor:
Collaborator:
Amylin Pharmaceuticals, LLC.
Information provided by (Responsible Party):
Abhimanyu Garg, University of Texas Southwestern Medical Center
ClinicalTrials.gov Identifier:
NCT00461552
First received: April 16, 2007
Last updated: June 19, 2013
Last verified: June 2013

April 16, 2007
June 19, 2013
January 2003
January 2016   (final data collection date for primary outcome measure)
fasting serum triglycerides [ Time Frame: 6 months ] [ Designated as safety issue: No ]
fasting serum triglycerides
Complete list of historical versions of study NCT00461552 on ClinicalTrials.gov Archive Site
  • HDL cholesterol [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • LDL cholesterol [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • fasting serum glucose [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • fasting serum insulin [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • overall and regional adiposity [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • HDL cholesterol
  • LDL cholesterol
  • fasting serum glucose
  • fasting serum insulin
  • overall and regional adiposity
Not Provided
Not Provided
 
Therapeutic Approaches to HAART-Induced Lipodystrophy
Therapeutic Approaches to HAART-Induced Lipodystrophy

To determine the efficacy and safety of 4 therapeutic interventions on HAART-Induced lipodystrophy. The interventions are: 1) Dietary - the effect of a high carbohydrate vs.a high cis-monounsaturated fatty acid diet. 2) The effect of aerobic exercise with dietary advice. 3) The effect of Omega-3 Fish Oil Capsules. 4) The effect of leptin therapy. These interventions are aimed at improving the metabolic complications of HAART therapy such as elevated lipids, and insulin resistance or diabetes.

Patients with HAART-induced lipodystrophy report loss of subcutaneous (sc) fat from the extremities and face and excess fat accumulation in the neck and truncal region. They also are predisposed to metabolic complications of insulin resistance, such as, dyslipidemia and diabetes mellitus. The pathogenesis of HAART-induced lipodystrophy is not fully understood although PIs have been strongly implicated as the cause. The metabolic complications pose an increased risk of atherosclerosis and acute pancreatitis whereas changes in body fat distribution cause physical discomfort and psychological distress. Management of these problems poses a therapeutic challenge. We propose potentially safe therapeutic lifestyle changes as well as novel therapies for management of HAART-induced lipodystrophy and its metabolic complications. The hypotheses to be tested and the aims are:

Hypothesis 1: A diet rich in cis-monounsaturated fatty acids improves HAART-induced glucose intolerance and dyslipidemia in HIV-infected patients.

Aim 1: To compare acceptability and effects of isocaloric diets rich in carbohydrates and cis-monounsaturated fats, each given for 6 wk, on glucose and lipid metabolism in patients with HAART-induced dyslipidemia in a randomized, cross-over study.

Hypothesis 2: A regimen of aerobic exercise improves insulin resistance, dyslipidemia and body fat distribution in HIV-infected patients with HAART-induced lipodystrophy.

Aim 2: To determine the effects of a supervised aerobic exercise regimen and dietary advice on glucose and lipid metabolism, and body fat distribution in HIV-infected patients with HAART-induced lipodystrophy.

Hypothesis 3: The n-3 polyunsaturated fats improve HAART-induced dyslipidemia in HIV-infected patients.

Aim 3: To determine the lipid-lowering effects of n-3 polyunsaturated fats in a randomized, double-blind, placebo-controlled, crossover trial in HIV-infected patients with HAART-induced dyslipidemia.

Hypothesis 4: Leptin replacement improves insulin resistance, dyslipidemia and body fat distribution in patients with HAART-induced lipodystrophy and hypoleptinemia.

Aim 4 To study efficacy and safety of recombinant methionyl leptin (r-metHuleptin) in improving insulin sensitivity, dyslipidemia and body fat distribution in patients with HAART-induced lipodystrophy and hypoleptinemia using a randomized, double-blind, placebo-controlled, parallel design.

Results from these studies may help in designing therapeutic approaches to HAART-induced lipodystrophy and its metabolic complications as well as for prevention of these problems in HIV-infected patients being placed on HAART.

Interventional
Phase 2
Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Double Blind (Subject, Caregiver, Investigator)
Primary Purpose: Treatment
  • HIV Infections
  • Lipodystrophy
Drug: Metreleptin (Leptin)
weight based, sub-cutaneous injection, twice daily
  • Active Comparator: Leptin ( still recruiting)
    Leptin weight and gender based dose, sub-cutaneous, twice daily. Leptin versus placebo for entire 6 months double-blind.
    Intervention: Drug: Metreleptin (Leptin)
  • Placebo Comparator: Leptin Placebo
    Placebo for Leptin, sub-Q injection twice daily.
    Intervention: Drug: Metreleptin (Leptin)
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
130
September 2016
January 2016   (final data collection date for primary outcome measure)

Inclusion Criteria - General inclusion:

  • Age > 14 years
  • HIV infection being treated with HIV-1 protease inhibitors for >6 months currently, or previous protease inhibitor therapy of at least 2 years duration with development of lipodystrophy and current stable therapy preferably for past 4 months.
  • Fasting serum triglycerides > 200 mg/dL

Exclusion Criteria - General exclusion:

  • Acute, ongoing AIDS-defining opportunistic infections.
  • Blood CD4 positive lymphocyte count < 200/mm3
  • Known liver disease due to causes other than nonalcoholic steatohepatitis with elevation of liver transaminases by more than two and a half times above the upper limits of normal (SGOT>105 U/L, SGPT>120 U/L) or total bilirubin (>1.5 mg/dL).
  • Hematocrit of less than 30%.
  • Current alcohol abuse (>7 drinks or 210 g per wk for women and >14 drinks or 420 g per wk for men).
  • Current substance abuse.
  • Uncontrolled diabetes mellitus with fasting plasma glucose > 180 mg/dL or hemoglobin A1c > 9%.
  • History of weight loss during the last 3 months.
  • Use of anorexiogenic drugs, thiazolidinediones, anabolic steroids and human growth hormone.
  • Major Neuro-psychiatric illnesses impeding competence or compliance.
  • Pregnant and lactating women.
  • Cancer excluding skin cancer other than melanoma.
  • Acute medical illnesses precluding participation in the studies.
  • Chronic renal insufficiency with serum creatinine > 2 mg/dL.
  • Untreated thyroid disorders such as hypothyroidism and hyperthyroidism. Each of the 4 treatment arms has additional specific inclusion and exclusion criteria
Both
14 Years to 65 Years
No
Contact: Claudia Quittner, RN, BSN, MS 214-648-9296 claudia.quittner@utsouthwestern.edu
Contact: Zahid Ahmad, M.D. 214-648-2377 zahid.ahmad@utsouthwestern.edu
United States
 
NCT00461552
063656
Yes
Abhimanyu Garg, University of Texas Southwestern Medical Center
University of Texas Southwestern Medical Center
Amylin Pharmaceuticals, LLC.
Principal Investigator: Abhimanyu Garg, M.D. Univeristy of Texas Southwestern Medical Center
University of Texas Southwestern Medical Center
June 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP