The Effects of Anti-HIV Drugs in HIV-Infected Patients Who Do Not Have AIDS
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Purpose
Immunopathogenesis objectives: To compare and quantitatively determine HIV burden and HIV replication in peripheral blood (PB) and lymphoid tissue (LT). To determine the degree to which antiretroviral therapy alters HIV replication in LT.
Clinical objectives: To gain insight into the degree of correlation between immunologic surrogate markers for HIV disease (e.g., CD4, beta-2 microglobulin) as compared to measures of HIV replication in PB and LT. To assess changes in PB and LT viral burden after antiretroviral therapy and to determine its ability to predict an antiviral response.
One of the major problems in defining the immunopathogenic changes in HIV infections has been the inability to correlate the extent of loss of immunologic function with the number of HIV-infected CD4+ cells in the peripheral blood. Few studies exist that measure viral burden in lymph nodes of HIV-infected individuals. Researchers hope to find out whether the amount of HIV virus or markers for the virus in the body's lymph tissue is a better measure of disease progression than the amount of virus or markers for the virus in the blood.
| Condition | Intervention |
|---|---|
|
HIV Infections |
Drug: Zidovudine Drug: Didanosine |
| Study Type: | Interventional |
| Study Design: | Primary Purpose: Treatment |
| Official Title: | A Multicenter, Open-Label Study of Viral Burden in Peripheral Blood Versus Lymphoid Tissue Before and After Antiretroviral Therapy in HIV-Infected Individuals Without AIDS (NOTE: One Arm Receives no Treatment) |
| Estimated Enrollment: | 32 |
| Study Completion Date: | June 2002 |
One of the major problems in defining the immunopathogenic changes in HIV infections has been the inability to correlate the extent of loss of immunologic function with the number of HIV-infected CD4+ cells in the peripheral blood. Few studies exist that measure viral burden in lymph nodes of HIV-infected individuals. Researchers hope to find out whether the amount of HIV virus or markers for the virus in the body's lymph tissue is a better measure of disease progression than the amount of virus or markers for the virus in the blood.
Sixteen antiretroviral-naive patients are randomized to either remain antiretroviral-naive (no treatment) or receive zidovudine daily (treatment). Additionally, 16 patients with 26 or more weeks of ongoing zidovudine (AZT) therapy are randomized to either continue on their prestudy AZT regimen or add didanosine (ddI) daily to their baseline AZT dose. Patients remain on their assigned treatment arms for 8 weeks. A lymph node biopsy is performed on day 0 and at week 8. Patients are evaluated at weeks 2, 4, 6, 8 and 9.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria
Concurrent Medication:
Allowed:
- Chemoprophylaxis against M. tuberculosis, therapy for oral candidiasis, and short courses (up to 10 days) of acyclovir for herpes lesions.
- Antibiotics as clinically indicated.
- Pneumococcal vaccine and hepatitis B vaccine as medically indicated.
- Regularly prescribed medications such as antipyretics, analgesics, allergy medications, antidepressants, sleep medications, oral contraceptives, or other medications deemed appropriate by the patient's primary care provider.
Recommended:
- PCP prophylaxis if patient's CD4 count falls below 200 cells/mm3 during the study.
Concurrent Treatment:
Allowed:
- Alternative therapies such as vitamins and acupuncture.
Patients must have:
- Documented HIV infection.
- At least two palpable lymph nodes above the waist.
- CD4 counts >= 350 cells/mm3 (if previously antiretroviral-naive) or >= 250 cells/mm3 (if receiving ongoing AZT therapy).
Patients with prior AZT therapy must have received a stable dose of 300-600 mg daily for 26 or more weeks.
Prior Medication:
Required in patients with prior ongoing therapy:
- AZT at dose of 300-600 mg daily for at least 26 weeks.
Exclusion Criteria
Co-existing Condition:
Patients with the following symptoms and conditions are excluded:
- Severe malabsorption.
- Current AIDS-related opportunistic infection, AIDS dementia, AIDS-wasting syndrome, or an AIDS-related malignancy other than minimal Kaposi's sarcoma disease.
- Current medical problems that may interfere with the evaluation of AZT or increase the potential toxicity of AZT (e.g., significant liver disease, diabetes, significant cardiovascular disease, seizure disorders, lymphoma, acute or chronic pancreatitis, or febrile illness).
- Current diagnosis of malignancy for which systemic therapy would be required during study.
Concurrent Medication:
Excluded:
- Ganciclovir, foscarnet, chronic acyclovir, or probenecid.
- Other proven or alleged antiretroviral or anti-HIV drugs.
- Biologic response modifiers.
- Valproic acid.
- Systemic cytotoxic chemotherapy.
- Steroids.
Concurrent Treatment:
Excluded:
- Radiation therapy.
Patients with the following prior conditions are excluded:
- Prior AIDS-related opportunistic infection, AIDS dementia, AIDS-wasting syndrome, or an AIDS-related malignancy other than minimal Kaposi's sarcoma disease.
- History of medical problems that may interfere with the evaluation of AZT or increase the potential toxicity of AZT (e.g., significant liver disease, diabetes, significant cardiovascular disease, seizure disorders, lymphoma, acute or chronic pancreatitis, or febrile illness).
- History of peripheral neuropathy (patients with prior AZT treatment only).
Prior Medication:
Excluded:
- Prior ddI therapy.
- Less than 26 weeks of prior AZT (in patients with ongoing AZT therapy only).
- Ganciclovir, foscarnet, chronic acyclovir, or probenecid.
- Cytotoxic chemotherapy within 1 month prior to study entry.
- Acute therapy for an infection or other medical illness within 14 days prior to study entry.
History of alcohol abuse (patients with prior AZT treatment).
Contacts and Locations| United States, California | |
| Palo Alto Veterans Affairs Health Care System | |
| Palo Alto, California, United States, 94304 | |
| Mount Zion Med Ctr / UCSF | |
| San Francisco, California, United States, 94115 | |
| Kaiser Permanente Med Ctr | |
| San Francisco, California, United States, 94115 | |
| United States, Illinois | |
| Univ of Illinois | |
| Chicago, Illinois, United States, 60612 | |
| United States, Maryland | |
| Univ of Maryland at Baltimore | |
| Baltimore, Maryland, United States, 21201 | |
| United States, New York | |
| SUNY / Health Sciences Ctr at Stony Brook | |
| Stony Brook, New York, United States, 117948153 | |
| United States, North Carolina | |
| Duke Univ Med Ctr | |
| Durham, North Carolina, United States, 27710 | |
| United States, Pennsylvania | |
| Univ of Pittsburgh | |
| Pittsburgh, Pennsylvania, United States, 15261 | |
| Study Chair: | J Cohn | |
| Study Chair: | M Niu |
More Information
Additional Information:
Publications:
| Responsible Party: | National Institute of Allergy and Infectious Diseases (NIAID) |
| ClinicalTrials.gov Identifier: | NCT00001024 History of Changes |
| Other Study ID Numbers: | DATRI 003, 11734 |
| Study First Received: | November 2, 1999 |
| Last Updated: | March 29, 2012 |
| Health Authority: | United States: Federal Government |
Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):
|
Didanosine AIDS-Related Complex Zidovudine Lymph Nodes Lymphoid Tissue |
Additional relevant MeSH terms:
|
HIV Infections Acquired Immunodeficiency Syndrome Lentivirus Infections Retroviridae Infections RNA Virus Infections Virus Diseases Sexually Transmitted Diseases, Viral Sexually Transmitted Diseases Immunologic Deficiency Syndromes Immune System Diseases Slow Virus Diseases Didanosine |
Zidovudine Antimetabolites Molecular Mechanisms of Pharmacological Action Pharmacologic Actions Reverse Transcriptase Inhibitors Nucleic Acid Synthesis Inhibitors Enzyme Inhibitors Anti-Retroviral Agents Antiviral Agents Anti-Infective Agents Therapeutic Uses Anti-HIV Agents |
ClinicalTrials.gov processed this record on May 19, 2013