Hormone Replacement Therapy and Anti-HIV Drugs in HIV-Infected, Postmenopausal Women

This study has been terminated.
Sponsor:
Information provided by:
National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier:
NCT00044837
First received: September 5, 2002
Last updated: September 8, 2008
Last verified: June 2003
  Purpose

The purpose of this study is to find out if the anti-HIV drugs nelfinavir (NFV), lopinavir/ritonavir (LPV/r), and efavirenz (EFV) change the amount of estrogen in the blood when taken along with hormone replacement therapy (HRT) for menopause.

HRT can be helpful for treating bothersome symptoms of menopause. However, it is not routinely used in HIV-infected postmenopausal women because it is not known how HRT interacts with anti-HIV drugs. The information obtained from this study will help doctors make recommendations for HRT in postmenopausal HIV-infected women.


Condition Intervention Phase
HIV Infections
Drug: Medroxyprogesterone acetate
Drug: Estradiol
Phase 1

Study Type: Interventional
Study Design: Endpoint Classification: Pharmacokinetics Study
Primary Purpose: Treatment
Official Title: A Phase I, Pharmacokinetic Study of Hormone Replacement Therapy in HIV-1-Infected, Postmenopausal Women on Nelfinavir, Lopinavir/Ritonavir, or Efavirenz

Resource links provided by NLM:


Further study details as provided by National Institute of Allergy and Infectious Diseases (NIAID):

Estimated Enrollment: 120
Detailed Description:

The benefits of hormone replacement therapy (HRT) in HIV-negative postmenopausal women include the abatement of menopausal symptoms such as hot flashes, insomnia, mood changes, vaginal dryness, urogenital and skin changes, and memory loss. HRT may also decrease risk for primary cardiovascular disease, osteoporosis, colon cancer, and possibly Alzheimer's disease and age-related macular degeneration. There may also be an overall survival benefit for HIV-negative postmenopausal women taking hormone replacement therapy. Despite the potential benefits of postmenopausal hormone replacement, it is seldom used in HIV-infected postmenopausal women. One concern about HRT in HIV-infected women is the potential for interaction with antiretroviral (ARV) drugs. Although the effect of HRT on ARV drug levels is likely to be small, it is important to evaluate the safety of administering HRT concurrently with ARVs. The information obtained from this study will help shape recommendations for postmenopausal HRT in HIV-infected women.

Patients are enrolled into 1 of 4 study arms based on their current oral ARV regimens. Arm A takes NFV plus nucleoside reverse transcriptase inhibitors (NRTIs). Arm B takes LPV/r plus NRTIs. Arm C takes EFV plus NRTIs. Arm D enrolls HIV-infected patients not on current ARVs, or who are taking NRTIs only (no protease inhibitors [PIs] or nonnucleoside reverse transcriptase inhibitors [NNRTIs]). All arms receive HRT with oral estradiol and medroxyprogesterone acetate for 12 weeks. Arms A, B, and C have intensive PI or NNRTI pharmacokinetic (PK) sampling at entry and Week 4. All arms have estradiol PK sampling at Week 4. Clinical and laboratory evaluations are done at entry, Week 4, and Week 12.

ARVs are not provided by this study. Only HRT is provided.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria

Patients may be eligible for this study if they:

  • Are postmenopausal women over 18 years old.
  • Are infected with HIV.
  • Have a CD4 cell count of 100 cells/mm3 or greater within 45 days prior to study entry.
  • Have a plasma viral load less than 55,000 copies/ml within 45 days prior to study entry.
  • Are willing to comply with study requirements. These include not changing smoking habits during the course of the study and not consuming caffeine or alcohol prior to PK sampling.
  • Have had a Pap smear within 12 months prior to study entry.
  • Meet one of the following requirements: a) patients must currently be on stable PI or EFV regimens plus 2 or more acceptable NRTIs, or b) patients must not currently be taking any ARVs, with the exception of an NRTI-only regimen.
  • Have a way to obtain their ARVs outside of the study and agree to continue their ARV regimen for at least 12 weeks of the study.

Exclusion Criteria

Patients may not be eligible for this study if they:

  • Have had breast or endometrial cancer, thrombophlebitis, or thromboembolism.
  • Have had serious nausea, vomiting, or abdominal pain within 30 days prior to study entry.
  • Have had a serious illness requiring systemic treatment and/or hospitalization within 14 days prior to study entry.
  • Are allergic or sensitive to the drugs that will be used for HRT.
  • Have undiagnosed postmenopausal bleeding.
  • Have coronary artery disease.
  • Have used hormonal therapies within 8 weeks prior to study entry.
  • Have used DMPA (Depo Provera) within 180 days prior to study entry.
  • Have used the anti-HIV drugs ZDV and d4T at the same time within 30 days prior to study entry.
  • Have used other medications specified in the protocol within 30 days prior to study entry.
  • Are using experimental drugs without the written approval of the study co-chairs.
  • Are unable to adhere to the ARV or HRT medications while on study, in the opinion of the investigator.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00044837

Locations
United States, Maryland
Barbara Brizz
Rockville, Maryland, United States, 20852
Sponsors and Collaborators
Investigators
Study Chair: Lori Kamemoto
Study Chair: Mary Vogler
  More Information

Additional Information:
Publications:
ClinicalTrials.gov Identifier: NCT00044837     History of Changes
Other Study ID Numbers: ACTG A5119, AACTG A5119
Study First Received: September 5, 2002
Last Updated: September 8, 2008
Health Authority: United States: Federal Government

Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):
Lopinavir
HIV-1
HIV Protease Inhibitors
Ritonavir
Postmenopause
Reverse Transcriptase Inhibitors
Pharmacokinetics
Area Under Curve
Hormone Replacement Therapy
efavirenz
estradiol

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
Estradiol
Polyestradiol phosphate
Hormones
Estradiol valerate
Estradiol 3-benzoate
Estradiol 17 beta-cypionate
Medroxyprogesterone
Medroxyprogesterone Acetate
HIV Protease Inhibitors
Reverse Transcriptase Inhibitors
Efavirenz
Estrogens
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Pharmacologic Actions
Contraceptive Agents
Reproductive Control Agents
Therapeutic Uses
Contraceptive Agents, Female

ClinicalTrials.gov processed this record on April 14, 2014