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Optimal Treatment for Kidney Disease in HIV Infected Adults

This study has been withdrawn prior to enrollment.
Sponsor:
Information provided by:
National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier:
NCT00089518
First received: August 5, 2004
Last updated: August 6, 2009
Last verified: August 2009
  Purpose

The angiotensin receptor blocker (ARB) valsartan is a drug commonly used to treat high blood pressure. Valsartan may also help slow down the progression of kidney disease in HIV infected people. The purpose of this study is to compare valsartan and antiretroviral therapy (ART) to ART alone in slowing kidney disease progression in people with HIV.


Condition Intervention Phase
HIV Infections
Kidney Disease
Drug: Valsartan
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double-Blind
Primary Purpose: Treatment
Official Title: A Phase III, Randomized, Placebo-Controlled, Double-Blind Trial of an Angiotensin Receptor Blocker (Valsartan) and Highly Active Antiretroviral Therapy (HAART) Versus HAART Alone for the Treatment of HIV-Associated Nephropathy

Resource links provided by NLM:


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

Estimated Enrollment: 64
Detailed Description:

ART for the treatment of HIV may slow the progression of HIV-associated nephropathy (HIVAN) to end-stage renal disease (ESRD); nevertheless, it is predicted that many HIV infected patients on ART will reach ESRD by the next decade. Medications that affect the renin-angiotensin system, such as the ARB valsartan, may be useful in treating HIVAN. In a small study of HIV infected patients with HIVAN treated with the angiotensin-converting enzyme inhibitor (ACEI) fosinopril, kidney function was stable in patients who took the ACEI, but function decreased in patients who did not. These data are promising, and suggest that an ARB like valsartan may also slow the progression of HIVAN and improve patients' prognosis. This study will compare valsartan and ART to ART alone in slowing kidney disease progression in people with HIV.

This study will last 96 weeks. All participants will continue taking their current ART regimen during the study and will be randomly assigned to one of two arms: Arm 1 will receive valsartan daily, while Arm 2 will receive placebo daily. Doses of drug or placebo may be adjusted during the first 8 weeks based on blood pressure readings taken during the study. In addition, if patients are on other antihypertensive drugs, dosage adjustments may be necessary for those drugs during the study. No ART or antihypertensive drugs other than valsartan will be provided by the study. Study visits will occur every week until Week 8, then every 8 weeks until the end of the study at Week 96. Study visits will include physical examination, medication assessment, and blood pressure readings. In addition, blood collection will occur at entry, Weeks 2, 4, 6, and 8, and every 8 weeks thereafter.

  Eligibility

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

Inclusion Criteria:

  • HIV infected
  • Evidence of HIV-associated nephropathy by kidney biopsy performed locally within 24 weeks prior to study entry
  • On ART for at least 42 days prior to study entry and willing to continue ART while on study
  • Systolic blood pressure (BP) between 91 mm Hg and 170 mm Hg and diastolic BP 105 mm Hg or less within 24 hours of study entry
  • Stable kidney function, as indicated by two consecutive calculated creatinine clearance measurements higher than 30 ml/min
  • Serum potassium of less than Grade 1 within 7 days prior to study entry
  • Willing to follow dose adjustments of non-study antihypertensive drugs if necessary
  • Willing to use acceptable forms of contraception

Exclusion Criteria:

  • Current treatment with hemodialysis or peritoneal dialysis
  • History of kidney transplant
  • Condition other than HIVAN contributing to decreased kidney function
  • ALT or AST greater than 5 times the upper limit of normal (ULN) within 28 days of study entry
  • Total bilirubin greater than 2.5 times ULN within 28 days of study entry. Patients with total bilirubin between 2.5 times and 5 times ULN who are receiving indinavir or atazanavir and do not have cirrhosis or severe liver disease are not excluded.
  • Current heart indication for an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB)
  • Use of an ACEI or ARB within 7 days prior to first creatinine clearance measurement obtained for screening or any time between screening and study entry
  • Systemic steroid therapy above a replacement level within 28 days of study entry, or possible need for ongoing systemic steroid therapy above replacement level during the study
  • Current use of cimetidine
  • Use of investigational agents, except when approved by the protocol chairs
  • Allergy or sensitivity to valsartan or its formulations
  • Blood pressure not measurable by the technique described in the protocol
  • Orthostatic drop in systolic BP of 30 mm Hg or more within 24 hours prior to study entry
  • Drug or alcohol use that, in the opinion of the investigator, would interfere with the study
  • Decreased mental capacity that, in the opinion of the investigator, would interfere with the study
  • AIDS-defining opportunistic infection (OI) within 28 days prior to study entry. Patients who are receiving maintenance therapy for OIs and have no evidence of active disease are not excluded.
  • Diabetes mellitus for 2 years or longer prior to study entry. Onset of diabetes is defined as the point at which patients began oral hypoglycemics or insulin.
  • Pregnancy or breastfeeding
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00089518

Locations
United States, Indiana
Indiana University Hospital
Indianapolis, Indiana, United States, 46202-5250
Methodist Hospital of Indiana
Indianapolis, Indiana, United States, 46202-5250
Wishard Hospital
Indianapolis, Indiana, United States, 46202
United States, Missouri
Washington University (St. Louis)
St. Louis, Missouri, United States, 63108-2138
United States, New York
NYU/Bellevue
New York, New York, United States, 10016-6481
United States, North Carolina
Duke University Medical Center
Durham, North Carolina, United States, 27710
United States, Ohio
MetroHealth Medical Center
Cleveland, Ohio, United States, 44109-1998
United States, Rhode Island
Rhode Island Hospital
Providence, Rhode Island, United States, 02906
Stanley Street Treatment and Resource
Providence, Rhode Island, United States, 02906
The Miriam Hospital
Providence, Rhode Island, United States, 02906
Sponsors and Collaborators
Investigators
Study Chair: Lynda Anne Szczech, MD, MSCE Division of Nephrology, Department of Medicine, Duke University Medical Center
  More Information

Additional Information:
Publications:
ClinicalTrials.gov Identifier: NCT00089518     History of Changes
Other Study ID Numbers: ACTG A5179
Study First Received: August 5, 2004
Last Updated: August 6, 2009
Health Authority: United States: Food and Drug Administration

Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):
Treatment Experienced

Additional relevant MeSH terms:
Acquired Immunodeficiency Syndrome
HIV Infections
Kidney Diseases
Immune System Diseases
Immunologic Deficiency Syndromes
Lentivirus Infections
RNA Virus Infections
Retroviridae Infections
Sexually Transmitted Diseases
Sexually Transmitted Diseases, Viral
Slow Virus Diseases
Urologic Diseases
Virus Diseases
Angiotensin Receptor Antagonists
Valsartan
Angiotensin II Type 1 Receptor Blockers
Antihypertensive Agents
Cardiovascular Agents
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Therapeutic Uses

ClinicalTrials.gov processed this record on November 25, 2014