Diet, Exercise, Niacin, and Fenofibrate to Reduce Heart Disease Risk Factors in Individuals With HIV Lipodystrophy or Dyslipidemia (Heart Positive)

This study has been completed.
Sponsor:
Collaborator:
Legacy Community Health Center
Information provided by (Responsible Party):
Ashok Balasubramanyam, National Heart, Lung, and Blood Institute (NHLBI)
ClinicalTrials.gov Identifier:
NCT00246376
First received: October 27, 2005
Last updated: April 25, 2012
Last verified: April 2012
  Purpose

This study will evaluate the efficacy of diet and exercise (DE), with and without niacin and fenofibrate, in reducing the cardiovascular risk of patients with HIV lipodystrophy or dyslipidemia.


Condition Intervention
Cardiovascular Diseases
Heart Diseases
HIV Infections
Hyperlipidemia
Hypertriglyceridemia
Insulin Resistance
Atherosclerosis
Behavioral: Diet
Behavioral: Exercise
Drug: Niacin
Drug: Fenofibrate
Other: Placebos

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator)
Primary Purpose: Treatment
Official Title: Diet/Exercise, Niacin, Fenofibrate for HIV Lipodystrophy

Resource links provided by NLM:


Further study details as provided by National Heart, Lung, and Blood Institute (NHLBI):

Primary Outcome Measures:
  • Fasting serum triglyceride level [ Time Frame: Measured at 24 hours ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Insulin sensitivity [ Time Frame: Measured at 24 hours ] [ Designated as safety issue: No ]
  • Body composition [ Time Frame: Measured at 24 hours ] [ Designated as safety issue: No ]
  • Lipoprotein fractions [ Time Frame: Measured at 4 days ] [ Designated as safety issue: No ]

Enrollment: 221
Study Start Date: January 2004
Study Completion Date: February 2012
Primary Completion Date: September 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Placebo Comparator: 1
Subjects receive lifestyle advice and placebos for Niaspan and Tricor
Other: Placebos
Placebos for Niaspan and Tricor
Experimental: 2
Diet, exercise, and two placebos
Behavioral: Diet
ATP-III diet
Behavioral: Exercise
Supervised exercise in study gym
Other: Placebos
Placebos for Niaspan and Tricor
Experimental: 3
Diet, exercise, Niaspan, and placebo
Behavioral: Diet
ATP-III diet
Behavioral: Exercise
Supervised exercise in study gym
Drug: Niacin
Niaspan, titrated up to 2 grams per day
Other: Placebos
Placebos for Niaspan and Tricor
Experimental: 4
Diet, exercise, placebo, and Tricor
Behavioral: Diet
ATP-III diet
Behavioral: Exercise
Supervised exercise in study gym
Drug: Fenofibrate
Tricor, 120 mg per day
Other: Placebos
Placebos for Niaspan and Tricor
Experimental: 5
Diet, exercise, Niaspan, and Tricor
Behavioral: Diet
ATP-III diet
Behavioral: Exercise
Supervised exercise in study gym
Drug: Niacin
Niaspan, titrated up to 2 grams per day
Drug: Fenofibrate
Tricor, 120 mg per day

Detailed Description:

BACKGROUND:

HIV lipodystrophy syndrome is associated with both metabolic (e.g., dyslipidemia and insulin resistance) and anthropomorphic (e.g., lipoatrophy and central obesity) abnormalities. These defects are likely to predispose HIV patients on highly active antiretroviral therapy (HAART) to accelerated cardiovascular morbidity. Based on studies of key mechanisms of altered lipid kinetics in these patients, evidence that DE patterns of patients with HIV lipodystrophy are inadequate to manage cardiovascular risk factors, and current recommendations for treatment of atherosclerosis and insulin resistance, the following is hypothesized: 1) an intensive lifestyle intervention with DE will improve the plasma lipid profile, decrease visceral fat mass, and improve hormonal, metabolic, and lipoprotein markers associated with insulin resistance; and 2) adding niacin, fenofibrate, or a combination of the two drugs to the intensive lifestyle intervention will result in further improvement in the cardiovascular risk profile.

DESIGN NARRATIVE:

This randomized, placebo-controlled study of 200 hypertriglyceridemic HIV patients on stable HAART treatment has the following specific aims: 1) to compare the effects of usual care, intensive DE, DE plus niacin, DE plus fenofibrate, and DE plus niacin plus fenofibrate on fasting plasma lipid concentrations (primary endpoint); 2) to compare the effects of the five treatment protocols on body fat distribution; and 3) to compare the effects of the five treatment protocols on hormonal, lipoprotein, and metabolic markers of insulin resistance. The collaborative team has expertise in lipid and lipoprotein metabolism, innovative and effective diet modification programs, intensive exercise programs in HIV patients, and studies of antilipidemic and antiretroviral agents. Therefore, this study will determine the efficacy of DE, with and without niacin and fenofibrate, in reducing the cardiovascular risk of patients with HIV lipodystrophy or dyslipidemia.

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • HIV positive
  • On stable HAART regimen for at least 6 months prior to study entry
  • T-cell count greater than 100 and viral load less than 1,000 for at least 6 months prior to study entry
  • Fasting triglyceride level greater than 150 mg/dl
  • Body mass index (BMI) greater than 18.5 and less than 30
  • Uses barrier contraception

Exclusion Criteria:

  • Fasting triglyceride level greater than 1000 mg/dl
  • BMI less than 18.5 or greater than 30
  • Taking diabetic medication or HbA1c less than 7.0
  • Use of lipid lowering medication in the 30 days prior to study entry
  • Unable to exercise
  • T-cell count less than 100
  • Current medical condition that makes exercise unadvisable
  • History of coronary artery disease (CAD)
  • Use of dietary supplements (within 30 days of study entry) that may affect lipid levels including, but not limited to, the following:

    1. Omega-3 fatty acids
    2. L-Carnitine
    3. Soluble fiber supplements
    4. Guggul
    5. Garlic supplements
    6. Niacin greater than 25mg/d
    7. Oral liquid supplements
  • Use of steroids, hormones, or testosterone (without diagnosis of hypogonadism, testosterone less than 300 ng/dl)
  • Irregular periods
  • Depo-Provera
  • Hypo- or Hyperthyroidism
  • Adrenal insufficiency
  • Serum alanine or aspartate aminotransferase level greater than 3 times the upper limit of normal
  • Alcohol abuse
  • Renal insufficiency (creatinine level greater than 1.5 mg/dl)
  • Coumadin therapy
  • Pregnancy
  • Peptic ulcer disease
  • Cholelithiasis
  • History of hyperuricemia
  • History of myositis or rhabdomyolysis
  • Known adverse reaction to niacin or fibrates
  • Hepatitis C therapy
  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: NCT00246376

Locations
United States, Texas
Baylor College of Medicine
Houston, Texas, United States, 77098
Sponsors and Collaborators
Legacy Community Health Center
Investigators
Principal Investigator: Ashok Balasubramanyam, MD Baylor College of Medicine
  More Information

Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Ashok Balasubramanyam, Principal Investigator, National Heart, Lung, and Blood Institute (NHLBI)
ClinicalTrials.gov Identifier: NCT00246376     History of Changes
Other Study ID Numbers: 340, R01 HL73696
Study First Received: October 27, 2005
Last Updated: April 25, 2012
Health Authority: United States: Federal Government

Additional relevant MeSH terms:
Acquired Immunodeficiency Syndrome
Arteriosclerosis
Atherosclerosis
Cardiovascular Diseases
Heart Diseases
HIV Infections
Hyperlipidemias
Hypertriglyceridemia
Insulin Resistance
Lipodystrophy
Arterial Occlusive Diseases
Dyslipidemias
Glucose Metabolism Disorders
Hyperinsulinism
Immune System Diseases
Immunologic Deficiency Syndromes
Lentivirus Infections
Lipid Metabolism Disorders
Metabolic Diseases
Retroviridae Infections
RNA Virus Infections
Sexually Transmitted Diseases
Sexually Transmitted Diseases, Viral
Skin Diseases
Skin Diseases, Metabolic
Slow Virus Diseases
Vascular Diseases
Virus Diseases
Fenofibrate
Niacin

ClinicalTrials.gov processed this record on October 23, 2014