The Effects of Anti-HIV Drugs in HIV-Infected Patients Who Do Not Have AIDS
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)
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.
調査の概要
詳細な説明
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.
研究の種類
入学
段階
- 適用できない
連絡先と場所
研究場所
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California
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Palo Alto、California、アメリカ、94304
- Palo Alto Veterans Affairs Health Care System
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San Francisco、California、アメリカ、94115
- Kaiser Permanente Med Ctr
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San Francisco、California、アメリカ、94115
- Mount Zion Med Ctr / UCSF
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Illinois
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Chicago、Illinois、アメリカ、60612
- Univ of Illinois
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Maryland
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Baltimore、Maryland、アメリカ、21201
- Univ of Maryland at Baltimore
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New York
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Stony Brook、New York、アメリカ、117948153
- SUNY / Health Sciences Ctr at Stony Brook
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North Carolina
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Durham、North Carolina、アメリカ、27710
- Duke Univ Med Ctr
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Pennsylvania
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Pittsburgh、Pennsylvania、アメリカ、15261
- Univ of Pittsburgh
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
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).
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
協力者と研究者
捜査官
- スタディチェア:M Niu
- スタディチェア:J Cohn
出版物と役立つリンク
一般刊行物
- Cohen OJ, Pantaleo G, Graziosi C, Niu M, Fauci AS. Effect of antiretroviral therapy on HIV burden and replication in lymphoid tissue. DATRI 003 Study Group. Int Conf AIDS. 1994 Aug 7-12;10(1):7 (abstract no 001B)
研究記録日
主要日程の研究
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
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