A Study to See if Certain Antioxidants and Vitamins Will Keep Lactate Levels Down in Patients Taking Anti-HIV Drugs - Full Text View

Sponsored by:	National Institute of Allergy and Infectious Diseases (NIAID)
Information provided by:	National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier:	NCT00037063

Purpose

The purpose of this study is to see if certain vitamins (C, E, B1, and B2) can keep lactate levels from becoming too high in patients who are taking nucleoside reverse transcriptase inhibitor (NRTI) anti-HIV drugs.

Some patients taking anti-HIV drugs develop hyperlactatemia. Hyperlactatemia is a condition in which lactate (a natural substance normally present in the body) levels are too high. Too much lactate in the body can lead to serious health problems. When patients suffer from hyperlactatemia while taking anti-HIV drugs, most doctors temporarily stop the drugs. Patients then restart the anti-HIV drugs when their lactate levels return to normal. If patients restart the same drugs they were taking when they developed hyperlactatemia, there is a risk that they may develop high lactate levels again. This study wants to find out if taking antioxidants (substances that reduce tissue damage due to oxygen radicals) and certain B vitamins may help prevent patients from developing hyperlactatemia when they restart the same anti-HIV drugs.

Condition	Intervention
HIV Infections	Drug: Thiamine hydrochloride Drug: Riboflavin Drug: Ascorbic acid Drug: Vitamin E

MedlinePlus related topics: AIDS AIDS Medicines Antioxidants

Drug Information available for: Vitamin E alpha-Tocopherol alpha-Tocopheryl acetate Tocopherols Lactic acid Ammonium lactate Riboflavin Thiamine 3-((4-Amino-2-methyl-5-pyrimidinyl)methyl)-5-(2-hydroxyethyl)-4-m- ethylthiazolium chloride, monohydrochloride Ascorbic acid

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Prevention, Efficacy Study
Official Title:	A Pilot Study of the Efficacy of a Combination of Antioxidants and B Vitamins in Preventing the Recurrence of Hyperlactatemia in Subjects Who Have Limited Antiretroviral Options

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

Estimated Enrollment:

19

Detailed Description:

Hyperlactatemia is a serious complication of NRTI treatment for HIV. Most physicians temporarily discontinue antiretroviral therapy in patients with serious hyperlactatemia, then restart antiretrovirals after lactate levels normalize. Two options for restarting antiretrovirals are to switch to different NRTIs or switch to an NRTI-sparing regimen. The latter option is probably safer, but a growing number of the HIV-infected population has already been exposed to all available classes of antiretrovirals and may lack this option. This study will investigate the ability of antioxidants and B vitamins to prevent the recurrence of hyperlactatemia in patients who restart the same NRTI-containing regimen.

Patients have 2 clinic visits (screening and pre-entry) prior to entry into the study. Prior to these visits, patients must fast and refrain from exercise for at least 8 hours. At the screening visit, blood is drawn for a lactate level. Women of reproductive potential have a pregnancy test. At the pre-entry visit, blood is drawn for a second lactate level.

Within 30 days of the screening visit, patients return to the clinic to enter the study. Patients should not eat or drink, except medications and water, for at least 8 hours prior to this visit. Upon study entry, the following are performed: a physical exam; blood draw for routine lab tests, HIV viral load, CD4 count, and repeat lactate; urinalysis; and a pregnancy test. All patients receive the following regimen through Week 48: vitamins C, E, B1, and B2. One week after starting the vitamin regimen, patients are restarted on the same antiretroviral regimen that they were receiving at the time of hyperlactatemia. Within 30 days of study entry, the patients should be on the exact same doses of antiretrovirals that they were receiving at the time of hyperlactatemia, taking into account any necessary dose escalations. Evaluations are performed at Weeks 2, 4, 6, and 8 and every 4 weeks thereafter until Week 24. After Week 24, evaluations are then performed at 8-week intervals through Week 48. Antiretrovirals are not supplied by the study.

Eligibility

Ages Eligible for Study:	13 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria

Patients may be eligible for this study if they:

Are at least 13 years old.
Are HIV infected.
Agree not to become pregnant or to impregnate during the study. The study volunteer/partner must use acceptable methods of contraception while receiving the study drugs and for 1 month after stopping the study drugs. Men and women who cannot have children do not need to use contraception.
Have had their first episode of serious hyperlactatemia (including lactic acidosis) within 180 days prior to study entry. Serious hyperlactatemia must have led to discontinuation of all anti-HIV drugs.
Have limited anti-HIV drug choices because of prior intolerance to anti-HIV drugs or virologic failure.
Are willing and able to restart the same anti-HIV regimen that led to the episode of serious hyperlactatemia.
Have complete resolution or return to baseline of all the signs and symptoms thought to be related to the episode of hyperlactatemia.

Exclusion Criteria

Patients may not be eligible for this study if they:

Were on an abacavir-containing regimen for less than 6 weeks at the time of the hyperlactatemia episode or had a fever or rash during the episode of hyperlactatemia, regardless of the length of time on abacavir.
Are pregnant or breast-feeding.
Have any medical condition or drug use that could have, by itself, resulted in hyperlactatemia.
Were diagnosed with pancreatitis at the time of the hyperlactatemia episode.
Are allergic/sensitive to vitamin C, E, B1, and/or B2.
Use systemic cytotoxic chemotherapy.
Actively use or are dependent on alcohol or drugs in a way that would affect the protocol.
Had a short but intense illness within 30 days before entry that would interfere with participation in the study.
Require or are unwilling to discontinue certain drugs.
Have any condition that would affect their ability to participate in the study.
Are taking vitamin supplements that include more that 200 percent of the Recommended Daily Allowance (RDA) of any of the study drugs and are unwilling to stop taking the supplements or substitute them with supplements that contain 200 percent or less than the RDA of the study drugs.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00037063

Locations

United States, Colorado
Univ of Colorado Health Sciences Ctr
Denver, Colorado, United States, 80262
United States, Ohio
Case Western Reserve Univ
Cleveland, Ohio, United States, 44106
MetroHealth Med Ctr
Cleveland, Ohio, United States, 441091998
United States, Pennsylvania
Univ of Pennsylvania, Philadelphia
Philadelphia, Pennsylvania, United States, 19104

Sponsors and Collaborators

National Institute of Allergy and Infectious Diseases (NIAID)

Investigators

Study Chair:

Grace McComsey

More Information

Haga clic aquí para ver información sobre este ensayo clínico en español. This link exits the ClinicalTrials.gov site

Publications:

Brinkman K, Vrouenraets S, Kauffmann R, Weigel H, Frissen J. Treatment of nucleoside reverse transcriptase inhibitor-induced lactic acidosis. AIDS. 2000 Dec 1;14(17):2801-2. No abstract available.

Brinkman K, Smeitink JA, Romijn JA, Reiss P. Mitochondrial toxicity induced by nucleoside-analogue reverse-transcriptase inhibitors is a key factor in the pathogenesis of antiretroviral-therapy-related lipodystrophy. Lancet. 1999 Sep 25;354(9184):1112-5. Review.

Brinkman K, Kakuda TN. Mitochondrial toxicity of nucleoside analogue reverse transcriptase inhibitors: a looming obstacle for long-term antiretroviral therapy? Curr Opin Infect Dis. 2000 Feb;13(1):5-11.

Study ID Numbers:	ACTG A5145, AACTG A5145
Study First Received:	May 14, 2002
Last Updated:	August 19, 2008
ClinicalTrials.gov Identifier:	NCT00037063
Health Authority:	United States: Federal Government

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

Pilot Projects
Recurrence
Antioxidants
Reverse Transcriptase Inhibitors
Anti-HIV Agents

Ascorbic Acid
Alpha-Tocopherol
Riboflavin
Thiamine
Lactic Acid

Study placed in the following topic categories:

Sexually Transmitted Diseases, Viral
Tocopherol acetate
Acquired Immunodeficiency Syndrome
Thiamine
Recurrence
Immunologic Deficiency Syndromes
Alpha-Tocopherol
Virus Diseases

Tocopherols
Vitamin E
Riboflavin
HIV Infections
Sexually Transmitted Diseases
Retroviridae Infections
Ascorbic Acid

Additional relevant MeSH terms:

RNA Virus Infections
Vitamin B Complex
Slow Virus Diseases
Antioxidants
Immune System Diseases
Molecular Mechanisms of Pharmacological Action
Growth Substances
Physiological Effects of Drugs
Infection

Protective Agents
Pharmacologic Actions
Photosensitizing Agents
Radiation-Sensitizing Agents
Therapeutic Uses
Vitamins
Lentivirus Infections
Micronutrients
Dermatologic Agents

ClinicalTrials.gov processed this record on January 16, 2009