Therapeutic Approaches to HAART-Induced Lipodystrophy
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
Purpose
To determine the efficacy and safety of 4 therapeutic interventions on HAART-Induced lipodystrophy. The interventions are: 1) Dietary - the effect of a high carbohydrate vs.a high cis-monounsaturated fatty acid diet. 2) The effect of aerobic exercise with dietary advice. 3) The effect of Omega-3 Fish Oil Capsules. 4) The effect of leptin therapy. These interventions are aimed at improving the metabolic complications of HAART therapy such as elevated lipids, and insulin resistance or diabetes.
| Condition | Intervention | Phase |
|---|---|---|
|
HIV Infections Lipodystrophy |
Drug: Metreleptin (Leptin) |
Phase 2 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Single Group Assignment Masking: Double Blind (Subject, Caregiver, Investigator) Primary Purpose: Treatment |
| Official Title: | Therapeutic Approaches to HAART-Induced Lipodystrophy |
- fasting serum triglycerides [ Time Frame: 6 months ] [ Designated as safety issue: No ]
- HDL cholesterol [ Time Frame: 6 months ] [ Designated as safety issue: No ]
- LDL cholesterol [ Time Frame: 6 months ] [ Designated as safety issue: No ]
- fasting serum glucose [ Time Frame: 6 months ] [ Designated as safety issue: No ]
- fasting serum insulin [ Time Frame: 6 months ] [ Designated as safety issue: No ]
- overall and regional adiposity [ Time Frame: 6 months ] [ Designated as safety issue: No ]
| Estimated Enrollment: | 130 |
| Study Start Date: | January 2003 |
| Estimated Study Completion Date: | September 2014 |
| Estimated Primary Completion Date: | September 2013 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Active Comparator: Leptin ( still recruiting)
Leptin weight and gender based dose, sub-cutaneous, twice daily. Leptin versus placebo for entire 6 months double-blind.
|
Drug: Metreleptin (Leptin)
weight based, sub-cutaneous injection, twice daily
|
|
Placebo Comparator: Leptin Placebo
Placebo for Leptin, sub-Q injection twice daily.
|
Drug: Metreleptin (Leptin)
weight based, sub-cutaneous injection, twice daily
|
Detailed Description:
Patients with HAART-induced lipodystrophy report loss of subcutaneous (sc) fat from the extremities and face and excess fat accumulation in the neck and truncal region. They also are predisposed to metabolic complications of insulin resistance, such as, dyslipidemia and diabetes mellitus. The pathogenesis of HAART-induced lipodystrophy is not fully understood although PIs have been strongly implicated as the cause. The metabolic complications pose an increased risk of atherosclerosis and acute pancreatitis whereas changes in body fat distribution cause physical discomfort and psychological distress. Management of these problems poses a therapeutic challenge. We propose potentially safe therapeutic lifestyle changes as well as novel therapies for management of HAART-induced lipodystrophy and its metabolic complications. The hypotheses to be tested and the aims are:
Hypothesis 1: A diet rich in cis-monounsaturated fatty acids improves HAART-induced glucose intolerance and dyslipidemia in HIV-infected patients.
Aim 1: To compare acceptability and effects of isocaloric diets rich in carbohydrates and cis-monounsaturated fats, each given for 6 wk, on glucose and lipid metabolism in patients with HAART-induced dyslipidemia in a randomized, cross-over study.
Hypothesis 2: A regimen of aerobic exercise improves insulin resistance, dyslipidemia and body fat distribution in HIV-infected patients with HAART-induced lipodystrophy.
Aim 2: To determine the effects of a supervised aerobic exercise regimen and dietary advice on glucose and lipid metabolism, and body fat distribution in HIV-infected patients with HAART-induced lipodystrophy.
Hypothesis 3: The n-3 polyunsaturated fats improve HAART-induced dyslipidemia in HIV-infected patients.
Aim 3: To determine the lipid-lowering effects of n-3 polyunsaturated fats in a randomized, double-blind, placebo-controlled, crossover trial in HIV-infected patients with HAART-induced dyslipidemia.
Hypothesis 4: Leptin replacement improves insulin resistance, dyslipidemia and body fat distribution in patients with HAART-induced lipodystrophy and hypoleptinemia.
Aim 4 To study efficacy and safety of recombinant methionyl leptin (r-metHuleptin) in improving insulin sensitivity, dyslipidemia and body fat distribution in patients with HAART-induced lipodystrophy and hypoleptinemia using a randomized, double-blind, placebo-controlled, parallel design.
Results from these studies may help in designing therapeutic approaches to HAART-induced lipodystrophy and its metabolic complications as well as for prevention of these problems in HIV-infected patients being placed on HAART.
Eligibility| Ages Eligible for Study: | 14 Years to 65 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria - General inclusion:
- Age > 14 years
- HIV infection being treated with HIV-1 protease inhibitors for >6 months currently, or previous protease inhibitor therapy of at least 2 years duration with development of lipodystrophy and current stable therapy preferably for past 4 months.
- Fasting serum triglycerides > 200 mg/dL
Exclusion Criteria - General exclusion:
- Acute, ongoing AIDS-defining opportunistic infections.
- Blood CD4 positive lymphocyte count < 200/mm3
- Known liver disease due to causes other than nonalcoholic steatohepatitis with elevation of liver transaminases by more than two and a half times above the upper limits of normal (SGOT>105 U/L, SGPT>120 U/L) or total bilirubin (>1.5 mg/dL).
- Hematocrit of less than 30%.
- Current alcohol abuse (>7 drinks or 210 g per wk for women and >14 drinks or 420 g per wk for men).
- Current substance abuse.
- Uncontrolled diabetes mellitus with fasting plasma glucose > 180 mg/dL or hemoglobin A1c > 9%.
- History of weight loss during the last 3 months.
- Use of anorexiogenic drugs, thiazolidinediones, anabolic steroids and human growth hormone.
- Major Neuro-psychiatric illnesses impeding competence or compliance.
- Pregnant and lactating women.
- Cancer excluding skin cancer other than melanoma.
- Acute medical illnesses precluding participation in the studies.
- Chronic renal insufficiency with serum creatinine > 2 mg/dL.
- Untreated thyroid disorders such as hypothyroidism and hyperthyroidism. Each of the 4 treatment arms has additional specific inclusion and exclusion criteria
Contacts and Locations| Contact: Claudia Quittner, RN, BSN, MS | 214-648-9296 | claudia.quittner@utsouthwestern.edu |
| Contact: Zahid Ahmad, M.D. | 214-648-2377 | zahid.ahmad@utsouthwestern.edu |
| United States, Texas | |
| UT Southwestern Medical Center | Recruiting |
| Dallas, Texas, United States, 75390 | |
| Sub-Investigator: Vinaya Simha, M.D. | |
| Sub-Investigator: Zahid Ahmad, M.D. | |
| Principal Investigator: | Abhimanyu Garg, M.D. | Univeristy of Texas Southwestern Medical Center |
More Information
Additional Information:
No publications provided
| Responsible Party: | Abhimanyu Garg, Chairman, Division Nutrition and Metabolic Diseases, Professor Internal Medicine, University of Texas Southwestern Medical Center |
| ClinicalTrials.gov Identifier: | NCT00461552 History of Changes |
| Other Study ID Numbers: | 063656 |
| Study First Received: | April 16, 2007 |
| Last Updated: | June 12, 2012 |
| Health Authority: | United States: Food and Drug Administration |
Keywords provided by University of Texas Southwestern Medical Center:
|
Lipodystrophy HIV HAART HIV Lipodystrophy Syndrome |
Lipodystrophy syndrome HIV-Associated Lipodystrophy HIV-Associated Lipodystrophy Syndrome Treatment Experienced |
Additional relevant MeSH terms:
|
HIV Infections Acquired Immunodeficiency Syndrome Lipodystrophy 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 Skin Diseases, Metabolic Skin Diseases Lipid Metabolism Disorders Metabolic Diseases |
ClinicalTrials.gov processed this record on March 07, 2013
