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)
Zidovudine
+ Didanosine
Blood-Borne Infections+13
+ Urogenital Diseases
+ Genital Diseases
Treatment Study
Summary
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.
Protocol
This section provides details of the study plan, including how the study is designed and what the study is measuring.32 patients to be enrolled
Total number of participants that the clinical trial aims to recruit.Treatment Study
Eligibility
Researchers look for people who fit a certain description, called eligibility criteria: person's general health condition or prior treatments.Any sex
Biological sex of participants that are eligible to enroll.Over 18 Years
Range of ages for which participants are eligible to join.Healthy volunteers not allowed
If individuals who are healthy and do not have the condition being studied can participate.Conditions
Pathology
Criteria
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).
Study Centers
These are the hospitals, clinics, or research facilities where the trial is being conducted. You can find the location closest to you and its status.This study has 8 locations
Palo Alto Veterans Affairs Health Care System
Palo Alto, United StatesOpen Palo Alto Veterans Affairs Health Care System in Google MapsKaiser Permanente Med Ctr
San Francisco, United StatesMount Zion Med Ctr / UCSF
San Francisco, United StatesUniv of Illinois
Chicago, United States