Brief Title
Effectiveness of Nucleoside Supplementation or Switch to Tenofovir in Reversing Fat Loss in HIV Infected Adults
Official Title
Reversibility of Mitochondrial Toxicity in HIV Lipoatrophy
Brief Summary
HIV lipoatrophy is a condition marked by fat loss; it occurs in many patients taking antiretroviral (ARV) therapy that includes nucleoside reverse transcriptase inhibitors (NRTIs). Lipoatrophy may be related to mitochondrial toxicity, a condition that can damage the heart, nerves, muscles, kidneys, and liver, and can affect the body's ability to produce energy. NucleomaxX is a food supplement consisting of a sugar cane extract high in nucleosides, which are building blocks that may counteract the negative effects of NRTIs. Tenofovir disoproxil fumarate (TDF) is an NRTI that may cause less lipoatrophy than other drugs in its class, such as zidovudine (ZDV) or stavudine (d4T). The purpose of this study is to determine whether nucleoside supplementation with NucleomaxX and substitution of TDF for ZDV or d4T in an ARV regimen can reverse fat loss caused by mitochondrial toxicity in HIV infected adults. Study hypotheses: 1) The substitution of TDF for d4T or ZDV in patients with HIV lipoatrophy will result in an increase in mitochondrial DNA content in fat, skeletal muscle, and peripheral blood mononuclear cells (PBMCs), which in turn will lead to an improvement in mitochondrial function as assessed by electron transport chain (ETC) and oxidative phosphorylation pathway (OXPHOS) activity. The latter should lead to a decrease in fat apoptosis and in mitochondrial and lipid oxidative damage biomarkers. 2) Supplementation with uridine (via NucleomaxX) will increase mtDNA content in adipose tissue and increase body fat content.
Detailed Description
NRTIs are an important part of many ARV regimens used to treat HIV infected patients; however, the relationship between NRTI-induced mitochondrial dysfunction and lipoatrophy is still unclear and requires additional research. Additionally, the relationship between the gain in dual-energy x-ray absorptiometry (DEXA)-measured limb fat and mitochondrial DNA (mtDNA) content, mitochondrial function, fat apoptosis, and oxidative damage will also be examined in this study. Patients will participate in this study for 48 weeks. Participants will be randomly assigned to one of two groups. Group 1 patients will receive NucleomaxX every other day. Group 2 patients will substitute TDF for ZDV or d4T every day in their current stable NRTI-containing ARV regimen. NucleomaxX will be provided to Group 1 patients, but TDF or any other ARV will not be provided by this study. There will be 10 study visits, which will occur at study entry and Weeks 2, 4, 8, 12, 18, 24, 30, 36, and 48. Blood collection will occur at all visits. Additionally, urine collection, DEXA scans, and fat biopsies will be done at study entry and Weeks 24 and 48.
Study Phase
Phase 2
Study Type
Interventional
Primary Outcome
Change in Fat mtDNA Content
Secondary Outcome
Change in Limb Fat
Condition
HIV Infections
Intervention
NucleomaxX
Study Arms / Comparison Groups
uridine supplementation
Description: NucleomaxX 36 grams TID every other day
Publications
* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.
Recruitment Information
Recruitment Status
Drug
Estimated Enrollment
50
Start Date
April 2005
Completion Date
October 2008
Primary Completion Date
October 2008
Eligibility Criteria
Inclusion Criteria: - Diagnosis of HIV lipoatrophy - Receiving a stable stavudine- or zidovudine-containing ARV regimen - HIV-1 RNA viral load less than 50 copies/ml Exclusion Criteria: - Coagulopathies or other bleeding disorders - Diabetes requiring medication - Creatinine clearance less than 50 ml/min - Pregnancy or breastfeeding
Gender
All
Ages
18 Years - N/A
Accepts Healthy Volunteers
No
Contacts
Grace A. McComsey, MD, ,
Location Countries
United States
Location Countries
United States
Administrative Informations
NCT ID
NCT00119379
Organization ID
1R01AI060484-01A2B
Secondary IDs
R01AI060484
Responsible Party
Principal Investigator
Study Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Study Sponsor
Grace A. McComsey, MD, Principal Investigator, Case Western Reserve University
Verification Date
May 2017