Effects of Anti-HIV Therapy on Nervous System Function
- Conditions
- HIV Infections
- Registration Number
- NCT00432003
- Brief Summary
The purpose of this study is to observe the way two different anti-HIV treatment strategies affect nerve and brain function in adults with HIV.
- Detailed Description
AIDS dementia complex (ADC) is a condition characterized by cognitive impairment, psychomotor slowing, and behavioral change. A milder form of ADC, called HIV minor cognitive/motor disorder (MCMD), is characterized by similar symptoms but has less of an impact on daily functioning. The neurocognitive impairment that results from ADC and MCMD carries an increased risk of poor drug adherence, morbidity, and mortality. It is unclear if highly active antiretroviral therapy (HAART) is effective in preserving neurocognitive function or in preventing or treating neurocognitive impairment. Distal symmetric sensory polyneuropathy (DSPN) and nucleoside-related neuropathy are two other serious conditions that HIV patients are at high risk for. DSPN is thought to be caused by active HIV infection; nucleoside-related neuropathy is thought to be caused by mitochondrial toxicity related to the use of certain antiretrovirals. These 2 conditions may lead to severe pain and discomfort in the feet. It is unknown what connection, if any, there is between DSPN and nucleoside-related neuropathy and the use of HAART. More data are needed on the natural history of these conditions.
This trial is a substudy of a study of management of antiretroviral therapy (SMART). In the SMART study, patients will participate in one of two strategies: a drug conservation (DC) strategy and a viral suppression (VS) strategy. Participants in the DC group will stop or defer HAART, then receive episodic HAART treatment for the minimum time needed to maintain a CD4 cell count of at least 250 cells/mm3. Participants in the VS group will receive HAART to maintain a viral load as low as possible, regardless of CD4 count. The purpose of this study is to compare changes in neurocognitive functioning and peripheral neuropathy symptoms between the 2 strategies of the SMART study.
Patients will participate in this substudy and the main SMART study at the same time. Within 45 days prior to randomization into the main SMART study, participants will have baseline data collected for this substudy. This data will include peripheral neuropathy assessments, treatments for symptoms of peripheral neuropathy. At selected study sites, additional measures will assess neurocognitive function, depression, alcohol and drug use, and education. At 6 months, 12 months, and every 12 months thereafter, peripheral neuropathy symptoms and treatment for the symptoms will be assessed; a pain questionnaire will also be completed. Participants will be followed until the SMART study ends.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 297
- Coenrollment in the SMART study
- Unable to comply with all study requirements
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method time to development of symptomatic peripheral neuropathy Change in QNPZ-5 scores change in peripheral neuropathy symptoms
- Secondary Outcome Measures
Name Time Method time to development of ADC, stage 2 or greater time to development of asymptomatic or symptomatic peripheral neuropathy time to resolution of symptomatic peripheral neuropathy chage in peripheral neuropathy symptoms Time to neurocognitive impairment
Trial Locations
- Locations (45)
Castro-Mission Health Ctr. CRS
🇺🇸San Francisco, California, United States
Kaiser Permanente of Denver CRS
🇺🇸Denver, Colorado, United States
Univ. of Colorado Health Science Ctr. CRS
🇺🇸Denver, Colorado, United States
Denver Public Health CRS
🇺🇸Denver, Colorado, United States
Eastside Family Health Ctr. CRS
🇺🇸Denver, Colorado, United States
Western Infectious Disease Consultants CRS
🇺🇸Wheat Ridge, Colorado, United States
Washington DC VAMC, Washington Regional AIDS Program, Infectious Diseases CRS
🇺🇸Washington, District of Columbia, United States
Univ. of Florida, Div. of Infectious Diseases CRS
🇺🇸Jacksonville, Florida, United States
Earl K. Long Med. Ctr., LSU - Mid City EIC Clinic CRS
🇺🇸Baton Rouge, Louisiana, United States
Wayne State Univ. CRS
🇺🇸Detroit, Michigan, United States
Scroll for more (35 remaining)Castro-Mission Health Ctr. CRS🇺🇸San Francisco, California, United States