Atorvastatin on Biomarkers of Inflammation, Coagulopathy, Angiogenesis & T-cells

NCT ID: NCT01351025

Last Updated: 2021-08-03

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 98 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2011-04-14
• Study Completion Date: 2014-05-31

Brief Summary

ACTG A5275 was a prospective, double-blind, randomized, placebo-controlled cross-over design pilot study evaluating the effect of atorvastatin on biomarkers of inflammation, coagulopathy, angiogenesis, and T-lymphocyte activation in HIV-1 infected individuals with suppressed HIV-1 RNA on stable protease inhibitor based antiretroviral therapy with fasting LDL cholesterol < 130 mg/dL.

Atorvastatin is a drug approved by the Food and Drug Administration (FDA) for treating high cholesterol. Atorvastatin has also been able to lower the level of inflammation blood tests in certain other diseases but has not been studied for this purpose in people who have HIV. The main goal of this experimental study is to see how taking atorvastatin affects inflammation blood tests in people infected with HIV who do not need to take medicine for high cholesterol. In addition to observing the effects of atorvastatin on the level of inflammation measured in the blood, this study evaluated if atorvastatin is safe for people with HIV who are also taking medication for HIV.

Detailed Description

Since people started taking HIV medications, illness from AIDS has decreased, but other serious diseases like heart disease (heart attacks) and certain kinds of cancer have increased. HIV causes inflammation (irritation) inside the body that cannot be felt but can be measured by levels of certain inflammation blood tests. Inflammation may contribute to diseases (such as heart attacks) that have become some of the leading causes of death in people with HIV. HIV therapy can partially lower levels of inflammation measured in blood, however, levels of inflammation in people who have HIV who are taking certain kinds of anti-HIV drugs may remain high compared with those found in people not infected with HIV.

Conditions

HIV-1 Infection

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: CROSSOVER
• Primary Study Purpose: TREATMENT
• Blinding Strategy: TRIPLE

Study Groups

Arm A: atorvastatin / placebo

At study entry (week 0), participants continued the entry boosted PI-based antiretroviral regimen (not provided by the study) and initiated atorvastatin at a daily dose of 10 mg for 4 weeks. If no symptoms or lab findings suggestive of atorvastatin toxicity were found, the dose of atorvastatin was increased to 20 mg daily at the week 4 visit. At week 20, atorvastatin was stopped for a 4-week washout period.

At week 24, placebo was started for 4 weeks. If no symptoms or lab findings suggestive of toxicity were found, the placebo dose was doubled at week 28. At week 44, the placebo was stopped to allow for another 4-week washout period.

Group Type: EXPERIMENTAL

atorvastatin

Intervention Type: DRUG

10 mg daily for 4 weeks, if no symptoms or lab findings suggestive of atorvastatin toxicity, dose increase to 20 mg daily from week 4- week 20

placebo for atorvastin

Intervention Type: DRUG

One tablet once daily for 4 weeks. If no symptoms or lab findings suggestive of toxicity were found, then increase the dose to two tablets once daily.

Arm B: placebo / atorvastatin

At study entry (week 0), participants continued the entry boosted PI-based antiretroviral regimen (not provided by the study) and initiated placebo for 4 weeks. If no symptoms or lab findings suggestive of toxicity were found, the dose of placebo was doubled at the week 4 visit. At week 20, the placebo was stopped for a 4-week washout period.

At week 24, atorvastatin was started at a daily dose of 10 mg for 4 weeks. If no symptoms or lab findings suggestive of atorvastatin toxicity were found, the dose of atorvastatin was increased to 20 mg daily at week 28. At week 44, atorvastatin was stopped to allow for another 4-week washout period.

Group Type: EXPERIMENTAL

atorvastatin

Intervention Type: DRUG

Starting at week 24, 10 mg daily for 4 weeks. If no symptoms or lab findings suggestive of atorvastatin toxicity were found, 20 mg daily from week 28- week 44.

placebo for atorvastin

Intervention Type: DRUG

One tablet once daily for 4 weeks. If no symptoms or lab findings suggestive of toxicity were found, then increase the dose to two tablets once daily.

Interventions

atorvastatin

10 mg daily for 4 weeks, if no symptoms or lab findings suggestive of atorvastatin toxicity, dose increase to 20 mg daily from week 4- week 20

Intervention Type: DRUG

atorvastatin

Starting at week 24, 10 mg daily for 4 weeks. If no symptoms or lab findings suggestive of atorvastatin toxicity were found, 20 mg daily from week 28- week 44.

Intervention Type: DRUG

placebo for atorvastin

One tablet once daily for 4 weeks. If no symptoms or lab findings suggestive of toxicity were found, then increase the dose to two tablets once daily.

Intervention Type: DRUG

Other Intervention Names

Lipitor; Lipitor; placebo

Eligibility Criteria

Inclusion Criteria

• HIV-1 infected
• Combination ART that includes any boosted PI regimen for at least 6 months prior to study entry
• No plans to change the antiretroviral regimen in the next year
• Must have been on the same HAART regimen for at least 12 weeks with no change prior to study entry. More information on this criterion can be found in the study protocol.
• If on vitamin D replacement therapy, must have been on stable regimen for ≥ 1 mo. prior to study entry.
• CD4+ T-cell count obtained within 45 days prior to study entry at any laboratory that has a Clinical Laboratory Improvement Amendments (CLIA) certification or its equivalent.
• Screening HIV-1 RNA < 40 copies/mL by Abbott RealTime PCR at a laboratory certified by the DAIDS Virology Quality Assurance (VQA) program within 45 days prior to study entry.
• All known HIV-1 RNA levels obtained within 180 days prior to study entry are below the limits of quantification on all tests, with documentation of at least 1 test by any FDA-approved assay at a CLIA-certified laboratory obtained between 90 to 180 days prior to study entry. A single RNA "blip" of < 500 copies/mL during this time period was permissible if RNA levels immediately before and after were below the limits of quantification for the assay.
• Laboratory values obtained within 45 days prior to study entry- Absolute neutrophil count (ANC) 750/mm3, Hemoglobin ≥ 9.0 g/dL for female subjects,10.0 g/dL for male subjects, Platelet count ≥ 100,000/mm3, Calculated creatinine clearance (CrCl) 30 mL/min, as estimated by the Cockcroft-Gault equation, Creatine kinase (CK) < 3 x ULN, AST ≤ 2.0 x ULN, ALT ≤ 2.0 x ULN, Total bilirubin ≤ 2.5 x ULN. If the subject was taking an indinavir- or atazanavir-containing regimen at the time of screening, a total bilirubin of ≤ 5 x ULN is acceptable, Fasting LDL cholesterol ≥ 70 mg/dL and < 130 mg/dL, Fasting triglycerides < 400 mg/dL, Fasting glucose < 110 mg/dL
• Screening plasma D-dimer > 0.34 μg/mL from a sample obtained within 45 days prior to study entry was the original D-dimer criterion. It was revised to ≥ 0.25 ug/mL four months after the first enrollment, and subsequently the D-dimer eligibility criterion was completely cut off a year later.
• For females of reproductive potential (women who had not been post-menopausal for at least 24 consecutive months, i.e., who had menses within 24 months prior to study entry), or women who had not undergone surgical sterilization, specifically hysterectomy or bilateral oophorectomy or tubal ligation) required a negative serum or urine pregnancy test within 48 hours prior to entry. More information on this criterion can be found in the study protocol.
• Must agree not to participate in the conception process (e.g., active attempt to become pregnant or to impregnate, sperm donation, in vitro fertilization), and if participating in sexual activity that could lead to pregnancy, the subject/partner must use at least 2 reliable methods of contraception, (condoms, without a spermicidal agent; a diaphragm or cervical cap without spermicide; an IUD; or hormone-based contraceptive), for 2 weeks before study treatment, while receiving study treatment, and for 6 weeks after receiving study treatment. As hormone-based contraceptives (oral, transdermal, or subdermal) can affect coagulopathy biomarkers, subjects who plan on using such a contraceptive during the study must be taking the same product for ≥ 4 weeks prior to screening and be encouraged to continue throughout the duration of the study if medically feasible.
• Karnofsky performance score ≥ 70 on at least one occasion within 45 days prior to study entry
• Confirmation of the availability of the stored pre-entry fasting plasma, serum, and cell samples. The site had to confirm that these samples had entered into the Laboratory Data Management System (LDMS).

Exclusion Criteria

• Current or past malignancy (except non-melanoma cancer of the skin)
• Coronary artery disease (CAD) or CAD equivalent including diabetes mellitus or National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) calculated 10-year coronary heart disease (CHD) risk of > 20%.
• Known cirrhosis.
• Known chronic active hepatitis B or C.
• Thyroid-stimulating hormone (TSH) < 1.0 x lower limit of normal or > 1.0 x ULN.
• Known inflammatory conditions, such as, but not limited to, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), sarcoidosis, inflammatory bowel disease (IBD), chronic pancreatitis, autoimmune hepatitis, myositis, or myopathy.
• Pregnant or breast-feeding.
• Previous intolerance to any statin or any of its components.
• Use of any lipid-lowering therapies including all statin drugs, Omega 3 fatty acids/fish oil, red yeast rice, and niacin products ≥ 1 g/day (e.g., niacin, nicotinic acid, vitamin B3) taken within 45 days prior to study entry. More information on this criterion can be found in the study protocol.
• Immunosuppressant use, such as, but not limited to, systemic or potentially systemic glucocorticoids (including nasal or inhaled steroids), azathioprine, tacrolimus, mycophenolate, sirolimus, rapamycin, or cyclosporine within 45 days prior to study entry.
• Use of any systemic antineoplastic or immunomodulatory treatment, investigational vaccines, interleukins, interferons, growth factors, or intravenous immunoglobulin (IVIG) within 45 days prior to study entry. More information on this criterion can be found in the study protocol.
• Concurrent use of prohibited medications. More information on this criterion can be found in the study protocol.
• Heavy alcohol use as defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (http://pubs.niaaa.nih.gov/publications/Practitioner/pocketguide/pocket_guide3.htm) and alcohol or drug use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements.
• Current use of anticoagulation therapy other than ≤ 325 mg of daily aspirin.
• Known coagulopathy, deep venous thrombosis, pulmonary embolism within 6 months prior to study entry.
• Known active or recent (not fully resolved within 4 weeks prior to study entry) bacterial, fungal, parasitic, or viral infections.
• Known history of recurrent rectal and/or genital herpes simplex virus (HSV) or varicella zoster virus (VZV) infection within 12 weeks prior to study entry.
• Serious illness or trauma requiring systemic treatment and/or hospitalization within 4 weeks prior to study entry.
• History of stroke.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Institute of Allergy and Infectious Diseases (NIAID)

NIH

Sponsor Role: collaborator

Pfizer

INDUSTRY

Sponsor Role: collaborator

Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections

NETWORK

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Judith A. Aberg, M.D.

Role: STUDY_CHAIR

NYU/Bellevue/HIV/AIDS CTU

Daniel E Nixon, D.O., Ph.D.

Role: STUDY_CHAIR

Virginia Commonwealth University Medical Center

Locations

31788 Alabama CRS

Birmingham, Alabama, United States

UCLA CARE Center CRS (601)

Los Angeles, California, United States

Ucsd, Avrc Crs (701)

San Diego, California, United States

Harbor-UCLA Med. Ctr. CRS (603)

Torrance, California, United States

University of Colorado Hospital CRS (6101)

Aurora, Colorado, United States

Georgetown University CRS (GU CRS) (1008)

Washington D.C., District of Columbia, United States

Northwestern University CRS (2701)

Chicago, Illinois, United States

Massachusetts General Hospital ACTG CRS (101)

Boston, Massachusetts, United States

Brigham and Women's Hosp. ACTG CRS (107)

Boston, Massachusetts, United States

Beth Israel Deaconess Med. Ctr., ACTG CRS (103)

Boston, Massachusetts, United States

Wayne State Univ. CRS (31478)

Detroit, Michigan, United States

Henry Ford Hosp. CRS (31472)

Detroit, Michigan, United States

Washington U CRS (2101)

St Louis, Missouri, United States

Cooper Univ. Hosp. CRS (31476)

Camden, New Jersey, United States

New Jersey Medical School-Adult Clinical Research Ctr. CRS (31486)

Newark, New Jersey, United States

Cornell CRS (7804)

New York, New York, United States

NY Univ. HIV/AIDS CRS (401)

New York, New York, United States

AIDS Care CRS (1101)

Rochester, New York, United States

University of Rochester Adult HIV Therapeutic Strategies Network CRS (31787)

Rochester, New York, United States

Unc Aids Crs (3201)

Chapel Hill, North Carolina, United States

Duke Univ. Med. Ctr. Adult CRS (1601)

Durham, North Carolina, United States

Univ. of Cincinnati CRS (2401)

Cincinnati, Ohio, United States

Case CRS (2501)

Cleveland, Ohio, United States

Metro Health CRS (2503)

Cleveland, Ohio, United States

The Ohio State Univ. AIDS CRS (2301)

Columbus, Ohio, United States

Hosp. of the Univ. of Pennsylvania CRS (6201)

Philadelphia, Pennsylvania, United States

Pitt CRS (1001)

Pittsburgh, Pennsylvania, United States

Houston AIDS Research Team CRS (31473)

Houston, Texas, United States

Virginia Commonwealth Univ. Medical Ctr. CRS (31475)

Richmond, Virginia, United States

University of Washington AIDS CRS (1401)

Seattle, Washington, United States

Puerto Rico-AIDS CRS (5401)

San Juan, , Puerto Rico

Countries

United States; Puerto Rico

References

Rahman F, Brates I, Aweeka F, Bosch RJ, Deitchman A, Nixon D, Aberg JA. Evaluating the effect of atorvastatin exposure and vitamin D levels on lipid outcomes in people with HIV-1 with suppressed HIV-1 RNA and LDL cholesterol <130 mg/dL. HIV Med. 2023 Jun;24(6):749-753. doi: 10.1111/hiv.13453. Epub 2022 Dec 22.

Reference Type: DERIVED

PMID: 36549898 (View on PubMed)

Other Identifiers

1U01AI068636

Identifier Type: NIH

Identifier Source: secondary_id

View Link

ACTG A5275

Identifier Type: -

Identifier Source: org_study_id