HIV Infection Clinical Trial
Official title:
Effect of Folic Acid on Homocysteine Levels and Flow-mediated Dilation in HIV and HIV-HCV Coinfected Patients: a Randomized Controlled Trial
Patients infected by HIV or HIV-HCV coinfected have higher survival due to the use of HAART,
but survival is accompanied by increased morbidity and associated cardiovascular disease
(CVD). Endothelial dysfunction is an early marker of atherogenesis, acting as an
intermediate in the causal pathway of CVD. Folinic acid (FA) has been shown to reduce CVD
outcomes, especially among individuals with hyperhomocisteinemia.
To date, few studies provided consistent information about efficacy of pharmacological
interventions that minimize damage to the vascular endothelium in patients infected by HIV
or HIV-HCV coinfected. The main hypothesis of this study is that FA supplementation protects
the vascular endothelium, and consequently might prevent subclinical atherosclerosis. Thus,
the first step is to determine the efficacy of supplementation with FA, and to compare the
effect between HIV and HIV-HCV coinfected.
Study design: This was a randomized placebo-controlled trial, with blinding of health care
team, participants, and investigators, in which the participants were randomly assigned in a
1:1 ratio to receive FA or placebo for four weeks.
Participants: Patients receiving care for HIV, at the outpatient clinic of the Hospital
Universitario de Santa Maria, in southern Brazil, from October 2012 to September 2013, were
recruited. Eligible participants: HIV infected or HIV-HCV coinfected patients, 18-50 years,
men and women, receiving HAART, had undetectable viral load for more than six months.
Patients were excluded: patients with diabetes mellitus, previous acute myocardial
infarction, myocardial revascularization, or stroke, creatinine >1.5 mg/dL, clinical
diagnosis or ultrasound, endoscopic, or laboratory evidence of liver cirrhosis, on treatment
with statins, fibrates, hormone replacement therapy, sulfonamides, vitamin supplements, or
FA in the last 30 days, and pregnant women.
Intervention Patients assigned to the intervention group received FA 5 mg, per oral, once a
day, in the morning, during four weeks. Patients assigned to the placebo group received the
same prescription. The trial provided FA and placebo in tablet form, identical in color,
smell, taste, shape, and size. Both FA and placebo were prepared in a single batch, in an
independent laboratory, by a pharmacist with no involvement in the trial. They were
pre-packed in bottles containing 30 tablets each, individually labeled with an alphanumeric
code and stored.
Outcomes The primary endpoint were changes in homocysteine, vitamin B12 levels, and brachial
artery FMD during reactive hyperemia, as measured by Doppler ultrasound, from randomization
to the end of follow-up. FMD was characterized by the variation in mean arterial flow
measured as the peak change in vessel diameters relative to the baseline.
Sample size Sample size was calculated based on the results of a previous RCT,(14) which
used plethysmography to measure FMD. To detect a difference of at least 6% between
intervention and placebo groups, with standard deviations ranging from 5% to 7%, we
calculated that a sample size of at least 17 patients per group, with randomization
stratified by HCV coinfection status, was required to achieve 80% power and a 95% confidence
interval.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator, Outcomes Assessor), Primary Purpose: Prevention
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