A Multicenter Placebo-Controlled Double-Blind Trial to Evaluate Azidothymidine (AZT) Treatment of the AIDS Dementia Complex and Central Nervous System (CNS) Human Immunodeficiency Virus (HIV) Infection

HIV Infections Clinical Trial

Official title:

A Multicenter Placebo-Controlled Double-Blind Trial to Evaluate Azidothymidine (AZT) Treatment of the AIDS Dementia Complex and Central Nervous System (CNS) Human Immunodeficiency Virus (HIV) Infection

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00000702
• Other study ID #: ACTG 005
• Secondary ID: 10981
• Status: Completed
• Phase: Phase 3
• Est. completion date: August 1990

Study information

• Verified date: October 2021
• Source: National Institute of Allergy and Infectious Diseases (NIAID)
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

To test whether zidovudine (AZT) is useful as a treatment for the neurologic syndrome called AIDS dementia complex. To determine how long AZT takes to reach cerebral spinal fluid (CSF), how long, and at what concentration it is found there. HIV infection can result in impairment in the function of the brain and spinal cord, leading to disturbances in the ability to think clearly and in strength and coordination. This disorder, which has been called the AIDS dementia complex, may be due to a direct effect of HIV on the nervous system. It is known that AZT does get into the brain to some extent, where it may reduce growth of HIV. It is hoped that AZT will stabilize or improve the symptoms of the AIDS dementia complex.

Description:

HIV infection can result in impairment in the function of the brain and spinal cord, leading to disturbances in the ability to think clearly and in strength and coordination. This disorder, which has been called the AIDS dementia complex, may be due to a direct effect of HIV on the nervous system. It is known that AZT does get into the brain to some extent, where it may reduce growth of HIV. It is hoped that AZT will stabilize or improve the symptoms of the AIDS dementia complex. The study is done in 2 stages. In Stage 1, patients are randomized to receive placebo or 1 of 2 doses of AZT. Stage 1 lasts for 4 months. In Stage 2, patients who were initially treated with placebo are randomized again and all patients receive AZT. Stage 2 lasts an additional 12 months, during which time there are periodic medical and neurologic evaluations. Before beginning treatment, all patients have a lumbar puncture and a computerized tomographic (CT) scan of the brain. The lumbar puncture is repeated twice during and once at the end of Stage 1; the CT scan is also repeated at the end of Stage 1. Patients receiving AZT in either stage 1 or Stage 2 are seen by their physicians every week for the first 4 weeks and every other week thereafter for the first 4 months of receiving the drug. After 4 months, patients are seen by their physicians at 4 to 12 week intervals.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 315
• Est. completion date: August 1990
• Accepts healthy volunteers: No
• Gender: All
• Age group: 12 Years and older

Eligibility

Inclusion Criteria Concurrent Medication:

Allowed:

• Aspirin, in modest doses.
• Ibuprofen, in modest doses.
• Maintenance antibiotic therapy posttherapy for an AIDS-defining opportunistic infection. Concurrent Treatment:

Allowed:

• Blood transfusion if cardiovascular status is compromised. Exclusion Criteria
• Active substance abuse. Co-existing Condition:

Patients with the following conditions will be excluded:

• Concurrent or previous central nervous system infections or neoplasms.
• Active AIDS-defining opportunistic infection.
• Severe premorbid psychiatric illness.
• Confounding neurological disease.
• Concurrent neoplasms. Concurrent Medication:

Excluded:

• Maintenance methadone or naltrexone.
• Acetaminophen.
• Mood- or central nervous system-altering drugs.
• Zidovudine for Pneumocystis carinii pneumonia (PCP).
• Acyclovir.
• Rifampin or derivatives.
• Drugs with antiretroviral activity.
• Experimental agents.

The following patients will be excluded from the study:

• Patients requiring ongoing therapy for an AIDS-defining opportunistic infection.
• Patients with a history of Mycobacterium avium intracellulare infection.
• Patients with a history of Pneumocystis carinii pneumonia infection.
• Patients with a daily temperature of 38 degrees C or more for 1 month. Prior Medication:

Excluded:

• Zidovudine (AZT).
• Excluded within 14 days of study entry:
• Systemic anti-infectives.
• Excluded within 30 days of study entry:
• Immunomodulators and biologic response modifiers.
• Any investigational agent.
• Cytotoxic chemotherapy for Kaposi's sarcoma. Prior Treatment:

Excluded:

• Radiation therapy.

Patients must demonstrate the following clinical and laboratory findings:

• No currently active AIDS-defining opportunistic infections.
• One negative blood culture for Mycobacterium avium intracellulare within 4-6 weeks prior to study entry.
• Constitutionally well without persistent fever.
• Less than 25 Kaposi's sarcoma lesions and less than 10 new lesions during the 30 days prior to study entry. Patients may have stable or indolently progressive mucocutaneous Kaposi's sarcoma.
• Characteristic clinical symptoms and signs of AIDS dementia complex.
• Abnormalities on 2 or more of 7 neuropsychological motor tests in the Neurological Screening Battery.
• Estimated premorbid IQ equal to or greater than 70 (+ or - 5), which is consistent with completion of sixth grade.

Related Conditions & MeSH terms

• Acquired Immunodeficiency Syndrome
• AIDS Dementia Complex
• Communicable Diseases
• Dementia
• HIV Infections
• Infections

Intervention

Drug:
• Zidovudine

Locations

Country	Name	City	State
United States	Johns Hopkins Hosp	Baltimore	Maryland
United States	Beth Israel Deaconess Med Ctr	Boston	Massachusetts
United States	Harvard (Massachusetts Gen Hosp)	Boston	Massachusetts
United States	Bronx Municipal Hosp Ctr/Jacobi Med Ctr	Bronx	New York
United States	Jack Weiler Hosp / Bronx Municipal Hosp	Bronx	New York
United States	SUNY / Erie County Med Ctr at Buffalo	Buffalo	New York
United States	City Hosp Ctr at Elmhurst / Mount Sinai Hosp	Elmhurst	New York
United States	UCLA CARE Ctr	Los Angeles	California
United States	Univ of Miami School of Medicine	Miami	Florida
United States	Charity Hosp / Tulane Univ Med School	New Orleans	Louisiana
United States	Louisiana State Univ Med Ctr / Tulane Med School	New Orleans	Louisiana
United States	Tulane Univ School of Medicine	New Orleans	Louisiana
United States	Bellevue Hosp / New York Univ Med Ctr	New York	New York
United States	Beth Israel Med Ctr / Peter Krueger Clinic	New York	New York
United States	Mem Sloan - Kettering Cancer Ctr	New York	New York
United States	Mount Sinai Med Ctr	New York	New York
United States	Univ of Rochester Medical Center	Rochester	New York
United States	Univ of California / San Diego Treatment Ctr	San Diego	California
United States	Univ of Washington	Seattle	Washington
United States	Stanford Univ School of Medicine	Stanford	California
United States	Julio Arroyo	West Columbia	South Carolina

Sponsors (1)

Lead Sponsor	Collaborator
National Institute of Allergy and Infectious Diseases (NIAID)

Country where clinical trial is conducted

United States, 

References & Publications (2)

Price RW, Koch MA, Sidtis JJ, Feinberg J, Collier A, Kennedy C, Singer E, Price S. Zidovudine (AZT) treatment of the AIDS dementia complex (ADC): results of a placebo-controlled, multicentered therapeutic trial. Int Conf AIDS. 1989 Jun 4-9;5:407 (abstract no WBP331)

Sidtis JJ, Gatsonis C, Price RW, Singer EJ, Collier AC, Richman DD, Hirsch MS, Schaerf FW, Fischl MA, Kieburtz K, et al. Zidovudine treatment of the AIDS dementia complex: results of a placebo-controlled trial. AIDS Clinical Trials Group. Ann Neurol. 1993 Apr;33(4):343-9. — View Citation