HIV Infections Clinical Trial
Official title:
Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN Study)
The SUN Study is a Centers for Disease Control and Prevention (CDC)-sponsored multi-site prospective observational cohort study designed to better understand the incidence and etiology of metabolic and other complications related to effective HIV treatment and longer survival. The SUN Study is also providing a platform to evaluate a behavioral intervention designed to reduce HIV transmission through prevention counseling in routine care.
Effective antiretroviral therapy has significantly improved and prolonged the lives of
HIV-infected persons. However, antiretroviral use has also been associated with a diverse
array of "unnatural" metabolic complications and other adverse medical conditions. These
problems, together with subsequent longer survival, have increased patients' risk for
developing renal, hepatic, cardiovascular, neurological, rheumatologic, and other end-organ
diseases, and cancers. Longer survival is also increasing the pool of HIV-infected persons
capable of transmitting the virus, which could accelerate the pace of the U.S. epidemic;
however, the ability of physicians caring for HIV-infected persons to incorporate prevention
into their clinical practices and the effectiveness of this intervention have not been
extensively evaluated.
The goals of the Study to Understand the Natural History of HIV and AIDS ("SUN" Study) are:
- to monitor the incidence of metabolic and other medical complications related to the
treatment of HIV infection and attendant prolonged survival,
- to identify risk factors associated with the development of these metabolic and other
medical complications,
- to monitor the contribution of these complications and other conditions to the
morbidity and mortality of HIV infection, and
- to evaluate the efficacy of a structured program of prevention activities, which are
integrated into the routine medical care of HIV patients to reduce HIV transmission.
The SUN Study is designed to enroll and follow for 5 or more years a cohort of up to 1,000
HIV-infected adults at HIV specialty care centers in four U.S. cities: Denver, Minneapolis,
Providence, and St. Louis. Data will be gathered through longitudinal real-time chart
review, biannual physical examination (e.g., body mass index [BMI], blood pressure),
repeated non-invasive imaging (e.g., dual energy x-ray absortiometry [DEXA] scanning,
carotid ultrasonography) and regularly scheduled laboratory testing (e.g., serum lipids, pap
smears, and urinary microalbumin). Data collection and quality control will be managed by
Cerner Corporation. After sufficient enrollment, (circa 200 persons per site) a structured
prevention program to reduce HIV transmission will be introduced. The impact of this
intervention will be evaluated both subjectively (e.g., self-reported change in behavior on
an audio computer-assisted self-interviewing [ACASI] questionnaire) and objectively (e.g.,
change in sexually transmitted disease [STD] incidence).
Outcomes include determination of the incidence of therapy-related metabolic complications
and other adverse conditions associated with longer survival, identification of risk factors
for these complications and conditions, and reduction in both reported and objective
measures of risky sexual behavior.
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Observational Model: Cohort, Time Perspective: Prospective
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