To determine the efficacy and safety of prednisone in patients with HIV-associated nephropathy. To determine the effects of prednisone on serum creatinine, urinary protein, and creatinine clearance. HIV-associated nephropathy is characterized by heavy proteinuria, rapidly progressive renal insufficiency, and distinct nephropathologic changes. The syndrome most often occurs in patients with advanced HIV disease. Little is known about the effects of corticosteroids on the progression of HIV disease. In light of the possible beneficial effects of corticosteroids on HIV-associated nephropathy, a controlled trial using prednisone is warranted.

Condition	Treatment or Intervention	Phase
HIV Infections AIDS-Associated Nephropathy	Drug: Prednisone	Phase II

Further Study Details: 

Expected Total Enrollment:  54

HIV-associated nephropathy is characterized by heavy proteinuria, rapidly progressive renal insufficiency, and distinct nephropathologic changes. The syndrome most often occurs in patients with advanced HIV disease. Little is known about the effects of corticosteroids on the progression of HIV disease. In light of the possible beneficial effects of corticosteroids on HIV-associated nephropathy, a controlled trial using prednisone is warranted.

Patients are randomized to receive prednisone or placebo for 11 weeks, followed by 13 weeks of observation.

Ages Eligible for Study:  18 Years and above,  Genders Eligible for Study:  Both

Criteria

Inclusion Criteria

Patients must have:

• HIV infection.
• Biopsy-confirmed glomerulosclerosis and/or mesangial proliferation within 90 days prior to study entry.
• Mild to severe renal insufficiency that is stable or worsening.
• No AIDS-defining opportunistic infections or malignancies.

Exclusion Criteria

Co-existing Condition: Patients with the following symptoms or conditions are excluded:

• Poorly controlled hypertension or diabetes mellitus.
• Peptic ulcer disease with gastrointestinal bleeding.
• Active symptomatic bacterial, protozoal, fungal, or viral infections (other than HIV disease).
• Superimposed renal disease that is due to processes other than focal glomerulosclerosis or mesangial proliferation, including but not limited to obstructive uropathy, acute tubular necrosis, and prerenal azotemia.
• Emotional problems sufficient to prevent adequate compliance with study therapy.

Concurrent Medication: Excluded:

• IV amphotericin B.
• IV aminoglycosides.
• IV foscarnet.
• IV pentamidine.
• Trimethoprim > 200 mg/day.
• Nonsteroidal anti-inflammatory agents.
• Angiotensin converting enzyme inhibitors (benzapril, captopril, enalapril, fosinopril, lisinopril, guinapril, and ramipril) except for refractory hypertension.

Concurrent Treatment: Excluded:

• Iodinated radiocontrast dye.

Patients with the following prior conditions are excluded:

• Active pulmonary disease on chest radiograph within 60 days prior to study entry.
• CMV retinitis on ophthalmologic evaluation within 60 days prior to study entry.
• Positive blood culture for mycobacteria 10-60 days prior to study entry.

Prior Medication: Excluded:

• Prior corticosteroid therapy for HIVAN.
• Corticosteroid therapy for any indication within 30 days prior to study entry.
• Continuous nonsteroidal anti-inflammatory agents for more than 15 days during the 4 weeks prior to study entry.

Prior Treatment: Excluded within 30 days prior to study entry:

• Dialysis for acute or chronic renal failure.
• Iodinated radiocontrast dye.

Required:

• Stable antiretroviral therapy with AZT alone or in combination with ddI, ddC, or d4T for at least 4 weeks unless contraindicated.
• PCP prophylaxis with TMP/SMX, pentamidine aerosol, dapsone, or atovaquone.
• MAC prophylaxis with rifabutin or clarithromycin for patients with CD4 count < 100 cells/mm3.
• Mycobacterium tuberculosis prophylaxis with isoniazid or another accepted regimen for patients with a positive or previously positive tuberculin test and for anergic patients who are known household or close contacts of infectious TB patients or who are from groups in which the prevalence of TB is 10 percent or higher.
• Investigational drugs unless exempted by protocol chair.
• Other medications unless expressly prohibited.

Active alcohol or drug abuse.

California
      San Francisco Gen Hosp, San Francisco,  California,  941102859,  United States
      UCLA CARE Ctr, Los Angeles,  California,  90095,  United States
      Harbor UCLA Med Ctr, Torrance,  California,  90502,  United States
Indiana
      Indiana Univ Hosp, Indianapolis,  Indiana,  462025250,  United States
Maryland
      Johns Hopkins Hosp, Baltimore,  Maryland,  21287,  United States
New York
      SUNY / State Univ of New York, Syracuse,  New York,  13210,  United States
      Bronx Veterans Administration / Mount Sinai Hosp, Bronx,  New York,  10468,  United States
      Beth Israel Med Ctr, New York,  New York,  10003,  United States
      Adirondack Med Ctr at Saranac Lake, Albany,  New York,  122083479,  United States
      Mid - Hudson Care Ctr, Albany,  New York,  122083479,  United States
      Albany Med College / Division of HIV Medicine A158, Albany,  New York,  122083479,  United States
      Harlem Hosp Ctr, New York,  New York,  10037,  United States
Ohio
      Case Western Reserve Univ, Cleveland,  Ohio,  44106,  United States
      MetroHealth Med Ctr, Cleveland,  Ohio,  441091998,  United States

Study chairs or principal investigators

Kalayjian R,  Study Chair
Smith MC,  Study Chair
Lederman M,  Study Chair

Study ID Numbers:  ACTG 271
Record last reviewed:  October 1996
Last Updated:  October 13, 2004
Record first received:  November 2, 1999
ClinicalTrials.gov Identifier:  NCT00000819
Health Authority: Unspecified
ClinicalTrials.gov processed this record on 2005-04-08