Alendronate is a drug that is used to treat osteoporosis. The purpose of this study is to examine whether alendronate in combination with calcium and vitamin D is safe and effective for treating bone loss in people with HIV.

Condition	Treatment or Intervention	Phase
HIV Infections	Drug: Alendronate  Drug: Calcium carbonate  Drug: Vitamin D	Phase II

Further Study Details: 

Expected Total Enrollment:  80

Decreased bone mineral density (BMD) has been identified in up to 50% of HIV infected men, with severe osteoporosis in up to 21% of these men. The mechanisms underlying these bone abnormalities remain unclear. Bisphosphonates are potent bone resorption inhibitors and have been shown to be effective in treating osteoporosis. While several bisphosphonates are approved for the treatment of osteoporosis in women, alendronate is the only bisphosphonate approved for treatment in men. This study hypothesizes that alendronate will be able to reverse decreased BMD secondary to inhibition of bone resorption in HIV infected patients treated with potent antiretroviral therapy, and that these patients will be able to tolerate alendronate without any significant toxicities. The study will also examine the efficacy of once-weekly alendronate with daily calcium and vitamin D in both men and women with HIV.

Patients will participate in this study for 48 weeks. Patients will be randomly assigned to receive either alendronate or placebo. All patients will receive calcium and vitamin D. Dual energy x-ray absorptiometry (DEXA) scans will be used to evaluate bone density at each visit. After study entry, patients will have visits at Weeks 2, 12, 24, 36, and 48. During these visits, blood will be drawn and a pregnancy test may be performed. Patients must fast for at least 8 hours prior to the entry visit and for the visits at Weeks 2, 12, 24, and 48.

Ages Eligible for Study:  25 Years and above,  Genders Eligible for Study:  Both

Criteria

Inclusion Criteria

• HIV-1 infection
• Lumbar spine DEXA scan confirming decreased BMD within 90 days prior to study entry
• CD4 cell count 100 cells/mm3 or more within 30 days prior to study entry
• Stable antiretroviral regimen for at least 12 weeks prior to study entry
• No plans to alter antiretroviral therapy or to initiate structured/strategic treatment interruptions
• No plans to significantly alter exercise habits or diet for the duration of the study
• Documentation of two consecutive measurements of viral load of 5000 copies/ml or less within 90 days prior to study entry, with at least one of the two values obtained within 30 days prior to study entry
• Willing to use acceptable methods of contraception
• For women with the absence of menses for at least 6 months, serum prolactin level in the normal range within 60 days prior to study entry
• For women taking estrogen therapy, stable estrogen regimen for at least 24 weeks prior to study entry, with no plan to change estrogen dose for the duration of the study
• Serum calcium between 8 mg/dl and 11 mg/dl within 30 days prior to study entry

Exclusion Criteria

• Men with untreated low total serum testosterone levels within 60 days prior to study entry, or men with plans to initiate testosterone replacement during the study
• Cannot receive vitamin D or calcium supplements
• Daily vitamin or dietary supplements that include 10,000 IU or greater of vitamin A within 90 days prior to study entry
• Hyperparathyroidism, vitamin D deficiency, or oral thrush within 60 days prior to study entry
• Any current or past conditions that predispose to disorders involving the esophagus. Participants with a history of mild or controlled reflux may be enrolled.
• Esophagitis within 6 months prior to study entry
• Pregnant or breastfeeding
• Paget's disease
• Spinal fracture (thoracic or lumbar spine) within 60 days prior to study entry
• Atraumatic bone fracture at any time since 18 years of age
• Spinal fracture at any time in the past
• Inability to stand or sit upright for at least 30 minutes
• Use of systemic glucocorticoids for a cumulative duration of longer than 4 weeks within 6 months immediately prior to study entry
• Use of medications for treatment of osteoporosis within 12 months prior to study entry
• Allergy/hypersensitivity to any component of alendronate, the components of the tablet, or bisphosphonate compounds
• Active drug or alcohol dependence which, in the opinion of the investigator, would interfere with adherence to study requirements or would endanger the patient's health while on study
• Hospitalization for alcohol-related liver disease at any time in the past
• Current use of systemic cytotoxic chemotherapy
• Acute illness within 30 days prior to study entry which, in the opinion of the investigator, would interfere with participation in the study
• History of hepatitis C virus infection
• For participants using anabolic steroids, use of steroids for less than 6 months prior to entry or plans to change current regimen during the course of the study; if a steroid regimen has been discontinued, it must have been discontinued at least 6 months prior to entry

Alabama
      University of Alabama-Birmingham, Birmingham,  Alabama,  35294-2050,  United States
California
      Stanford Univ, Stanford,  California,  94305-5107,  United States
      UCLA School of Medicine, Los Angeles,  California,  90095-1793,  United States
      University of California, San Diego, San Diego,  California,  92103,  United States
      San Francisco General Hospital, San Francisco,  California,  94110,  United States
District of Columbia
      Georgetown University Medical Center, Washington,  District of Columbia,  20007,  United States
Illinois
      Northwestern University, Chicago,  Illinois,  60611-5012,  United States
      Cook County Hospital Core Center, Chicago,  Illinois,  60612,  United States
Indiana
      Indiana Univ Hosp, Indianapolis,  Indiana,  46202-5250,  United States
      Methodist Hosp of Indiana, Indianapolis,  Indiana,  46202-5250,  United States
      Wishard Hosp, Indianapolis,  Indiana,  46202,  United States
Minnesota
      Univ of Minnesota, Minneapolis,  Minnesota,  55455-0392,  United States
Nebraska
      Nebraska Health System, Omaha,  Nebraska,  68198-5130,  United States
New York
      Univ of Rochester Med Ctr, Rochester,  New York,  14642-0001,  United States
      AIDS Community Health Center, Rochester,  New York,  14642-0001,  United States
      NYU/Bellevue, New York,  New York,  10016-6481,  United States
      Chelsea Clinic, New York,  New York,  10011,  United States
North Carolina
      Univ of North Carolina, Chapel Hill,  North Carolina,  27514,  United States
Ohio
      Case Western Reserve Univ, Cleveland,  Ohio,  44106-5083,  United States
      MetroHealth Medical Center, Cleveland,  Ohio,  44109-1998,  United States
      Ohio State University, Columbus,  Ohio,  43210,  United States
Pennsylvania
      University of Pennsylvania, Philadelphia, Philadelphia,  Pennsylvania,  19104,  United States
Rhode Island
      The Miriam Hosp, Providence,  Rhode Island,  02906,  United States
      Rhode Island Hosp, Providence,  Rhode Island,  02906,  United States
      Stanley Street Treatment and Resource, Providence,  Rhode Island,  02906,  United States
Tennessee
      Comprehensive Care Clinic, Nashville,  Tennessee,  37203,  United States
Texas
      Univ of Texas, Galveston, Galveston,  Texas,  77555-0435,  United States
Washington
      University of Washington (Seattle), Seattle,  Washington,  98104,  United States

Study chairs or principal investigators

Grace McComsey, MD,  Study Chair,  Division of Infectious Diseases, Case Western Reserve University   

Study ID Numbers:  ACTG A5163
Record last reviewed:  March 2005
Last Updated:  April 7, 2005
Record first received:  May 22, 2003
ClinicalTrials.gov Identifier:  NCT00061256
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-04-08