Clinical trial NCT01407237: Physiologic Investigation of the Renin Angiotensin Aldosterone Axis in HIV
Official title: Physiologic Investigation of the Renin Angiotensin Aldosterone Axis in HIV
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: HIV-infection
Keywords: HIV-infection
renin
aldosterone
visceral fat
Lead sponsor: Massachusetts General Hospital
Sponsor class: OTHER
First posted: 2011-08-02
Enrollment: 30
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: CROSS_SECTIONAL
Sampling method: NON_PROBABILITY_SAMPLE
Study population: 50 HIV-infected and 50 non-HIV-infected male and female volunteers, ages 18-65 years old.

Brief summary: The purpose of this study is to see if individuals with HIV-infection, particularly those with increased belly fat, have abnormalities in the renin angiotensin aldosterone axis. Renin, angiotensin, and aldosterone are hormones that regulate salt and water balance in the body, and they may also have effects on sugar metabolism and cardiovascular health. There is some evidence that individuals with HIV-associated abdominal fat accumulation may have increased aldosterone, which may contribute to abnormalities in sugar metabolism and increased cardiovascular disease seen in HIV. The purpose of this study is the measure renin, angiotensin, and aldosterone activity, as well as other hormonal axes, in people with and without HIV infection, and with and without increased belly fat. The investigators hypothesize that aldosterone will be increased in HIV-infected individuals compared to those without HIV-infection, and that aldosterone will be further increased in HIV-infected individuals with increased abdominal fat compared to those without abdominal fat accumulation.


Eligibility criteria: Inclusion Criteria:

1. Stable use of antiretroviral therapy for at least 3 months (HIV group)
2. Age ≥ 18 and ≤ 65 years of age

Exclusion Criteria:

1. Antihypertensive use, including angiotensin converting enzyme inhibitors or angiotensin II receptor blocker use, diuretics, beta-blockers, calcium-channel blockers, potassium supplements, and spironolactone; and/or blood pressure (BP) \>140/90 at screen
2. Current or recent steroid use within last 2 months.
3. Known diabetes and/or use of antidiabetic medications
4. Creatinine \> 1.5 mg/dL
5. Potassium (K) \> 5.5 mEq/L
6. Hemoglobin (Hgb) \< 11.0 mg/dL
7. Alanine aminotransferase (ALT) \> 2.5 x upper limit of normal (ULN)
8. Thyroid disease/abnormal thyroid stimulating hormone (TSH)
9. Significant electrocardiographic abnormalities at screen such as heart block or ischemia
10. History of congestive heart failure, stroke, myocardial infarction, or known coronary artery disease (CAD)
11. For women: Pregnant or actively seeking pregnancy, or breastfeeding
12. Estrogen, progestational derivative, growth hormone (GH), growth hormone releasing hormone (GHRH) or ketoconazole use within 3 months.
13. Current viral, bacterial or other infections (excluding HIV)
14. Current cigarette smoker/use of nicotine (patch/gum) or current active substance abuse

Primary outcomes:
measure: 24-hour urine aldosterone to creatinine ratio
timeFrame: baseline
Secondary outcomes:
measure: Plasma Renin Activity
timeFrame: baseline
measure: Aldosterone response to Angiotensin II Infusion
timeFrame: baseline
measure: Flow mediated dilation
timeFrame: baseline
measure: Intramyocellular Lipid
timeFrame: baseline
measure: Hepatic fat
timeFrame: baseline
measure: Insulin stimulated glucose uptake
timeFrame: baseline
Other outcomes:
Locations:
city: Boston
country: United States
facility: Massachusetts General Hospital
state: Massachusetts
Study officials:
References:
citation: Bogorodskaya M, Fitch KV, Burdo TH, Maehler P, Easly RM, Murray GR, Feldpausch M, Adler GK, Grinspoon SK, Srinivasa S. Serum Lipocalin 2 (Neutrophil Gelatinase-Associated Lipocalin) in Relation to Biomarkers of Inflammation and Cardiac Stretch During Activation of the Renin-Angiotensin-Aldosterone System in Human Immunodeficiency Virus. J Infect Dis. 2019 Sep 26;220(9):1420-1424. doi: 10.1093/infdis/jiz346.
citation: Murphy CA, Fitch KV, Feldpausch M, Maehler P, Wong K, Torriani M, Adler GK, Grinspoon SK, Srinivasa S. Excessive Adiposity and Metabolic Dysfunction Relate to Reduced Natriuretic Peptide During RAAS Activation in HIV. J Clin Endocrinol Metab. 2018 Apr 1;103(4):1558-1565. doi: 10.1210/jc.2017-02198.
citation: O'Malley TK, Burdo TH, Robinson JA, Fitch KV, Grinspoon SK, Srinivasa S. Acute hyperinsulinemia effects on systemic markers of immune activation in HIV. AIDS. 2017 Jul 31;31(12):1771-1773. doi: 10.1097/QAD.0000000000001545.
citation: Srinivasa S, Burdo TH, Williams KC, Mitten EK, Wong K, Fitch KV, Stanley T, Adler GK, Grinspoon SK. Effects of Sodium Restriction on Activation of the Renin-Angiotensin-Aldosterone System and Immune Indices During HIV Infection. J Infect Dis. 2016 Nov 1;214(9):1336-1340. doi: 10.1093/infdis/jiw392. Epub 2016 Aug 22.
citation: Srinivasa S, Fitch KV, Wong K, Torriani M, Mayhew C, Stanley T, Lo J, Adler GK, Grinspoon SK. RAAS Activation Is Associated With Visceral Adiposity and Insulin Resistance Among HIV-infected Patients. J Clin Endocrinol Metab. 2015 Aug;100(8):2873-82. doi: 10.1210/jc.2015-1461. Epub 2015 Jun 18.