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Home > "A" Clinical Trials Conditions > A Study of Azithromycin Plus Pyrimethamine in the Treatment of a Brain Infection in Patients with AIDS  A Study of Azithromycin Plus Pyrimethamine in the Treatment of a Brain Infection in Patients with AIDS
A Study of Azithromycin Plus Pyrimethamine in the Treatment of a Brain Infection in Patients with AIDS
For Condition: Toxoplasmosis, Cerebral,HIV Infections
Status: Completed
Sponsor(s): Pfizer , National Institute of Allergy and Infectious Diseases (NIAID)
Synopsis: To evaluate the effectiveness and toxicity of oral azithromycin and pyrimethamine as acute therapy for toxoplasmic encephalitis in AIDS patients. To assess the toxicity and effectiveness of azithromycin alone as maintenance therapy. Encephalitis caused by Toxoplasma gondii is the most frequent cause of focal central nervous system infection in patients with AIDS. Untreated, the encephalitis is fatal. Standard treatment for toxoplasmic encephalitis is associated with serious adverse effects. Thus, alternative treatments are needed.
Details: Encephalitis caused by Toxoplasma gondii is the most frequent cause of focal central nervous system infection in patients with AIDS. Untreated, the encephalitis is fatal. Standard treatment for toxoplasmic encephalitis is associated with serious adverse effects. Thus, alternative treatments are needed. Patients with toxoplasmosis are given azithromycin at doses starting at the lowest dose for the first cohort, an intermediate dose for the second cohort, and a higher dose for the third cohort. Subsequent cohorts may receive azithromycin in increased dosage, if needed to determine the MTD. All patients also receive pyrimethamine. Folinic acid is also provided for as long as patients receive pyrimethamine. Patients are evaluated for clinical response to treatment at days 3, 7, and 14, and weekly for 6 weeks. Maintenance treatment with azithromycin continues for an additional 24 weeks. Patients who complete the study period without relapse or significant toxicity are offered continued therapy by the drug company and are followed for survival and relapse on a monthly basis for 1 year. After the MTD is determined, a subsequent cohort may be added for special studies.
Eligibility:
Study Type: Interventional, Treatment
Minimum Age/Maximum Age: 13 Years/
Genders: Both
Protocol Entry Criteria: Inclusion Criteria Concurrent Medication: Allowed: - Aerosolized pentamidine for prophylaxis against Pneumocystis carinii pneumonia (PCP). - Allowed during maintenance period (weeks 7 - 24): - Zidovudine and other antiretrovirals available through treatment IND mechanisms, ganciclovir, and maintenance doses of amphotericin (other investigational therapies require permission from the study chair), steroids for the treatment of acute PCP. - Isoniazid (INH) only for patients already on INH. Patients must have the following: - HIV infection or belong to high-risk group. Presumptive or definite diagnosis of toxoplasmic encephalitis. - Each patient, or his/her appropriate family member, or legal designee must be able to understand and sign a written informed consent, in accordance with the local practices at each site. Exclusion Criteria Co-existing Condition: Patients with the following conditions or symptoms are excluded: - History of cerebral toxoplasmosis or toxoplasmosis infection in any other organ or tissue. - Coma. - More than 72 hours of treatment for current episode of toxoplasmic encephalitis prior to study entry. - Central nervous system (CNS) lymphoma. - Cerebral Kaposi's sarcoma. - Active hepatitis or clinical jaundice. - History of serious hypersensitivity or intolerance to any of the study drugs. - Serum or cerebrospinal fluid (CSF) positive for cryptococcus antigen or culture. - Malignancies requiring use of cytotoxic chemotherapy. - Inability to take oral therapy reliably. - Malabsorption syndrome. Concurrent Medication: Excluded: - Opportunistic infection requiring either acute treatment or maintenance therapy with azithromycin, erythromycin or other macrolides, sulfonamides, amphotericin, dapsone, ganciclovir, antifolates, and other investigational agents except erythropoietin. For first 6 weeks of treatment, patients may not receive treatment with erythromycin (or other macrolides), sulfonamides, immunomodulators with the exception of alpha interferon, lymphocyte replacement, cytotoxic chemotherapy, dapsone, ganciclovir, rifampicin, coumadin, antiretrovirals, and investigational agents other than erythropoietin. Patients with the following are excluded: - Negative HIV antibodies by a federally licensed ELISA, unless there is documentation of a previously positive HIV culture or p24 antigen. - Infections of the central nervous system. - Malignancies requiring the use of cytotoxic chemotherapy. - Any medical or social condition that, in the opinion of the investigator, would adversely affect participation and/or compliance in this study.
Total Enrollment: 45
Location and Contact Information:
Overall Study Official:
LuftB, Study Chair,
SUNY - Stony Brook
Stony Brook, New York, 117948153
United States
Julio Arroyo
West Columbia, South Carolina, 29169
United States
Los Angeles County - USC Med Ctr
Los Angeles, California, 90033
United States
Bellevue Hosp / New York Univ Med Ctr
New York City, New York, 10016
United States
Nassau County Med Ctr
East Meadow, New York, 11554
United States
Univ of Miami School of Medicine
Miami, Florida, 331361013
United States
Montefiore Med Ctr / Bronx Municipal Hosp
Bronx, New York, 10467
United States
Bronx Veterans Administration / Mount Sinai Hosp
Bronx, New York, 10468
United States
Cornell Univ Med Ctr
New York City, New York, 10021
United States
Univ of Massachusetts Med Ctr
Worcester, Massachusetts, 01655
United States
Bronx Municipal Hosp Ctr/Jacobi Med Ctr
Bronx, New York, 10461
United States
Additional Information:
Study ID Numbers: ACTG 156;
Study Start Date:
Record last reviewed: October 1994
Additional information available at: clinicaltrials.gov
Clinicaltrials.gov Reference link: NCT00000966
Other Hiv Infections Studies:
1. A Pilot Study of 566C80 for the Salvage Treatment of Toxoplasmic Encephalitis in Patients Infected With the Human Immunodeficiency Virus (HIV) Who Have Failed or are Intolerant of Pyrimethamine-Sulfadiazine
2. Phase II Randomized Open-Label Trial of Atovaquone Plus Pyrimethamine and Atovaquone Plus Sulfadiazine for the Treatment of Acute Toxoplasmic Encephalitis
3. A Randomized Prospective Study of Pyrimethamine Therapy for Prevention of Toxoplasmic Encephalitis in HIV-Infected Individuals With Serologic Evidence of Latent Toxoplasma gondii Infection
4. A Study of Azithromycin Plus Pyrimethamine in the Treatment of a Brain Infection in Patients with AIDS
5. A Pilot Study of Oral Clindamycin and Pyrimethamine for the Treatment of Toxoplasmic Encephalitis in Patients With AIDS
Related Studies:
Other HIV Infections Clinical Trials
Other New York Clinical Trials
Other East Meadow Clinical Trials
A Study of Azithromycin Plus Pyrimethamine in the Treatment of a Brain Infection in Patients with AIDS
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