Effects of Eplerenone on Cardiovascular Disease in HIV (MIRACLE HIV Study)

• Status: Active, not recruiting
• Trial end date: 2022-05-01
• Target enrollment: 0
• Participant gender: All

Summary

HIV-infected individuals treated with antiretroviral medications are living longer, but have an increased risk of heart disease when compared to non-HIV-infected individuals. A hormone called aldosterone, which regulates blood pressure and sodium balance, is elevated in the HIV population in association with with increased belly fat and altered glucose metabolism. Elevations in aldosterone hormone may also be associated with abnormal blood flow, inflammation, and coronary plaque in the heart. This study is being conducted to evaluate whether therapies to reduce the actions of aldosterone may decrease the burden and progression of heart disease in the HIV population.

• Phase: N/A
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Massachusetts General Hospital
• Treatments: Eplerenone; Mineralocorticoid Receptor Antagonists; Mineralocorticoids; Spironolactone

Criteria

Inclusion Criteria:

1. Ages 40-65 years

2. Antiretroviral use (ART) >12 months and HIV viral load <100 copies/mL

3. VAT> 110cm2

Exclusion Criteria:

1. Antihypertensive use including, ACE Inhibitor, ARB, MR blockade, diuretic, potassium (K) supplementation; or BP>140/90 mmHg. Stable use (>3 months) of beta-blockers or calcium channel blockers (CCB) (except verapamil) is allowed.

2. Unstable statin use <12 months. Stable use (>12 months) is allowed.

3. Use of full dose ritonavir, nelfinavir, clarithromycin, and other strong inhibitiors of CYP3A4, as well as CYP3A4 inducers.

4. Continuous oral steroid use (equivalent to prednisone > 5 mg daily) within the last 3 months.

5. Uncontrolled diabetes requiring insulin and/or HbA1c > 7.5%.

6. Creatinine (Cr) > 1.5 mg/dL or estimated GFR<60 mL/min/1.73m2.

7. K > 5.5 mEq/L.

8. Hemoglobin < 10 g/dL.

9. Known liver disease or ALT >3x ULN.

10. History of congestive heart failure, stroke, myocardial infarction, or known coronary artery disease.

11. Pregnant, actively seeking pregnancy or breastfeeding.

12. Estrogen, progestin derivative, or other sex steroid use within last 3 months. Stable physiologic testosterone replacement (> 3 months) is acceptable.

13. Current bacterial or other infections.

14. Active substance abuse.

15. Significant radiation exposure over the course of the year prior to randomization (e.g., radiation therapy, PCI, catheter ablation of arrhythmia) within 12 months of randomization.

16. Previous reaction or contraindication to iodine-containing contrast media and gadolinium.

17. Coronary artery luminal narrowing >70% on coronary CTA.