Placebo-controlled trial of prednisone in advanced HIV-1 infection.
OBJECTIVE
To examine the safety and the immunologic and virologic consequences of corticosteroid use in HIV-1 infection.


METHODS
A randomized, double-blinded, placebo-controlled trial of corticosteroid administration in 41 patients with advanced HIV-1 infection. Patients had a baseline median CD4 cell count of 131 x 10(6) cells/l at enrollment and 85% had a history of opportunistic infection. All but one of the patients had been taking stable antiretroviral regimen, including a protease inhibitor in 36, for a median duration of 158 days. Patients were randomized to 8 weeks of prednisone 0.5 mg/kg daily or placebo.


RESULTS
No AIDS-defining events occurred; two patients in each group developed oral candidiasis, and two patients on prednisone developed mild herpes simplex flares. None who developed oral candidiasis or herpes simplex was receiving prophylaxis and each responded promptly to therapy. In the prednisone group, two patients developed hyperglycemia and one diabetic increased insulin requirements. CD4 cell counts and plasma HIV-1 RNA levels did not change, but plasma tumor necrosis factor alpha levels and CD38+ CD8+ cells decreased significantly in those taking prednisone.


CONCLUSIONS
Short-term prednisone administration is well tolerated and reasonably safe in advanced HIV-1 disease and decreases immune activation without effects on HIV-1 RNA levels or CD4 cell counts. These results suggest that, in stable HIV-1 disease, these immune activation markers are more likely consequences of but not inducers of HIV-1 replication.
Case Western Reserve University and University Hospitals of Cleveland, Ohio, USA.
G A
GA
McComsey
C C
CC
Whalen
S D
SD
Mawhorter
R
R
Asaad
H
H
Valdez
A H
AH
Patki
J
J
Klaumunzner
K V
KV
Gopalakrishna
L H
LH
Calabrese
M M
MM
Lederman
D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D010919:Placebos; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use*; D012313:RNA / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D019562:Viral Load
D019380:Anti-HIV Agents; D000893:Anti-Inflammatory Agents; D017320:HIV Protease Inhibitors; D015850:Interleukin-6; D010919:Placebos; D014409:Tumor Necrosis Factor-alpha; D012313:RNA; D011241:Prednisone