An open-label, multicenter clinical trial assessed the tolerance of HPA-23 (ammonium-21-tungsto-9-antimoniate) in patients with acquired immune deficiency syndrome. Sixty-nine patients were sequentially assigned to receive 0.25, 0.5, 1.0, or 2.0 mg of HPA-23 per kg intravenously 5 days per week for 8 weeks. HPA-23 was fairly well tolerated at doses of 1.0 mg/kg or less; nearly 60% of patients given 2.0 mg/kg discontinued treatment. Twenty-six patients discontinued treatment because of adverse events or concurrent illness. HPA-23 produced dose-related decreases in platelet count and increases in serum glutamine oxalacetic transaminase. There were no changes in immune system function, as determined by total lymphocyte count, T4-cell count, T8-cell count, and T4/T8 ratio. The effects of HPA-23 seemed to be more closely related to the total dose than to the daily dose. No improvement in the clinical status of the patients was observed during the 8 weeks of treatment.Acquired immune deficiency syndrome (AIDS) is caused by a retrovirus, human immunodeficiency virus type 1 (HIV-1) (2, 6, 11, 13). HPA-23 (ammonium-21-tungsto-9-antimoniate) inhibits retrovirus replication by inhibiting RNA-dependent DNA polymerases and thus could be effective in the treatment of HIV-1 infections and AIDS. HPA-23 inhibits nucleic acid polymerases in vitro (1, 4, 7, 10) and has antiviral activity both in vitro (14) and in vivo (8, 9). Furthermore, HPA-23 inhibits HIV-1 reverse transcriptase in vitro (5). Preliminary observations in a limited number of AIDS patients suggest that HPA-23 inhibits HIV-1 replication (12). The goal of this study was to assess the tolerance of patients with AIDS to HPA-23.(Portions of this study were presented at the Third International Conference on Acquired Immunodeficiency Syndrome, 1-5 June 1987, Washington, D.C.)
MATERIALS AND METHODSThis was an open-label, multicenter clinical trial. The Institutional Review Board at each institution approved the study protocol, and all patients gave informed consent. Patients were assigned nonrandomly to the treatment groups, and no placebo was used. patients was treated with the lowest dose of HPA-23 (0.25 mg/kg per day), and the preliminary data on adverse events in these patients were evaluated. After evaluation of the results from this group, additional groups of patients were treated with higher doses of HPA-23.Patients who had AIDS, as defined by the Centers for Disease Control (Atlanta, Ga.), and who were between 18 and 60 years old, clinically stable, and ambulatory were eligible for this clinical trial. Excluded were females of childbearing potential; patients who had hemophilia; lymphoma; visceral Kaposi's sarcoma (KS); neutropenia (leukocyte count, <1,000/mm3); thrombocytopenia (platelet count, <100,000/mm3); prolonged coagulation times (prothrombin time or partial thromboplastin time of more than 2 or 8 s longer than the control times, respectively); elevated serum glutamic oxalacetic transaminase (SGOT), serum glutamic pyruvic transaminase, or alkaline phospha...