Lopinavir/Ritonavir Monotherapy Versus Standard Highly Active Antiretroviral Therapy (HAART) in HIV/HCV Coinfected Antiretroviral (ARV) Naive Patients Starting Treatment With Anti-HCV Therapy - Full Text View

Sponsors and Collaborators:	IRCCS San Raffaele Abbott Hoffmann-La Roche
Information provided by:	IRCCS San Raffaele
ClinicalTrials.gov Identifier:	NCT00437476

Purpose

The purpose of this study is to evaluate if the combination of Lpv/r monotherapy and anti-HCV drugs does not match with additional toxicity induced by the association of HAART and Peg-IFN + ritonavir in patients naive for HIV and HCV.

Secondary objective is to assess if Lpv/r monotherapy during HCV-treatment is associated with HIV efficacy vs optimized HAART.

Condition	Intervention	Phase
HIV Infections Hepatitis C	Drug: LPV/r Drug: Nucleoside Reverse Transcriptase Inhibitors Drug: PEG-IFNa 2a Drug: Ribavirin	Phase III

Study Type:	Interventional
Study Design:	Treatment, Randomized, Open Label, Active Control, Parallel Assignment, Safety/Efficacy Study
Official Title:	Pilot, Multicenter, Randomized Study on Lopinavir/Ritonavir-Monotherapy vs Lopinavir/Ritonavir Plus Selected Nucs, in HIV/HCV ARV-Naive Coinfected Patients With Chronic Hepatitis C or Compensated Cirrhosis, Starting Treatment With Ribavirin and Pegylated Interferon

Resource links provided by NLM:

MedlinePlus related topics: AIDS Hepatitis Hepatitis C

Drug Information available for: Ribavirin Ritonavir Lopinavir Peginterferon Alfa-2a

U.S. FDA Resources

Further study details as provided by IRCCS San Raffaele:

Primary Outcome Measures:

To assess if the combination of LPV/r monotherapy in association with [ Time Frame: 18 months ] [ Designated as safety issue: No ]
anti-HCV therapy (PEG IFN alfa 2a + Ribavirin) does not match with additional [ Time Frame: 18 months ] [ Designated as safety issue: No ]
toxicity induced by the combination of optimized HAART (Lopinavir/ritonavir + selected Nucs) and PEG-IFN alfa 2a+Ribavirin [ Time Frame: 18 months ] [ Designated as safety issue: No ]
in patients naïve for HIV and HCV [ Time Frame: 18 months ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:

To assess if LPV/r monotherapy during the HCV treatment [ Time Frame: 18 and 24 months ] [ Designated as safety issue: No ]
is associated with anti HIV efficacy and a better patient satisfaction [ Time Frame: 18 and 24 months ] [ Designated as safety issue: No ]
vs optimized HAART. [ Time Frame: 18 and 24 months ] [ Designated as safety issue: No ]

Estimated Enrollment:	60
Study Start Date:	February 2007
Estimated Study Completion Date:	December 2010
Estimated Primary Completion Date:	July 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
A: Experimental LPV/r + selected NRTIs for 26 weeks, followed by LPV/r monotherapy and anti HCV drugs for 48 weeks. All the patients will be followed-up for 24 weeks after the end of anti-HCV drugs for the evaluation of SVR.As anti-HCV drugs the patients will receive PEG-IFNa 2a 180 mcg/week + Ribavirin 1-1.2 g/day At the end of week 12 of combined therapy, only patients who will reach an early virological response will continue anti-HCV drugs.	Drug: LPV/r Lopinavir/Ritonavir 200/50 mg 2 cpr BID monotherapy - 26 weeks (A) or 24 weeks (B) Drug: Nucleoside Reverse Transcriptase Inhibitors NRTIs for 26 weeks (A) or 24 weeks (B) Drug: PEG-IFNa 2a PEG-IFNa 2a 180 mcg/week (48 weeks) Drug: Ribavirin Ribavirin 1-1.2 g/day (48 weeks)
B: Active Comparator LPV/r+ selected NRTIs for 24 weeks, followed by the same HAART and anti-HCV drugs for 48 weeks. At the end of the co-treatment for HCV/HIV, each subject will be treated for HIV infection according to physician decision. All the patients will be followed-up for 24 weeks after the end of anti-HCV drugs for the evaluation of SVR.As anti-HCV drugs the patients will receive PEG-IFNa 2a 180 mcg/week + Ribavirin 1-1.2 g/day . At the end of week 12 of combined therapy, only patients who will reach an early virological response will continue anti-HCV drugs.	Drug: LPV/r Lopinavir/Ritonavir 200/50 mg 2 cpr BID monotherapy - 26 weeks (A) or 24 weeks (B) Drug: Nucleoside Reverse Transcriptase Inhibitors NRTIs for 26 weeks (A) or 24 weeks (B) Drug: PEG-IFNa 2a PEG-IFNa 2a 180 mcg/week (48 weeks) Drug: Ribavirin Ribavirin 1-1.2 g/day (48 weeks)

Arms

Assigned Interventions

A: Experimental

LPV/r + selected NRTIs for 26 weeks, followed by LPV/r monotherapy and anti HCV drugs for 48 weeks. All the patients will be followed-up for 24 weeks after the end of anti-HCV drugs for the evaluation of SVR.As anti-HCV drugs the patients will receive PEG-IFNa 2a 180 mcg/week + Ribavirin 1-1.2 g/day

At the end of week 12 of combined therapy, only patients who will reach an early virological response will continue anti-HCV drugs.

Drug: LPV/r

Lopinavir/Ritonavir 200/50 mg 2 cpr BID monotherapy - 26 weeks (A) or 24 weeks (B)

Drug: Nucleoside Reverse Transcriptase Inhibitors

NRTIs for 26 weeks (A) or 24 weeks (B)

Drug: PEG-IFNa 2a

PEG-IFNa 2a 180 mcg/week (48 weeks)

Drug: Ribavirin

Ribavirin 1-1.2 g/day (48 weeks)

B: Active Comparator

LPV/r+ selected NRTIs for 24 weeks, followed by the same HAART and anti-HCV drugs for 48 weeks. At the end of the co-treatment for HCV/HIV, each subject will be treated for HIV infection according to physician decision. All the patients will be followed-up for 24 weeks after the end of anti-HCV drugs for the evaluation of SVR.As anti-HCV drugs the patients will receive PEG-IFNa 2a 180 mcg/week + Ribavirin 1-1.2 g/day . At the end of week 12 of combined therapy, only patients who will reach an early virological response will continue anti-HCV drugs.

Drug: LPV/r

Lopinavir/Ritonavir 200/50 mg 2 cpr BID monotherapy - 26 weeks (A) or 24 weeks (B)

Drug: Nucleoside Reverse Transcriptase Inhibitors

NRTIs for 26 weeks (A) or 24 weeks (B)

Drug: PEG-IFNa 2a

PEG-IFNa 2a 180 mcg/week (48 weeks)

Drug: Ribavirin

Ribavirin 1-1.2 g/day (48 weeks)

Detailed Description:

This is a pilot, randomised, open label, controlled clinical trial. All eligible patients (CD4 count > 200 and no PI resistance)will receive 26 weeks induction HAART (LPV/r + selected NUCS). At the end of induction period (Phase I), all subjects with negative HIV-RNA from at least two months, Hb > 11 g/dL and CD4 count > 350 cells/mmc will be randomised (1:1), to receive LPV/r new tabs (200/50 mg, 2 cpr BID) monotherapy (arm A) or to continue the same HAART (arm B), associated to anti-HCV therapy for other 48 weeks (Phase II). The number of subjects to recruit will be 60 subjects to start the induction-phase with the aim to randomize, at least 25 subjects in each arm of the study. The total number of subjects to randomize will be 50. The Group A: will receive LPV/r + selected NRTIs for 26 weeks, followed by LPV/r monotherapy and anti HCV drugs for 48 weeks. Group B: will receive LPV/r+ selected NRTIs for 24 weeks, followed by the same HAART and anti-HCV drugs for 48 weeks. At the end of the co-treatment for HCV/HIV, each subject will be treated for HIV infection according to physician decision.All the patients will be followed-up for 24 weeks after the end of anti-HCV drugs for the evaluation of SVR.As anti-HCV drugs the patients will receive PEG-IFNa 2a 180 mcg/week + Ribavirin 1-1.2 g/day . At the end of week 12 of combined therapy, only patients who will reach an early virological response will continue anti-HCV drugs.

Eligibility

Ages Eligible for Study:	18 Years to 65 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Subject is >18 years old
Subject has given written informed consent
Serologic evidence of HIV infection by HIV antibody and HIV-RNA detection
Serologic evidence of HCV infection by HCV antibody and HCV-RNA detection
Subject is naive for HIV and HCV therapy
Subject has active chronic hepatitis or compensated cirrhosis (Child-Pugh class A)
Subject has a CD4+ count > 200 cell/mm3 and <500 cell/mm3.
Subject has genotype available at baseline and no mutations (IAS)associated with resistance to antiretroviral drugs used.
Subject and partner will use effective contraceptive methods for the duration of the study

Exclusion Criteria:

Subject is HbsAg positive
Subject has cirrhosis score Child-Pugh B/C, no previous hepatic decompensation
Subject has HIV-related thrombocytopenia (Platelets count < 50.000 mmc)
Subject has neutrophils count < 1500/mmc
Subject has Hb value < 9 g/dL at screening and <11 g/dL at randomization
Subject has creatinine value > 1.5 mg/dL
Subject is on a HAART regimen included ddI and/or AZT
Subject is pregnant or wishes to become so
Subject has any cause of liver disease other than chronic hepatitis C, status of liver decompensation or any other condition consistent with decompensated liver disease (bleeding from esophageal varices, signs of current bleeding, significant ascites, hepatic encephalopathy)
Subject is alcohol abuser (> 30 gr/die)
Prior treatment with PEG-IFN/ribavirin
Illicit drugs abuse that in the opinion of the investigator could lead to poor compliance with the terms of the protocol (maintenance treatment with methadone allowed)
Active heart disease (e.g. angina, congestive heart failure, recent myocardial infarction, or significant arrhythmia)
Subject has pre-existing severe depression, condition of severe psychiatric disorders such as suicidal ideation, suicide attempts, depression or acute psychosis

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00437476

Contacts

Contact: Adriano Lazzarin, MD	+39/02/26437939	adriano.lazzarin@hsr.it
Contact: Caterina Uberti-Foppa, MD	+39/02/26437938	caterina.uberti@hsr.it

Locations

Italy
San Raffaele Hospital Dep. Infectious Diseases	Recruiting
Milan, Italy, 20127
Contact: Vega Rusconi +39/02/26433646 vega.rusconi@hsr.it
Contact: Giulia Gallotta, MD +39/02/26437938 giulia.gallotta@hsr.it
Sub-Investigator: Caterina Uberti-Foppa, MD
Principal Investigator: Adriano Lazzarin, MD

Sponsors and Collaborators

IRCCS San Raffaele

Abbott

Hoffmann-La Roche

Investigators

Principal Investigator:

Adriano Lazzarin, MD

IRCCS San Raffaele Hospital

More Information

No publications provided

Responsible Party:	IRCCS San Raffaele ( adriano lazzarin )
Study ID Numbers:	Kamon 1
Study First Received:	February 20, 2007
Last Updated:	February 5, 2009
ClinicalTrials.gov Identifier:	NCT00437476 History of Changes
Health Authority:	Italy: Ministry of Health

Keywords provided by IRCCS San Raffaele:

HIV/HCV
HIV and HCV coinfected patients
Treatment Naive

Study placed in the following topic categories:

Antimetabolites
Liver Diseases
Sexually Transmitted Diseases, Viral
Hepatitis, Chronic
Ribavirin
Hepatitis, Viral, Human
Liver Cirrhosis
Reverse Transcriptase Inhibitors
Lopinavir
Anti-Retroviral Agents
Hepatitis C
Retroviridae Infections
HIV Protease Inhibitors
Anti-HIV Agents

Acquired Immunodeficiency Syndrome
Interferons
Antiviral Agents
Immunologic Deficiency Syndromes
Protease Inhibitors
Virus Diseases
Hepatitis
Digestive System Diseases
HIV Infections
Ritonavir
Sexually Transmitted Diseases
Peginterferon alfa-2a
Hepatitis C Antibodies
Hepatitis C, Chronic

Additional relevant MeSH terms:

Antimetabolites
Anti-Infective Agents
Sexually Transmitted Diseases, Viral
Liver Diseases
Slow Virus Diseases
Flaviviridae Infections
Molecular Mechanisms of Pharmacological Action
Ribavirin
Hepatitis, Viral, Human
Infection
Reverse Transcriptase Inhibitors
Anti-Retroviral Agents
Lopinavir
Therapeutic Uses
Hepatitis C

Retroviridae Infections
Nucleic Acid Synthesis Inhibitors
HIV Protease Inhibitors
RNA Virus Infections
Anti-HIV Agents
Immune System Diseases
Acquired Immunodeficiency Syndrome
Enzyme Inhibitors
Antiviral Agents
Immunologic Deficiency Syndromes
Pharmacologic Actions
Protease Inhibitors
Virus Diseases
Hepatitis
Digestive System Diseases

ClinicalTrials.gov processed this record on July 02, 2009