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Boceprevir in HIV-HCV Coinfected Patients Who Have Failed to a Previous Therapy With Peg-Interferon/Ribavirin (BocepreVIH)
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Purpose
The majority of Human immunodeficiency Virus (HIV)/Hepatitis C Virus (HCV) co-infected patients are non responders after 48 weeks of the current standard-of-care with Peg-Interferon/Ribavirin. The results of re-treatment are disappointing. The addition of Boceprevir to the current standard-of-care has been shown to increase the efficacy of therapy in HCV mono-infected patients previously treated with a bi-therapy. Knowing that HIV/HCV co-infected patients are subject to more rapid hepatic fibrosis as well as to increased risks of cirrhosis, end-stage liver disease and hepatocellular carcinoma, it is important to improve the response rate of the re-treatment of hepatitis C in these patients.
The aim of this pilot study is to evaluate the efficacy and safety of Boceprevir in combination with Peg-Interferon alfa 2b plus ribavirin, in patients co-infected with HIV and chronic genotype 1 HCV, and previously treated with Peg-Interferon/Ribavirin. 80 subjects will be enrolled. The primary endpoint will be the Sustained Virologic Response (SVR) defined as undetectable HCV-RNA at Week 24 after the end of therapy.
| Condition | Intervention | Phase |
|---|---|---|
| HCV Coinfection HIV-1 Infection | Drug: Boceprevir, Peg-interferon alfa 2b and Ribavirin | Phase 2 |
| Study Type: | Interventional |
| Study Design: | Allocation: Non-Randomized Intervention Model: Single Group Assignment Masking: None (Open Label) Primary Purpose: Treatment |
| Official Title: | Pilot Study to Assess the Efficacy and Safety of Boceprevir, in Combination With Peg-Interferon Alfa and Ribavirin, in Patients With HCV/HIV Co-infection Who Have Failed to a Previous Therapy With Peg-Interferon/Ribavirin |
- Sustained Virologic Response [ Time Frame: Week 72 or Week 96 (W72 or W96) ]HCV-RNA measured 24 weeks after the end of the HCV treatment (W72 or W96)
- HCV viral load [ Time Frame: W4, W8, W12, W16, W28, W36 and at treatment completion at W48/72 ]HCV-RNA
- Predictive factors of Sustained virologic Response (SVR) [ Time Frame: Baseline ]
- Sex
- Age (< vs ≥ 40 years)
- Risk factor of HIV infection (drug consumer versus other risk factors)
- Risk factor of HCV infection (drug consumer versus other risk factors)
- Ethnic origin (Africano-American or Subsaharian-African or West Indies versus others)
- CDC stade (C vs. A-B)
- CD4 number (< vs. ≥ 350/mm3)
- HCV viral load (< versus ≥ 800 000 UI/ml)
- HCV genotype (1a versus 1b)
- Cirrhosis (F4 versus no cirrhosis)
- Alcohol, tobacco, cannabis, intravenous/nasal drugs consumption
- IL28 gene polymorphism
- HIV virologic endpoints [ Time Frame: W4, W8, W12, W16, W20, W24, W28, W32, W36, W40, W44, W48, W60, W72 and W84, W96 if treatment duration is 72 weeks ]
- HIV-RNA
- CD4 and CD8 count
- Residual plasmatic concentration (Cres) of Ribavirin [ Time Frame: W4 and W8 ]
- Hepatic factors: liver fibrosis score [ Time Frame: Screen, W4, W8, W16, W28, W48, W72, W96. ]Evolution of liver fibrosis between baseline and 24 weeks post-treatment, according to baseline value and Sustained Virologic Response (at W4, W8, W16, W28, W48/72 and 24 weeks post-treatment).
- Alcohol consumption [ Time Frame: W4, W8, W16, W28, W48, W72, W96 ]
- Evaluation of Pharmacokinetic parameters of anti-retroviral treatments [ Time Frame: Day 0, W8 ]Pharmacokinetic parameters (Cres, Cmax, AUC) of anti-retroviral treatments before (baseline) and after (W8) the starting of Boceprevir combination in a sub-group of subjects and according to UGTA1 polymorphism.
- Clinical and biological adverse events [ Time Frame: Up to 24 weeks after treatment completion (W72 or W96) ]
- Number of participants classified by virologic failure type: non responder, relapser, null responder [ Time Frame: W8, W12, W16, W28, W48, W72, W96 ]
- Relapse patients: undetectable HCV RNA at the end of therapy, becoming detectable after treatment cessation.
- Break-through patients: undetectable HCV-RNA at least once during treatment, becoming detectable before treatment cessation.
- Non-responder patients: detectable HCV-RNA at W24, never achieved undetectable and HCV RNA drop ≥ 2 log at W12.
- Null responder patients: HCV RNA drop < 2 log at W12
- ITPA gene polymorphism [ Time Frame: Day 0 ]The relation between ITPA gene polymorphism and onset of haemolytic anaemia will be analysed.
- CYP3A4 Polymorphism [ Time Frame: W8 ]Evaluation of Pharmacokinetic parameters (Cres, Cmax, AUC) of Boceprevir at W8 in a sub-group of subjects, according to antiretroviral treatment and CYP3A4 polymorphism.
- Maximal Concentration (Cmax) of antiretroviral treatments [ Time Frame: Day 0 and W8 ]Evaluation of Pharmacokinetic parameters (Cres, Cmax, AUC) of anti-retroviral treatments before (baseline) and after (W8) the starting of Boceprevir combination in a sub-group of subjects and according to UGTA1 polymorphism.
- Area Under the Curve (AUC) of antiretrovirals [ Time Frame: Day 0 and W8 ]Evaluation of pharmacokinetic parameters (Cres, Cmax, AUC) of anti-retroviral treatments before (baseline) and after (W8) the starting of Boceprevir combination in a sub-group of subjects and according to UGTA1 polymorphism.
- Insulin resistance [ Time Frame: at W4, W8, W16, W28, W48, W72, W96 ]Evolution of insulin resistance between baseline and 24 weeks post-treatment according to baseline value and Sustained Virologic Response (at W4, W8, W16, W28, W48/72 and 24 weeks post-treatment).
- Metabolic syndrome [ Time Frame: W4, W8, W16, W28, W48, W72, W96 ]Evaluation of metabolic syndroms parameters according to baseline value and Sustained Virologic Response (at W4, W8, W16, W28, W48/72 and 24 weeks post-treatment).
- Reasons and dates of treatment discontinuation [ Time Frame: Up to W72 ]
- Perceived symptoms [ Time Frame: Day 0, W28, W48, W72, W96 ]Perceived symptoms will be assessed on "AC24 French AIDS scale"
- French AIDS questionnaire of compliance [ Time Frame: W0, W28, W48, W72 ]
- Tobacco consumption [ Time Frame: W4, W8, W16, W28, W48, W72, W96 ]
- Cannabis consumption [ Time Frame: W4, W8, W16, W28, W48, W72, W96 ]
- Intravenous/nasal drugs consumption [ Time Frame: W4, W8, W16, W28, W48, W72, W96 ]
- Residual Concentration (Cres) of atazanavir boosted or not by ritonavir [ Time Frame: At screening day, at W48 and in the case of virological rebound ]Measure of residual concentration of atazanavir for patients treated by atazanavir boosted or not by ritonavir at screening day, at W48 and in case of virological rebound (HIV and HCV).
- Residual concentration (Cres) of ritonavir [ Time Frame: At screening day, at W48 and in the case of virological rebound ]Measure of residual concentration of ritonavir for patients treated by atazanavir boosted by ritonavir at screening day, at W48 and in case of virological rebound (HIV and HCV).
| Enrollment: | 69 |
| Study Start Date: | May 2011 |
| Study Completion Date: | May 2014 |
| Primary Completion Date: | May 2014 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Boceprevir, PegIFN alfa 2b, Ribavirin
Standard Treatment :
Three-drug-regimen:
|
Drug: Boceprevir, Peg-interferon alfa 2b and Ribavirin
Other Names:
|
Detailed Description:
The majority of HIV/HCV co-infected patients are non responders after 48 weeks of the current standard-of-care with Peg-Interferon/Ribavirin. The results of re-treatment are disappointing. The addition of Boceprevir to the current standard-of-care has been shown to increase the efficacy of therapy in HCV mono-infected patients previously treated with a bi-therapy. Knowing that HIV/HCV co-infected patients are subject to more rapid hepatic fibrosis as well as to increased risks of cirrhosis, end-stage liver disease and hepatocellular carcinoma, it is important to improve the response rate of the re-treatment of hepatitis C in these patients.
Subjects enrolled in this trial will have many predictive factors of failure: HIV co-infection, previous failure to Peg-Interferon/Ribavirin, HCV genotype 1 infection. One study reported a SVR rate of 9% after re-treatment with Peg-Interferon/Ribavirin in such patients. Another trial has shown a substantial increase of the response rate with a tri-therapy in HCV mono-infected patients.
The investigators propose to carry out a multicentric, national, non-randomized phase II trial in 80 patients.
The proportion of patients with F4 cirrhosis will have to be inferior to 50% of enrolled subjects.
The number of null responders to a previous treatment (HCV RNA drop < 2 log10 at W12) and without F4 cirrhosis will have to be lower or equal to 20.
The primary objective of the study is to estimate, in Genotype 1 - HCV/HIV co-infected patients, non responders to a previous therapy with Peg-Interferon/Ribavirin, the rate of SVR after 48 or 72 weeks of a three-drug regimen containing Peg-Interferon, Ribavirin and Boceprevir according to the Virologic Response and to compare the SVR rate to a threshold rate 20%, lowest rate to consider a therapeutic benefit in this population.
A pharmacokinetic sub-study including 30 patients will be performed to estimate pharmacokinetic parameters of antiretroviral treatment (Atazanavir combined with Ritonavir, Raltegravir, Tenofovir) in combination with anti HCV treatment at baseline and W8 and pharmacokinetic parameters of Boceprevir at W8.
Eligibility| Ages Eligible for Study: | 18 Years and older (Adult, Senior) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Adult ≥18 years
- HIV-1 infection
- Infection to genotype 1 HCV only
- Patients must have received at least 12 weeks of treatment with Peg-Interferon alfa 2a ≥ 135 µg / once weekly or Peg-Interferon alfa 2b ≥ 1,0 µg/kg/ once weekly + Ribavirin ≥ 600 mg daily and must have failed to treatment.
- Anti-HCV treatment stopped for at least 6 months
-
Patients must be already treated at screen since at least 3 months with a stable combination of antiretroviral treatment as following:
- Either tenofovir - emtricitabine, and atazanavir in combination with ritonavir
- Or tenofovir - emtricitabine, and raltegravir
- If patients cannot receive neither of the two antiretroviral regimens proposed, for virologic, safety or toxicity reasons, patients could receive any effective antiretroviral therapy including : tenofovir, emtricitabine, lamivudine, atazanavir alone or in combination with ritonavir, raltegravir, abacavir. These patients are not allowed to take part in the pharmacokinetic sub-study.
- CD4 > 200/mm3 et >15%, at screen
- HIV-RNA < 50 copies/ml since at least 6 months at screen
- ≥ 40 Kg and ≤ 125 Kg
- Patients with any fibrosis grade. Proportion of F4 subjects should not excess 50% of the overall subjects.
- Male and female subjects must agree to use acceptable methods of contraception 1 month prior to starting the study treatment and to continue until 7 months after the last doses of study drugs for male subjects and their partner(s), 4 months for female subjects.
- Subjects must be willing to give written informed consent for principal study (signed at least at screen visit and prior to any study investigation)and + for the pharmacokinetic sub-study (for the concerned centers).
- Subjects must be willing to give written informed consent for biological collection.
- Subjects must be willing to give written informed consent for treatment of genetics data.
- Subjects affiliated or beneficiary to a medical insurance.
Exclusion Criteria:
History:
- Patients with cirrhosis (F4) and nul responders to prior treatment
- Cirrhosis classified Child-Pugh B or C or history of decompensated cirrhosis of the liver. If Child A classification, significant varicose veins (grade 2 or 3) observed with a fibroscopy realized for < 3 years.
- History of ocular neuritis, retinal disorders, transplant
- Opportunistic infections (classification C), active or occurred within the 6 months prior to baseline.
- History of neoplasia within the last 5 years, except cutaneous basocellular carcinoma, recovering Kaposi's sarcoma, in situ cervical or anal canal cancer.
Current condition:
- Co-infection with Hepatitis B virus
- Pregnancy and lactation
- Cardiac or severe pulmonary disease
- Untreated dysthyroidism
- Autoimmune disease contraindicating to an interferon treatment
- Severe haemoglobinopathies
- Any condition needing a systemic corticotherapy or an immunosuppressive treatment
- Evolutive current malignancy, including hepatocarcinoma which should be specifically controlled prior to baseline.
- Alcohol consumption which may disturb the study participation according to the investigator
- Drug addiction which may disturb the study participation according to the investigator. Patients taking part to a substitution program with methadone or buprenorphine are allowed to be enrolled in the study.
Biological criteria:
• Haemoglobin < 12 g/dL (female) or < 13g/dL (male), Platelets < 90 000/mm3, Neutrophil count < 1500/mm3, Renal failure defined as creatinine clearance < 50ml/min, Uncontrolled thyroid function, HbA1c ≥ 7% in case of diabetes
Criteria related to study drugs
- Contra-indication to Ribavirin, interferon treatment including psychiatric contra-indications.
- History of discontinuation for intolerance to anti-HCV treatment.Patients with a history of discontinuation for intolerance, especially anaemia or leuconeutropenia, and who were not treated with hematopoietic growth factor, are eligible
- Concomitant medication which may interfere with Boceprevir, atazanavir, ritonavir and raltegravir pharmacokinetic
- St.John's-wort consumption
Contacts and LocationsPlease refer to this study by its ClinicalTrials.gov identifier: NCT01335529
| France | |
| CHU Sainte Marguerite | |
| Marseille, France, 13009 | |
| Principal Investigator: | Isabelle Poizot-Martin, MD | Marseille University Hospital |
| Study Chair: | Eric Bellissant, MD, PhD | Rennes University Hospital |
More Information
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | French National Institute for Health and Medical Research-French National Agency for Research on AIDS and Viral Hepatitis (Inserm-ANRS) |
| ClinicalTrials.gov Identifier: | NCT01335529 History of Changes |
| Other Study ID Numbers: |
ANRS HC27 BOCEPREVIH |
| Study First Received: | March 25, 2011 |
| Last Updated: | October 10, 2014 |
Keywords provided by French National Institute for Health and Medical Research-French National Agency for Research on AIDS and Viral Hepatitis (Inserm-ANRS):
|
HCV infection HIV-1 infection |
Additional relevant MeSH terms:
|
Infection Communicable Diseases Coinfection Virus Diseases Parasitic Diseases Interferons Ribavirin Interferon-alpha |
Peginterferon alfa-2b Antineoplastic Agents Antiviral Agents Anti-Infective Agents Antimetabolites Molecular Mechanisms of Pharmacological Action Immunologic Factors Physiological Effects of Drugs |
ClinicalTrials.gov processed this record on August 17, 2017