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Efficacy of PTX+IFN Alpha+ RBV on Hepatitis C Virus Coinfected HIV Patients

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ClinicalTrials.gov Identifier: NCT02008214
Recruitment Status : Unknown
Verified December 2013 by JAIME ANDRADE VILLANUEVA, Centro Universitario de Ciencias de la Salud, Mexico.
Recruitment status was:  Not yet recruiting
First Posted : December 11, 2013
Last Update Posted : December 11, 2013
Sponsor:
Information provided by (Responsible Party):
JAIME ANDRADE VILLANUEVA, Centro Universitario de Ciencias de la Salud, Mexico

Study Description
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Brief Summary:

Current Hepatitis C virus (HCV) treatment consists of the combination of interferon alpha 2a (IFN-alpha 2a) plus ribavirin (RBV) and it provides sustained virologic responses (SVR) on 54 to 56% on HCV monoinfected patients and this response is even lower on HIV-HCV coinfected patients. A previous study on HCV monoinfected patients showed that the addition of pentoxyfylline (PTX) to a treatment scheme based on interferon-alfa and ribavirin increased SVR on 25%, although it is not known if the same effect is to be obtained in HCV-HIV coinfected patients.

On the other hand, other factors such as host genetics, have proved to influence treatment response on HCV infected patients. The best described genetic factor so far is the interleukin 28B (IL28B) polymorphism rs12979860, where a cytosine-cytosine (CC) genotype provides an almost twice increase on SVR than the rest of the genotypes.

Therefore, this is a randomized, double blind study to assess the efficacy of pentoxyfylline addition to a treatment scheme based on interferon-alfa and ribavirin in chronic HCV genotype 1, co-infected HIV-1 positive subjects, considering the IL28B polymorphism rs12979860.

HIV-HCV coinfected subjects currently receiving Highly active antiretroviral therapy (HAART), with at least 8 months on undetectable HIV viral load and T helper cells count of 200 or higher will be included. Patients will be randomized on one of two groups:

  • Group A: IFN alpha 2a + RBV + PTX
  • Group B: IFN alpha 2a + RBV + placebo

Patients will be followed for primary outcome during 72 (for rapid responders) or 96 weeks (for non rapid responses). Outcome measures will be the following:

  • SVR rate 24 weeks after the end of treatment
  • Grade of Hepatic fibrosis from baseline to the end of treatment, measured by transient elastography and the AST to platelet ratio index (APRI index)
  • IL28B rs12979860 genotype

The study hypothesis is that the addition of PTX to a treatment scheme based on IFN-alfa2a and RBV in chronic HCV genotype 1, co-infected HIV-1 positive subjects will improve SVR rate and fibrosis progression irrespectively of IL28B rs12979860 genotype.


Condition or disease Intervention/treatment Phase
Hepacivirus HIV Infections Drug: Pentoxifylline Drug: Placebo Phase 4

Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 60 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: Efficacy of Pentoxyfylline Addition to a Treatment Scheme Based on Interferon Alpha and Ribavirin on Hepatitis C Virus Coinfected HIV Patients, Considering Interleukin 28B Polymorphism rs12979860
Study Start Date : December 2013
Estimated Primary Completion Date : March 2015
Estimated Study Completion Date : March 2016

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Arms and Interventions
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Arm Intervention/treatment
Experimental: PTX
IFN 180 micrograms subcutaneous weekly RBV 400 mg each 12 h, oral PTX 400 mg each 12 h, oral
 Drug: Pentoxifylline
Addition of pentoxifylline to current HCV treatment
Placebo Comparator: Placebo
IFN 180 micrograms subcutaneous weekly RBV 400 mg each 12 h, oral Placebo oral daily
 Drug: Placebo
Placebo matching pentoxifylline dosage


Outcome Measures
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Primary Outcome Measures :
  1. sustained virologic rate 24 weeks post treatment with IFNalpha 2a/RBV/PTX with genotype 1 chronic HCV infection + HIV infection [ Time Frame: SVR rate at 24 weeks after the end of therapy ]
    Primary objective: is to evaluate sustained virologic response at post treatment week 24 following treatment with IFNalpha 2a/RBV/PTX with genotype 1 chronic HCV infection + HIV infection


Secondary Outcome Measures :
  1. grade of hepatic fibrosis [ Time Frame: Baseline and week 72 (for quick responders) or week 96 (for non-quick responders) ]
    The liver stiffness (hepatic fibrosis) will be measured by transient elastography and the APRI index on the baseline visit and then at the follow up visit after treatment, which will be after 72 weeks, for patients that turn out to be quick responders; or 96 weeks, for patients that turn out to be non-quick responders.

  2. rapid virologic response (RVR) and extended rapid virologic response (eRVR) rates [ Time Frame: RVR at week 4 and eRVR at week 48 post treatment ]
    secondary objective (2): Evaluate rapid virologic response (RVR) and extended rapid virologic response (eRVR)


Other Outcome Measures:
  1. Percentage of patients with CC genotype on the IL28B rs12979860 polymorphism [ Time Frame: week 72 ]
    We will compare the percentage of patients with CC genotype among patients that achieved sustained virologic response and those who did not achieved it. This is to confirm if the intervention provides a beneficial effect, irrespectively of host genetic factors.


Eligibility Criteria
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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • HIV/HCV coinfected patients
  • 18 to 65 years old
  • currently receiving HAART
  • non-pregnant women
  • HIV infection controlled as: undetectable viral load (<40 copies/mL) for at least 8 months and T helper cells count of 200 cells/μL or above
  • no contraindications to IFN alpha2a, RBV or PTX treatment
  • sign informed consent form
  • laboratory parameters within acceptable ranges

Exclusion Criteria:

  • Women that present a positive pregnancy test during the study
  • Patients that for any reason no longer wish to receive IFN alpha2a, RBV or PTX treatment
  • Serious adverse events that prevent to continue IFN alpha2a, RBV or PTX treatment; such as severe neutropenia, severe thrombocytopenia or severe anemia
  • Presence of an opportunistic infection or malignancy that requires treatment with drugs interacting with IFN alpha2a, RBV or PTX
  • Patients that fail to adhere to treatment
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02008214


Contacts
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Contact: Jaime Andrade-Villanueva, MD, MSc +52 33 36147586 andradevjav@gmail.com
Contact: Luz A Gonzalez-Hernandez, MD, PhD +52 33 36147586 luceroga08@gmail.com

Locations
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Mexico
Hospital Civil de Guadalajara Not yet recruiting
Guadalajara, Jalisco, Mexico, 44280
Contact: Mara Llamas-Covarrubias, BSc, PhD    +52 33 36147586    mara.covarrubias@gmail.com   
Principal Investigator: Jaime Andrade-Villanueva, MD, MSc         
Sub-Investigator: Luz A Gonzalez-Hernandez, MD, PhD         
Sub-Investigator: Mara A Llamas-Covarrubias, BSc, PhD         
Sponsors and Collaborators
Centro Universitario de Ciencias de la Salud, Mexico
More Information
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Responsible Party: JAIME ANDRADE VILLANUEVA, Professor-Investigator, Centro Universitario de Ciencias de la Salud, Mexico
ClinicalTrials.gov Identifier: NCT02008214     History of Changes
Other Study ID Numbers: PTX-HCV/HIV
First Posted: December 11, 2013    Key Record Dates
Last Update Posted: December 11, 2013
Last Verified: December 2013
Keywords provided by JAIME ANDRADE VILLANUEVA, Centro Universitario de Ciencias de la Salud, Mexico:
Pentoxifylline
Sustained virologic response
Hepatic fibrosis
Additional relevant MeSH terms:
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Hepatitis C
Hepatitis
Liver Diseases
Digestive System Diseases
Hepatitis, Viral, Human
Virus Diseases
Flaviviridae Infections
RNA Virus Infections
Pentoxifylline
Phosphodiesterase Inhibitors
 Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Platelet Aggregation Inhibitors
Radiation-Protective Agents
Protective Agents
Physiological Effects of Drugs
Vasodilator Agents
Free Radical Scavengers
Antioxidants