Pioglitazone to Treat Fatty Liver in Patients With HIV and Hepatitis C Infections
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| ClinicalTrials.gov Identifier: NCT00742326 |
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Recruitment Status :
Terminated
(Enrollment stopped prior to complete enrollment due to slow accrual)
First Posted : August 27, 2008
Results First Posted : June 16, 2014
Last Update Posted : December 9, 2016
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This study will evaluate the effectiveness of pioglitazone in reducing liver fat content in patients with HIV and hepatitis C virus (HCV) infections. Fatty liver and accompanying insulin resistance in patients with HIV and HCV co-infections is associated with inflammatory changes, liver fibrosis and a poorer response to HCV treatment. Pioglitazone is a drug that helps to reduce the body's resistance to insulin. It is approved by the Food and Drug Administration to treat diabetes.
Patients with HIV and HCV co-infections who have hepatic steatosis (fatty liver) may be eligible for this study. Candidates are screened with a medical history and physical examination, blood and urine tests, magnetic resonance imaging (MRI) of the liver to measure liver fat and, if needed, a liver biopsy to confirm the diagnosis of liver steatosis.
- Participants are randomly assigned to take either pioglitazone therapy or placebo for 48 weeks. This is followed by a second 48-week treatment period in which all participants take pioglitazone.
- There are approximately 12 visits during the 96 weeks of the study. Participants will receive a physical assessment, blood and urine tests at each visit. In addition, periodic assessments of dietary habits, body composition, oral glucose tolerance testing, and health related quality of life questionnaires will be completed.
- A repeat MRI of the liver is performed at 48 weeks and at the end of the study to evaluate any potential changes in liver fat and inflammation. In addition, there is a follow-up liver biopsy at 48 weeks and an optional liver biopsy at 96 weeks.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| HIV Hepatitis C Liver Disease Fatty Liver Steatosis | Drug: Pioglitazone Drug: Placebo | Phase 4 |
Following the introduction of effective antiretroviral therapy for HIV, the management of co-morbidities such as hepatitis C virus (HCV) has taken on increasing significance in the care and health maintenance of chronically infected patients. HCV co-infection is common in HIV, with an estimated prevalence of 30 percent among HIV-infected adults in the US. Further, the reported prevalence of hepatic steatosis in HIV/HCV co-infection is between 40-67 percent.
In recent years, the significance of hepatic steatosis and accompanying insulin resistance in HCV has gained increasing recognition. For example, steatosis is associated with increased rates of necro-inflammatory change and fibrosis in HIV/HCV co-infected patients. Furthermore, studies showed that, among non-HIV infected HCV patients, the presence of steatosis and/or insulin resistance was associated with poorer response to HCV therapy. These observations have led to research interest in treating hepatic steatosis in HCV, particularly in the context of pegylated interferon and ribavirin therapy.
Administration of the thiazolidinedione, pioglitazone, leads to significant reductions in hepatic steatosis, inflammation and in some cases fibrosis in patients with non-alcoholic steatohepatitis (NASH). Therefore, the potential benefits of pioglitazone therapy in the setting of HIV/HCV co-infection and hepatic steatosis will be determined. The proposed study is a 48-week, double-blind, randomized placebo-controlled trial of pioglitazone (45 mg/day) in 50 HIV/HCV-infected men and women. After the 48-week randomized portion of the trial, all participants will enter a 48-week open treatment extension arm irrespective of original randomization. It is anticipated that 100 subjects will be needed to be screened to identify a sufficient number of eligible participants to enroll in the study.
The primary outcome variable of interest in this trial will be the change in hepatic fat content measured by magnetic resonance (MR) spectroscopy. Important secondary outcomes will be histologic improvement on liver biopsy performed at baseline and 48 weeks, as well as improvements in transaminase levels and insulin resistance. The open treatment extension will allow all participants an opportunity to receive active study medication and it will allow the potential benefits of additional pioglitazone therapy to be assessed. In this way, important information about the efficacy of pioglitazone to treat hepatic steatosis and improve the metabolic profile in HIV/HCV co-infected patients will be obtained.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 13 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) |
| Primary Purpose: | Treatment |
| Official Title: | Pioglitazone for Hepatic Steatosis in HIV/HCV Co-infection |
| Study Start Date : | August 2008 |
| Actual Primary Completion Date : | January 2013 |
| Actual Study Completion Date : | January 2013 |
| Arm | Intervention/treatment |
|---|---|
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Experimental: Pioglitazone
pioglitazone 45 mg daily for 48 weeks
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Drug: Pioglitazone
45 mg/daily
Other Name: Avandia |
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Placebo Comparator: Placebo
one capsule daily for 48 weeks
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Drug: Placebo
one capsule daily |
- Change in Hepatic Steatosis and Hepatic Inflammation/Fibrosis in HIV/HCV Co-infected Patients With Steatosis. [ Time Frame: 48 weeks ]Change in hepatic steatosis and hepatic inflammation/fibrosis in HIV/HCV co-infected patients with steatosis. Change in Hepatic Fat Content measured by MR spectroscopy: 48 weeks compared to Baseline
- Change in Insulin Resistance in HIV- and HCV-infected Patients With Steatosis Compared to Placebo [ Time Frame: 48 weeks ]Change in Glucose Area Under the Curve from standard oral glucose challenge ( baseline to 2 hours): Week 48 - Baseline values
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
| Ages Eligible for Study: | 18 Years to 99 Years (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
- INCLUSION CRITERIA:
Men and women, 18 years of age or greater
Confirmed HIV infection by ELISA and Western blot
No changes in antiretroviral regimen within the prior 3 months--Individuals not currently taking antiretroviral therapy will be eligible. Individuals requiring medically indicated adjustments of antiretroviral therapy during the course of the study will be eligible.
Confirmed HCV infection, and no current or recent (within the past 3 months) HCV treatment and no plans to start HCV antiviral therapy in the foreseeable future.
H-MRS liver fat content greater than 5 percent and confirmed steatosis on liver biopsy within 1 year
Fasting glucose less than 126 mg/dL
Platelets greater than or equal to 75,000/uL; INR less than 1.6
Willingness to avoid medications and herbal supplements which may increase the risk of bleeding for one week prior to and one week following liver biopsy (e.g. aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), Vitamin E, fish oil and gingko biloba).
Willingness to restrict physical activity 72 hours after liver biopsy
If premenopausal female, willingness to use 2 forms of effective birth control on this study to avoid pregnancy.
Have a primary care physician
Willingness to have specimens stored.
EXCLUSION CRITERIA:
Current thiazolidinedione use or use in the last 6 months, known allergy or sensitivity to a thiazolidinedione
Use of insulin or other oral hypoglycemics, or known diabetes
Current pregnancy, breast feeding, or pregnancy within the past 6 months or desire to become pregnant within the next 2 years.
Child-Pugh-Turcotte (CPT) score greater than class A
ALT greater than 4 times the upper limit of normal
Current or history of heart failure (New York Heart Association [NYHA] Class III or IV cardiac status)
Hemoglobin level less than 9g/dL
Active or ongoing infection with Hepatitis A or B
Known or suspected liver disease such as autoimmune hepatitis, Wilson's disease, alpha-1-antitrypsin deficiency, cystic fibrosis, hemochromatosis, glycogen storage disease, amyloidosis, primary biliary cirrhosis, sclerosing cholangitis, or any primary or secondary hepatic tumor
Current alcohol/substance abuse
Use of growth hormone, prednisone or other anabolic agents (except for physiologic testosterone replacement) currently or within the past 3 months. One day or less of corticosteroid within the prior 90 days of screening is allowed as is stable dose inhalation corticosteroids
Concurrent use of ketoconazole
Active opportunistic infection (except thrush) or neoplasm (except Kaposi's sarcoma, skin cancer, cancer of the cervix or anus)
Any known contraindications to percutaneous liver biopsy including elevated PT/PTT
Severe psychiatric illness that would interfere with adherence to protocol requirements
Current treatment with interleukin-2, interferon-alpha, or other investigational agent(s) within the past 6 months (This does not pertain to ARVs obtained through expanded access)
Any significant medical condition for which the investigator believes a liver biopsy or participation in the research protocol may be contraindicated
Any contraindication to MRI scan, including excess body size
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): NCT00742326
| United States, District of Columbia | |
| VA Medical Center | |
| Washington, District of Columbia, United States, 20422 | |
| United States, Maryland | |
| National Institutes of Health Clinical Center, 9000 Rockville Pike | |
| Bethesda, Maryland, United States, 20892 | |
| Principal Investigator: | Colleen M Hadigan, M.D. | National Institute of Allergy and Infectious Diseases (NIAID) |
| Responsible Party: | National Institute of Allergy and Infectious Diseases (NIAID) |
| ClinicalTrials.gov Identifier: | NCT00742326 |
| Other Study ID Numbers: |
080201 |
| First Posted: | August 27, 2008 Key Record Dates |
| Results First Posted: | June 16, 2014 |
| Last Update Posted: | December 9, 2016 |
| Last Verified: | October 2016 |
| Individual Participant Data (IPD) Sharing Statement: | |
| Plan to Share IPD: | No |
| Plan Description: | Decision will be made at the time of request |
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HIV Hepatitis C Liver Disease Fatty Liver Steatosis |
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Hepatitis A Hepatitis C Hepatitis Liver Diseases Fatty Liver Digestive System Diseases Hepatitis, Viral, Human Virus Diseases |
Enterovirus Infections Picornaviridae Infections RNA Virus Infections Flaviviridae Infections Pioglitazone Hypoglycemic Agents Physiological Effects of Drugs |