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Treatment of HIV/HCV Coinfection With Peg-IFN and Ribavirin in Patients Receiving ART Monotherapy With Lopinavir/r (PEKARI)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00866021
Recruitment Status : Completed
First Posted : March 20, 2009
Last Update Posted : March 22, 2013
Information provided by (Responsible Party):

Brief Summary:
The aim of this study is to assess the efficacy of lopinavir/r in monotherapy and peg-interferon plus ribavirin for the control of both HIV and HCV infection respectively after 12 months of active treatment for HCV.

Condition or disease Intervention/treatment Phase
HIV/HCV Co-infection HIV Infections Drug: Lopinavir/ritonavir Drug: Lopinavir/ritonavir with two nucleoside analogs Phase 4

Detailed Description:

Viral hepatitis, mainly when caused by the hepatitis C virus (HCV), is highly significant in the setting of infection by the human immunodeficiency virus (HIV) because high activity antiretroviral therapy (HAART) has a very favorable impact upon morbidity and mortality of this disease. HAART has achieved disease control, significantly increasing survival and improving the quality of life of subjects with HIV infection.

Spain has one of the highest prevalences of HIV-HCV co-infection because both HCV and HIV infection are strongly associated to being or having been an intravenous drug user (IDU); thus, from 61% to 69% of these subjects infected by HIV in Spain are also infected by HCV.

From 1998, standard treatment for chronic C hepatitis consists of the combination of interferon alpha and ribavirin, based on an increased efficacy versus interferon monotherapy; however, development of pegylated interferon, with a more convenient bioavailability as compared to conventional interferon alpha, has allowed for developing even more effective combined therapies and the possibility of improving response prediction based on changes in viremia within the first few weeks of treatment. However, treatment of HCV infection usually involves severe side effects, which often lead to treatment discontinuation or to the need for adjusting drug dosage, in which case treatment efficacy may decrease.

HCV+ subjects who, because of HIV co-infection, should also receive HAART, may have an increased number or increased severity of adverse reactions due to interactions occurring with drug co-administration.

Lopinavir/ritonavir (LPV/r) is a potent HIV protease inhibitor and is characterized by a very high pharmacological and genetic barrier.

Different studies (subject cohorts, uncontrolled studies) during the past years have appeared in the literature showing the efficacy of LPV/r or controlling viral replication.

Most studies were conducted with the soft gel capsule formulation of LPV/r. In this study, the new formulation of LPV/r (Kaletra) as tablets approved by the FDA and EMEA (Spain authorization 30th Oct 2006) will be used. This new formulation will provide additional benefits to this strategy that has only been studied to date with soft gel capsules.

Based on the foregoing and on the additional cost savings involved in this strategy, we think that LPV/r, as single antiretroviral agent concomitantly administered with treatment for hepatitis C virus infection may provide significant benefits because it would prevent interactions between NRTIs and ribavirin, thus being potentially able to decrease the adverse events derived from mitochondrial toxicity and minimizing the possibility of anemia. In addition, replacement of NNRTIs by LPV/r may significantly decrease CNS involvement that may be enhanced by co-administration of efavirenz and peg-interferon, or minimize the risk of hepatotoxicity caused by nevirapine.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 68 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Multicenter, Randomized, Open Label, Pilot Study to Assess the Possibility of Concomitant Treatment of HCV/HIV co Infection With Peg-interferon + Ribavirin, and Lopinavir/r as a Single Antiretroviral Agent.
Study Start Date : February 2008
Actual Primary Completion Date : June 2012
Actual Study Completion Date : October 2012

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS

Arm Intervention/treatment
Experimental: 1
Lopinavir/ritonavir (LPV/r) as single antiretroviral administered concomitantly with peg-interferon and ribavirin
Drug: Lopinavir/ritonavir
NRTI sparing-regimen
Other Name: Kaletra

Active Comparator: 2
Lopinavir/ritonavir (LPV/r) with 2 NRTIs, administered concomitantly with peg-interferon and ribavirin
Drug: Lopinavir/ritonavir with two nucleoside analogs
LPV/r plus 2NRTIs + PEG-INF + RBV

Primary Outcome Measures :
  1. Assess efficacy of concomitant treatment with lopinavir/r monotherapy and PEG-INF plus RBV for the control of both HIV and HCV infection respectively after 12 months of active treatment for HCV [ Time Frame: 80 weeks ]

Secondary Outcome Measures :
  1. Tolerability and safety of concomitant treatment with LPV/r, PEG-INF and RBV [ Time Frame: 80 weeks ]
  2. CD4 [ Time Frame: 80 weeks ]
  3. Efficacy [ Time Frame: 80 weeks ]
  4. Adherence [ Time Frame: 80 weeks ]

Information from the National Library of Medicine

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.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

Subjects must meet all the following criteria in the 30 days prior to study inclusion.

  1. Subject consent to participate in this study after being informed of all trial aspects that may influence his/her decision, given by signing and dating the informed consent form approved by the CREC of the corresponding center.
  2. Subject is at least 18 years old, is co-infected by HIV and HCV, and has been recommended treatment for HCV infection.
  3. Liver biopsy confirming the presence of chronic hepatitis performed within one year of patient entry into the study.
  4. Undetectable viral load (<50 cop/mL) during at least the 6 last months (confirmed). At least two viral load determinations lower than 50 cop/mL 6 months apart are required. The inclusion of patients showing one single "blip" during the pre-enrollment past 6 months is allowed. A "blip" is defined as a HIV viral load greater or equal to 50 cop/mL both preceded and followed of viral loads inferior to 50 cop/mL without changes in the antiretroviral treatment.
  5. CD4 at screening should be at least or greater to 350 cells/microl
  6. Subject on continued, uninterrupted antiretroviral therapy for the past 6 months with

    1. LPV/r + 2 NRTIs/NtRTIs for at least 4 weeks;
    2. 1 NNRTI + 2 NRTIs
    3. 3 NRTIs Only changes in protease inhibitor due solely to toxicity, simplification, or optimization are acceptable
  7. Subject has not been treated for an active opportunistic infection within 30 days of the baseline visit.
  8. Subject has a Karnofsky index >-70.
  9. Throughout the study, the patient does not require and agrees not to take any of the following drugs, that are contraindicated with Kaletra: astemizole, terfenadine, midazolam, triazolam, cisapride, certain ergot derivatives (ergotamine, dihydroergotamine, ergonovine, methylergonovine), pimozide, propafenone, and flecainide. Rifampin, a potent enzyme inducer, should not be administered with the study medication due to the possibility of a significant decrease in Kaletra concentrations during concomitant administration.
  10. Subject agrees not to take any medication, including over-the-counter medicines, alcohol, drugs, or herbal preparations without the knowledge and approval of the principal investigator.
  11. Laboratory tests have been made in the subject in the past 30 days.
  12. Hemoglobin >8.0 g/dL Absolute neutrophil count >750 cells/microL Platelet count >20.000/microL ALT or AST <5 x upper normal limit (UNL) Creatinine <1.5 x UNL
  13. Triglycerides <750 mg/dL.
  14. For women with childbearing potential, a negative result of a pregnancy test is available and they agree to use throughout the study at least two contraceptive methods (including a barrier one) of proven reliability in the investigator's opinion.
  15. In the case of men subjects, they are agreed to use during the hepatitis C treatment with ribavirin at least two contraceptive methods (including a barrier one).

Exclusion Criteria:

Subjects will be excluded from study participation if they meet any of the following criteria:

  1. Subjects in whom a switch in protease inhibitor has ever been made due to suspected or documented virological failure.
  2. Subjects requiring treatment with drugs whose association with LPV/r is contraindicated based on Kaletra prescribing information..
  3. Active drug addiction or psychiatric disease that may prevent protocol compliance. Use of cannabis or being on methadone treatment are excepted, provided protocol compliance is not compromised in the investigator's opinion.
  4. Pregnancy or nursing, and in women of childbearing age, if they do not agree to use throughout the study a barrier contraceptive method of proven reliability in the investigator's opinion.
  5. In the opinion of the principal investigator, patient is unlikely to comply with the study protocol, or the patient was not eligible for any other reason.
  6. Subjects infected by the hepatitis B virus and who are being treated with tenofovir (TDF) or lamivudine (3TC).
  7. Prior treatment with interferon (pegylated or not) and/or ribavirin.

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 identifier (NCT number): NCT00866021

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Hospital Germans Trias i Pujol
Badalona, Barcelona, Spain, 08910
Hospital Donostia
San Sebastian, Guipuzcoa, Spain
Hospital General Sta. Mª del Rosell
Cartagena, Murcia, Spain, 30203
Hospital General de Castellón
Castellón, Spain, 12004
Hospital Gregorio Marañón
Madrid, Spain, 28007
Hospital Ramón y Cajal
Madrid, Spain, 28034
Hospital la Paz
Madrid, Spain, 28046
Hospital La Princesa
Madrid, Spain
Hospital La Fe
Valencia, Spain, 46009
Hospital General Universitario de Valencia
Valencia, Spain, 46014
Sponsors and Collaborators
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Study Chair: Enrique Ortega Hospital General Universitario de Valencia
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Responsible Party: Fundacion SEIMC-GESIDA Identifier: NCT00866021    
Other Study ID Numbers: GESIDA-5506
2007-003544-30 ( EudraCT Number )
First Posted: March 20, 2009    Key Record Dates
Last Update Posted: March 22, 2013
Last Verified: March 2013
Keywords provided by Fundacion SEIMC-GESIDA:
HIV infection
HCV infection
treatment experienced
Additional relevant MeSH terms:
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Communicable Diseases
HIV Infections
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Parasitic Diseases
HIV Protease Inhibitors
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Anti-HIV Agents
Anti-Retroviral Agents
Antiviral Agents
Anti-Infective Agents
Cytochrome P-450 CYP3A Inhibitors
Cytochrome P-450 Enzyme Inhibitors