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Treatment of Hepatitis C in Hemophilic Patients With HIV

Primary Purpose

HIV Infections, Hepatitis C, Hemophilia

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Peginterferon alfa-2a
Ribavirin
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infections

Eligibility Criteria

15 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria Hemophilia A or B Exposure to blood or blood products prior to 1987 Participating in "The Second Multicenter Hemophilia Cohort Study (MHCS-II)" HCV reactive by second/third generation ELISA assay and/or RIBA HCV RNA positive (PCR or bDNA methods) Chronic hepatitis confirmed by liver biopsy within 6 months prior to study entry (Note: cirrhosis is not an exclusion factor) HIV infection for coinfected group; HIV viral load of 10,000 copies/ml or less If on antiretroviral drugs, stable regimen for at least 8 weeks prior to study entry Acceptable methods of contraception Exclusion Criteria Hemoglobin less than 10 g/dl For HIV coinfected group, CD4 count less than 200 cells/mm3 at time of screening visit Previous interferon or ribavirin therapy Corticosteroids or immunomodulatory drugs within 3 months prior to study entry Hepatitis B (HBsAg reactive) Alpha-1 antitrypsin deficiency Wilson's disease Hemochromatosis Autoimmune disorder Decompensated liver disease evidenced by encephalopathy, ascites, or variceal bleed Prothrombin Time greater than 3 seconds above normal (International Normalized Ratio [INR] greater than 1.3) Platelet count less than 90,000/microL Active thyroid disease (thyroid replacement with normal TSH permitted) Chronic renal insufficiency, defined as creatinine greater than 1.5 mg/dl Life-threatening disease processes that could preclude completion of trial Alcohol abuse that the local investigator feels would interfere with compliance Illicit recreational drug use or methadone use within 6 months of study entry Major depression with hospitalization or suicide attempt is a relative, but not absolute, contraindication to therapy based on timing, circumstances, and current stability as assessed by the investigator Pregnant or breastfeeding

Sites / Locations

  • University of Cincinnati

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
February 25, 2003
Last Updated
July 29, 2008
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT00055341
Brief Title
Treatment of Hepatitis C in Hemophilic Patients With HIV
Official Title
A Prospective Multicenter, Phase II, Open Label, Controlled Trial Evaluating the Response of Hepatitis C Virus (HCV) to Pegylated Interferon Alpha-2A and Ribavirin in Hemophilic Patients With and Without Coinfection With the Human Immunodeficiency Virus (HIV)
Study Type
Interventional

2. Study Status

Record Verification Date
December 2006
Overall Recruitment Status
Completed
Study Start Date
March 2002 (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
June 2005 (undefined)

3. Sponsor/Collaborators

Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)

4. Oversight

5. Study Description

Brief Summary
Pegylated interferon (PEG-interferon) and ribavirin are accepted treatments for hepatitis C virus (HCV) infection. However, HCV infection progresses differently in patients who are coinfected with HIV and in hemophiliacs. This study will evaluate the effectiveness of PEG-interferon and ribavirin for treating HCV in HIV infected hemophiliacs.
Detailed Description
Hemophiliacs with symptomatic disease often receive blood products to correct clotting factor deficiencies. Prior to routine use of heat inactivation and screening of donor blood for specific viral pathogens, hemophiliacs were routinely exposed to, and infected with, viruses such as hepatitis B (HBV), HCV, and HIV. Studies in hemophiliacs suggest several important findings that warrant further investigation, including: 1) hemophiliacs infected with HCV may have more rapid progression to liver failure and death; 2) pooled blood concentrate from multiple donors leads to a high risk of mixed infection; and 3) different clinical outcomes and altered immune responses of HIV coinfected hemophiliacs may enhance understanding of mutant virus selection and the associated clinical outcomes. The purpose of this trial is to determine response rates to PEG-interferon and ribavirin in hemophiliacs with HCV alone and with HCV/HIV coinfection. Participants in this study will be followed for 48 weeks on treatment and up to 36 months after treatment. Participants in this study will be admitted to the Clinical Research Center for 2 days at the beginning of the study. Participants will have 3 additional study visits in the first week of the study. After that, study visits occur at Weeks 2, 4, 8, 12, 16, 24, 32, 40, and 48. The follow-up visits will be at 4, 12, and 24 weeks following the end of treatment. Study visits include a physical exam and blood tests. Patients who do not respond to treatment will be followed in a prospective cohort study for up to 3 additional years so that evolution of the virus and associated immune responses can be evaluated.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections, Hepatitis C, Hemophilia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
22 (false)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Peginterferon alfa-2a
Intervention Type
Drug
Intervention Name(s)
Ribavirin

10. Eligibility

Sex
All
Minimum Age & Unit of Time
15 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria Hemophilia A or B Exposure to blood or blood products prior to 1987 Participating in "The Second Multicenter Hemophilia Cohort Study (MHCS-II)" HCV reactive by second/third generation ELISA assay and/or RIBA HCV RNA positive (PCR or bDNA methods) Chronic hepatitis confirmed by liver biopsy within 6 months prior to study entry (Note: cirrhosis is not an exclusion factor) HIV infection for coinfected group; HIV viral load of 10,000 copies/ml or less If on antiretroviral drugs, stable regimen for at least 8 weeks prior to study entry Acceptable methods of contraception Exclusion Criteria Hemoglobin less than 10 g/dl For HIV coinfected group, CD4 count less than 200 cells/mm3 at time of screening visit Previous interferon or ribavirin therapy Corticosteroids or immunomodulatory drugs within 3 months prior to study entry Hepatitis B (HBsAg reactive) Alpha-1 antitrypsin deficiency Wilson's disease Hemochromatosis Autoimmune disorder Decompensated liver disease evidenced by encephalopathy, ascites, or variceal bleed Prothrombin Time greater than 3 seconds above normal (International Normalized Ratio [INR] greater than 1.3) Platelet count less than 90,000/microL Active thyroid disease (thyroid replacement with normal TSH permitted) Chronic renal insufficiency, defined as creatinine greater than 1.5 mg/dl Life-threatening disease processes that could preclude completion of trial Alcohol abuse that the local investigator feels would interfere with compliance Illicit recreational drug use or methadone use within 6 months of study entry Major depression with hospitalization or suicide attempt is a relative, but not absolute, contraindication to therapy based on timing, circumstances, and current stability as assessed by the investigator Pregnant or breastfeeding
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kenneth E. Sherman, MD, PhD
Organizational Affiliation
University of Cincinnati
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Cincinnati
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45267
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
17058240
Citation
Shire NJ, Horn PS, Rouster SD, Stanford S, Eyster ME, Sherman KE; Multicenter Hemophilia Cohort HCV Study Group. HCV kinetics, quasispecies, and clearance in treated HCV-infected and HCV/HIV-1-coinfected patients with hemophilia. Hepatology. 2006 Nov;44(5):1146-57. doi: 10.1002/hep.21374.
Results Reference
result
PubMed Identifier
15374882
Citation
Qin H, Shire NJ, Keenan ED, Rouster SD, Eyster ME, Goedert JJ, Koziel MJ, Sherman KE; Multicenter Hemophilia Cohort Study Group. HCV quasispecies evolution: association with progression to end-stage liver disease in hemophiliacs infected with HCV or HCV/HIV. Blood. 2005 Jan 15;105(2):533-41. doi: 10.1182/blood-2004-04-1452. Epub 2004 Sep 16.
Results Reference
result

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Treatment of Hepatitis C in Hemophilic Patients With HIV

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