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Pioglitazone to Treat Fatty Liver in Patients With HIV and Hepatitis C Infections

Primary Purpose

HIV, Hepatitis C, Liver Disease

Status

Terminated

Phase

Phase 4

Locations

United States

Study Type

Interventional

Intervention

Pioglitazone

Placebo

About this trial

This is an interventional treatment trial for HIV focused on measuring HIV, Hepatitis C, Liver Disease, Fatty Liver, Steatosis

Eligibility Criteria

18 Years - 99 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

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

Sites / Locations

VA Medical Center
National Institutes of Health Clinical Center, 9000 Rockville Pike

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Pioglitazone

Placebo

Arm Description

pioglitazone 45 mg daily for 48 weeks

one capsule daily for 48 weeks

Outcomes

Primary Outcome Measures

Change in Hepatic Steatosis and Hepatic Inflammation/Fibrosis in HIV/HCV Co-infected Patients With Steatosis.

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

Secondary Outcome Measures

Change in Insulin Resistance in HIV- and HCV-infected Patients With Steatosis Compared to Placebo

Change in Glucose Area Under the Curve from standard oral glucose challenge ( baseline to 2 hours): Week 48 - Baseline values

Full Information

NCT ID

NCT00742326

First Posted

August 26, 2008

Last Updated

October 26, 2016

Sponsor

National Institute of Allergy and Infectious Diseases (NIAID)

1. Study Identification

Unique Protocol Identification Number

NCT00742326

Brief Title

Pioglitazone to Treat Fatty Liver in Patients With HIV and Hepatitis C Infections

Official Title

Pioglitazone for Hepatic Steatosis in HIV/HCV Co-infection

Study Type

Interventional

2. Study Status

Record Verification Date

October 2016

Overall Recruitment Status

Terminated

Why Stopped

Enrollment stopped prior to complete enrollment due to slow accrual

Study Start Date

August 2008 (undefined)

Primary Completion Date

January 2013 (Actual)

Study Completion Date

January 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Sponsor

Name of the Sponsor

National Institute of Allergy and Infectious Diseases (NIAID)

4. Oversight

Data Monitoring Committee

Yes

5. Study Description

Brief Summary

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.

Detailed Description

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.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

HIV, Hepatitis C, Liver Disease, Fatty Liver, Steatosis

Keywords

HIV, Hepatitis C, Liver Disease, Fatty Liver, Steatosis

7. Study Design

Primary Purpose

Treatment

Study Phase

Phase 4

Interventional Study Model

Parallel Assignment

Masking

ParticipantCare ProviderInvestigatorOutcomes Assessor

Allocation

Randomized

Enrollment

13 (Actual)

8. Arms, Groups, and Interventions

Arm Title

Pioglitazone

Arm Type

Experimental

Arm Description

pioglitazone 45 mg daily for 48 weeks

Arm Title

Placebo

Arm Type

Placebo Comparator

Arm Description

one capsule daily for 48 weeks

Intervention Type

Drug

Intervention Name(s)

Pioglitazone

Other Intervention Name(s)

Avandia

Intervention Description

45 mg/daily

Intervention Type

Drug

Intervention Name(s)

Placebo

Intervention Description

one capsule daily

Primary Outcome Measure Information:

Title

Change in Hepatic Steatosis and Hepatic Inflammation/Fibrosis in HIV/HCV Co-infected Patients With Steatosis.

Description

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

Time Frame

48 weeks

Secondary Outcome Measure Information:

Title

Change in Insulin Resistance in HIV- and HCV-infected Patients With Steatosis Compared to Placebo

Description

Change in Glucose Area Under the Curve from standard oral glucose challenge ( baseline to 2 hours): Week 48 - Baseline values

Time Frame

48 weeks

10. Eligibility

Sex

All

Minimum Age & Unit of Time

18 Years

Maximum Age & Unit of Time

99 Years

Accepts Healthy Volunteers

Eligibility Criteria

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

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Colleen M Hadigan, M.D.

Organizational Affiliation

National Institute of Allergy and Infectious Diseases (NIAID)

Official's Role

Principal Investigator

Facility Information:

Facility Name

VA Medical Center

City

Washington

State/Province

District of Columbia

ZIP/Postal Code

20422

Country

United States

Facility Name

National Institutes of Health Clinical Center, 9000 Rockville Pike

City

Bethesda

State/Province

Maryland

ZIP/Postal Code

20892

Country

United States

12. IPD Sharing Statement

Plan to Share IPD

IPD Sharing Plan Description

Decision will be made at the time of request

Citations:

PubMed Identifier

12684916

Citation

Jain MK, Skiest DJ, Cloud JW, Jain CL, Burns D, Berggren RE. Changes in mortality related to human immunodeficiency virus infection: comparative analysis of inpatient deaths in 1995 and in 1999-2000. Clin Infect Dis. 2003 Apr 15;36(8):1030-8. doi: 10.1086/368186. Epub 2003 Apr 2.

Results Reference

background

PubMed Identifier

10770916

Citation

Sulkowski MS, Mast EE, Seeff LB, Thomas DL. Hepatitis C virus infection as an opportunistic disease in persons infected with human immunodeficiency virus. Clin Infect Dis. 2000 Apr;30 Suppl 1:S77-84. doi: 10.1086/313842.

Results Reference

background

PubMed Identifier

15802977

Citation

Sulkowski MS, Mehta SH, Torbenson M, Afdhal NH, Mirel L, Moore RD, Thomas DL. Hepatic steatosis and antiretroviral drug use among adults coinfected with HIV and hepatitis C virus. AIDS. 2005 Mar 24;19(6):585-92. doi: 10.1097/01.aids.0000163935.99401.25.

Results Reference

background

PubMed Identifier

26214341

Citation

Matthews L, Kleiner DE, Chairez C, McManus M, Nettles MJ, Zemanick K, Morse CG, Benator D, Kovacs JA, Hadigan C. Pioglitazone for Hepatic Steatosis in HIV/Hepatitis C Virus Coinfection. AIDS Res Hum Retroviruses. 2015 Oct;31(10):961-6. doi: 10.1089/AID.2015.0093. Epub 2015 Aug 24.

Results Reference

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Pioglitazone to Treat Fatty Liver in Patients With HIV and Hepatitis C Infections

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