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Changes in Liver Steatosis After Switching to Raltegravir in HIV/HCV Coinfection (STERAL)

Primary Purpose

HCV Coinfection, HIV Infection

Status
Completed
Phase
Phase 4
Locations
Spain
Study Type
Interventional
Intervention
Raltegravir
Efavirenz
Sponsored by
Juan Macías
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HCV Coinfection

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Each subject must be willing and able to provide written informed consent for the trial.
  2. Each subject must be ≥ 18 years of age.
  3. Each subject must be male or non-pregnant, non-breastfeeding female
  4. Each subject must have diagnosis of HIV infection.
  5. Each subject must have concomitant coinfection by HCV as shown by detectable plasma HCV RNA.
  6. Each subject must have stable treatment with EFV plus two nucleoside analogs for ≥24 weeks.
  7. Each subject must have at least 2 documented plasma HIV RNA <50 copies/ml during the last 24 weeks, as observed in, at least, two clinical visits.
  8. Each subject must have HS involving more than 10% of hepatocytes, as determined by a CAP measurement ≥238 dB/m.
  9. Each sexually active female subject of child-bearing potential must agree to use a medically accepted method of contraception while receiving protocol-specified medication and for 3 months after stopping the medication.Medically accepted methods of contraception include condoms (male or female) with or without a spermicidal agent, diaphragm or cervical cap with spermicide, medically prescribed IUD, inert or copper-containing IUD, hormone releasing IUD, systemic hormonal contraceptive, and surgical sterilization (eg,hysterectomy or tubal ligation).Postmenopausal women are not required to use contraception.Postmenopausal is defined as at least 12 consecutive months without a spontaneous menstrual period.
  10. Each sexually active male subject with a female partner(s) of child-bearing potential must also provide written informed consent to provide information regarding any pregnancy.
  11. Average daily alcohol intake lower than 50 g for men and 40 g for women.

Exclusion Criteria:

  1. The subject has an allergy/sensitivity to investigational product or its/their excipients.
  2. The female subject is nursing.
  3. The female subject is pregnant or intending to become pregnant.
  4. History of ARV failure or documented resistance.
  5. Baseline resistance to EFV or to any of the nucleoside analogues inhibitors in the regimen.
  6. The subject has any clinically significant condition or situation, other than the condition being studied that, in the opinion of the investigator, would interfere with the trial evaluations or optimal participation in the trial.
  7. The subject has active AIDS-defining event (CDC-C) within 24 weeks before screening.
  8. The subject is candidate for therapy against HCV infection during the 48 week trial period in the opinion of the investigator.
  9. The subject has a history of malignant neoplasia.
  10. Active illicit drug use or any other condition that may compromise the study drug adherence in the opinion of the investigators.
  11. The subject has used any investigational drugs within 30 days of Baseline.
  12. A subject who has participated in any other clinical trial within 30 days,inclusive, of signing the informed consent form of the current trial.
  13. The subject or a family member is among the personnel of the investigational or SPONSOR staff directly involved with this trial.

Sites / Locations

  • Hospital La Línea
  • Hospital Universitario Reina Sofía
  • Hospital Infanta Elena
  • Complejo Hospitalario de Jaen
  • Hospital Universitario 12 de Octubre
  • Hospital Universitario La Paz
  • Hospital Regional Universitario Carlos Haya
  • Hospital Universitario Virgen de la Victoria
  • Hospital Universitario Virgen del Rocío
  • H.U. Valme

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Raltegravir

Efavirenz

Arm Description

Patients on current EFV plus two nucleoside analogs will be randomly assigned to switch EFV to RAL (400mg BID), maintaining nucleoside analogs unchanged, or to continue the current regimen.

Patients on current EFV plus two nucleoside analogs will be randomly assigned to switch EFV to RAL (400mg BID), maintaining nucleoside analogs unchanged, or to continue the current regimen.

Outcomes

Primary Outcome Measures

To compare the impact of switching from EFV plus two nucleoside analogs to RAL plus two nucleoside analogs versus keeping the same antiretroviral regimen on HS as measured by CAP among HIV/HCV-coinfected patients.

Secondary Outcome Measures

To evaluate the proportion of patients who maintain viral control (HIV RNA < 50 copies/mL) after switching.

Full Information

First Posted
July 12, 2013
Last Updated
July 24, 2017
Sponsor
Juan Macías
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1. Study Identification

Unique Protocol Identification Number
NCT01900015
Brief Title
Changes in Liver Steatosis After Switching to Raltegravir in HIV/HCV Coinfection
Acronym
STERAL
Official Title
Changes in Liver Steatosis After Switching From Efavirenz to Raltegravir Among HIV/HCV-Coinfected Patients Receiving Two Nucleoside Analogs Plus Efavirenz: The Steral Study
Study Type
Interventional

2. Study Status

Record Verification Date
July 2017
Overall Recruitment Status
Completed
Study Start Date
February 3, 2014 (Actual)
Primary Completion Date
January 17, 2017 (Actual)
Study Completion Date
January 17, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Juan Macías

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Primary Objective: To compare the impact of switching from efavirenz (EFV) plus two nucleoside analogs to rategravir (RAL) plus two nucleoside analogs versus keeping the same antiretroviral regimen on hepatic steatosis (HS) as measured by the controlled attenuation parameter (CAP) among HIV/HCV-coinfected patient. Secondary Trial Objective: To compare the proportion of HIV/HCV-coinfected patients with one category decrease in the grade of HS between patients continuing with EFV plus two nucleoside analogs and those switching from EFV plus two nucleoside analogs to RAL plus two nucleoside analogs. To evaluate the proportion of patients who maintain viral control (HIV RNA < 50 copies/mL) after switching. Design: Open-label, randomized clinical trial to evaluate safety (phase IV) Condition: HIV and HCV coinfection. Intervention: Patients on current EFV plus two nucleoside analogs will be randomly assigned to switch EFV to RAL (400mg BID), maintaining nucleoside analogs unchanged, or to continue the current regimen.
Detailed Description
Primary Objective: To compare the impact of switching from efavirenz (EFV) plus two nucleoside analogs to rategravir (RAL) plus two nucleoside analogs versus keeping the same antiretroviral regimen on hepatic steatosis (HS) as measured by the controlled attenuation parameter (CAP) among HIV/HCV-coinfected patient. Secondary Trial Objective: To compare the proportion of HIV/HCV-coinfected patients with one category decrease in the grade of HS between patients continuing with EFV plus two nucleoside analogs and those switching from EFV plus two nucleoside analogs to RAL plus two nucleoside analogs. To evaluate the proportion of patients who maintain viral control (HIV RNA < 50 copies/mL) after switching. Design: Open-label, randomized clinical trial to evaluate safety (phase IV) Condition: HIV and HCV coinfection. Intervention: Patients on current EFV plus two nucleoside analogs will be randomly assigned to switch EFV to RAL (400mg BID), maintaining nucleoside analogs unchanged, or to continue the current regimen. Study population and sample size HIV-infected patients with concomitant coinfection by HCV, as shown by detectable plasma HCV RNA, not candidates for therapy against HCV infection during the 48 week period of the Number of patients to recruit: 96, 48 patients per treatment group should be recruited.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HCV Coinfection, HIV Infection

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
45 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Raltegravir
Arm Type
Active Comparator
Arm Description
Patients on current EFV plus two nucleoside analogs will be randomly assigned to switch EFV to RAL (400mg BID), maintaining nucleoside analogs unchanged, or to continue the current regimen.
Arm Title
Efavirenz
Arm Type
Active Comparator
Arm Description
Patients on current EFV plus two nucleoside analogs will be randomly assigned to switch EFV to RAL (400mg BID), maintaining nucleoside analogs unchanged, or to continue the current regimen.
Intervention Type
Drug
Intervention Name(s)
Raltegravir
Other Intervention Name(s)
Issentres
Intervention Description
Patients on current EFV plus two nucleoside analogs will be randomly assigned to switch EFV to RAL (400mg BID), maintaining nucleoside analogs unchanged, or to continue the current regimen.
Intervention Type
Drug
Intervention Name(s)
Efavirenz
Other Intervention Name(s)
Sustiva
Intervention Description
Patients on current EFV plus two nucleoside analogs will be randomly assigned to switch EFV to RAL (400mg BID), maintaining nucleoside analogs unchanged, or to continue the current regimen.
Primary Outcome Measure Information:
Title
To compare the impact of switching from EFV plus two nucleoside analogs to RAL plus two nucleoside analogs versus keeping the same antiretroviral regimen on HS as measured by CAP among HIV/HCV-coinfected patients.
Time Frame
48 weeks
Secondary Outcome Measure Information:
Title
To evaluate the proportion of patients who maintain viral control (HIV RNA < 50 copies/mL) after switching.
Time Frame
48 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Each subject must be willing and able to provide written informed consent for the trial. Each subject must be ≥ 18 years of age. Each subject must be male or non-pregnant, non-breastfeeding female Each subject must have diagnosis of HIV infection. Each subject must have concomitant coinfection by HCV as shown by detectable plasma HCV RNA. Each subject must have stable treatment with EFV plus two nucleoside analogs for ≥24 weeks. Each subject must have at least 2 documented plasma HIV RNA <50 copies/ml during the last 24 weeks, as observed in, at least, two clinical visits. Each subject must have HS involving more than 10% of hepatocytes, as determined by a CAP measurement ≥238 dB/m. Each sexually active female subject of child-bearing potential must agree to use a medically accepted method of contraception while receiving protocol-specified medication and for 3 months after stopping the medication.Medically accepted methods of contraception include condoms (male or female) with or without a spermicidal agent, diaphragm or cervical cap with spermicide, medically prescribed IUD, inert or copper-containing IUD, hormone releasing IUD, systemic hormonal contraceptive, and surgical sterilization (eg,hysterectomy or tubal ligation).Postmenopausal women are not required to use contraception.Postmenopausal is defined as at least 12 consecutive months without a spontaneous menstrual period. Each sexually active male subject with a female partner(s) of child-bearing potential must also provide written informed consent to provide information regarding any pregnancy. Average daily alcohol intake lower than 50 g for men and 40 g for women. Exclusion Criteria: The subject has an allergy/sensitivity to investigational product or its/their excipients. The female subject is nursing. The female subject is pregnant or intending to become pregnant. History of ARV failure or documented resistance. Baseline resistance to EFV or to any of the nucleoside analogues inhibitors in the regimen. The subject has any clinically significant condition or situation, other than the condition being studied that, in the opinion of the investigator, would interfere with the trial evaluations or optimal participation in the trial. The subject has active AIDS-defining event (CDC-C) within 24 weeks before screening. The subject is candidate for therapy against HCV infection during the 48 week trial period in the opinion of the investigator. The subject has a history of malignant neoplasia. Active illicit drug use or any other condition that may compromise the study drug adherence in the opinion of the investigators. The subject has used any investigational drugs within 30 days of Baseline. A subject who has participated in any other clinical trial within 30 days,inclusive, of signing the informed consent form of the current trial. The subject or a family member is among the personnel of the investigational or SPONSOR staff directly involved with this trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Juan Macías, MD, PhD
Organizational Affiliation
Infectious Diseases and Microbiology Unit. Hospital Universitario de Valme. Servicio Andaluz de Salud
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hospital La Línea
City
La Línea de la Concepción
State/Province
Cádiz
Country
Spain
Facility Name
Hospital Universitario Reina Sofía
City
Córdoba
Country
Spain
Facility Name
Hospital Infanta Elena
City
Huelva
Country
Spain
Facility Name
Complejo Hospitalario de Jaen
City
Jaen
Country
Spain
Facility Name
Hospital Universitario 12 de Octubre
City
Madrid
Country
Spain
Facility Name
Hospital Universitario La Paz
City
Madrid
Country
Spain
Facility Name
Hospital Regional Universitario Carlos Haya
City
Málaga
Country
Spain
Facility Name
Hospital Universitario Virgen de la Victoria
City
Málaga
Country
Spain
Facility Name
Hospital Universitario Virgen del Rocío
City
Sevilla
Country
Spain
Facility Name
H.U. Valme
City
Seville
ZIP/Postal Code
41014
Country
Spain

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
28903510
Citation
Macias J, Mancebo M, Merino D, Tellez F, Montes-Ramirez ML, Pulido F, Rivero-Juarez A, Raffo M, Perez-Perez M, Merchante N, Cotarelo M, Pineda JA; Spanish AIDS Research Network-HEP09 Study Group. Changes in Liver Steatosis After Switching From Efavirenz to Raltegravir Among Human Immunodeficiency Virus-Infected Patients With Nonalcoholic Fatty Liver Disease. Clin Infect Dis. 2017 Sep 15;65(6):1012-1019. doi: 10.1093/cid/cix467.
Results Reference
derived
Links:
URL
http://www.croiconference.org/sessions/changes-liver-steatosis-after-switching-efavirenz-raltegravir-steral-study-0
Description
Abstract presented at CROI 2017. Poster available to download
URL
http://www.croiwebcasts.org/p/2017croi/croi33405
Description
CROI webcast. THEMED DISCUSSION: OBESITY AND FATTY LIVER DISEASE

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Changes in Liver Steatosis After Switching to Raltegravir in HIV/HCV Coinfection

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