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Entecavir Intensification for Persistent HBV Viremia in HIV-HBV Infection

Primary Purpose

HIV Infections, Hepatitis B

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Entecavir with continued standard of care antiretroviral therapy
continued standard of care with tenofovir in addition to emtricitabine or lamivudine
Sponsored by
University of California, San Francisco
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infections focused on measuring HIV, Hepatitis B, treatment experienced

Eligibility Criteria

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

Inclusion Criteria:

  • Ability and willingness to provide written informed consent
  • HIV infection, documented in patient medical record. Acceptable forms of documentation include positive HIV antibody or detectable HIV RNA.
  • Chronic HBV infection, defined as HBsAg positivity. Both hepatitis B "e" antigen (HBeAg) positive and negative subjects will be eligible.
  • Detectable HBV DNA ( > 160 copies/ml) after 48 weeks of therapy with TDF in conjunction with either 3TC or FTC
  • Compensated liver disease, defined as a Child-Pugh-Turcot(CPT) Score <7 at the time of enrollment.

Note: If Bilirubin in elevated, direct and indirect bilirubin levels will be evaluated. If only indirect bilirubin elevated, direct bilirubin will be used for CPT score. If BOTH direct and indirect bilirubin are elevated, total bilirubin will be used for the CPT score.

  • Stable antiretroviral therapy with no changes in the prior 8 weeks due to antiretroviral failure. HIV therapy modification for reasons other than virologic failure and without change in the tenofovir(TDF), lamivudine(3TC) or emtricitabine(FTC) moiety of the antiretroviral therapy will be permitted. HIV therapy must include TDF in conjunction with 3TC or FTC, and at least one other anti-HIV agent.
  • HIV RNA of <75 copies/ml within 8 weeks of study enrollment.
  • Estimated creatinine clearance by Cockcroft-Gault of ≥ 50 ml/min
  • Serum alpha-fetoprotein (AFP) of ≤50 ng/ml within 8 weeks of study entry, or if elevated > 50 ng/ml, an imaging study demonstrating no evidence of hepatic tumor within 8 weeks of enrollment.
  • Female study volunteers must not participate in a conception process (e.g., active attempt to become pregnant). If participating in sexual activity that could lead to pregnancy, the female study volunteer must use the following forms of contraception while receiving study-specific medication(s) and for 30 days after stopping the medication. One of the following methods MUST be used appropriately:

    • Condoms1 (male or female) with or without a spermicidal agent
    • Diaphragm or cervical cap with spermicide
    • intrauterine device(IUD)
    • Hormonal-based method

      1. Condoms are recommended because their appropriate use is the only contraception method effective for preventing HIV transmission.

Note: Subjects with concomitant Hepatitis C infection will be permitted to enroll.

Exclusion Criteria:

  • Allergy or sensitivity to study drug
  • Pregnancy, breastfeeding or unwillingness/inability to adhere to contraceptive methods for the duration of the study
  • Prisoners or subjects who are incarcerated.
  • Evidence of malignancy that would make the subject, in the opinion of the investigator, unsuitable for the study. This includes any systemic antineoplastic or immunomodulatory treatment or radiation within 24 weeks prior to study entry or the expectation that such treatment will be needed at any time during the study.
  • Receipt of systemic corticosteroids within 90 days prior to study entry (as this medication may increase HBV replication).
  • Investigational anti-HIV agents will be allowed on a case-by-case basis with the approval of the protocol team.
  • Active drug or alcohol use or dependence that, in the opinion of the investigator, would interfere with adherence to study requirements.
  • Any active medical, psychiatric or social circumstance that in the opinion of the investigator puts the subject at potential risk from study participation or makes adherence to the study protocol unlikely.
  • Receipt of the following drugs with anti-HBV activity within 90 days prior to study entry or anticipated receipt during the course of the study including: adefovir(ADV), telbivudine, alpha interferon, penciclovir (Denavir) (except if given for < 4 weeks), famciclovir (Famvir), diaminopurine dioxolane (DAPD), clevudine (L-FMAU), thymosin alpha 1, ganciclovir (treatment limited to < 7 days is acceptable) (Cytovene), L-deoxythymidine, and L-deoxythymidine compounds and other investigational agents with anti-HBV activity.
  • Receipt of nephrotoxic drugs (e.g., aminoglycosides, amphotericin B, vancomycin, cidofovir [Vistide], foscarnet [Foscavir], cisplatin, intravenous pentamidine [Pentam], oral tacrolimus [Prograf], cyclosporine [Sandimmune]) or the competitor of renal excretion, probenecid (Benemid), within 8 weeks prior to study entry or expected use of these agents during the course of the study. (Topical tacrolimus is allowed.)

Sites / Locations

  • San Francisco General HIV Clinical Trials Group

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

A

B

Arm Description

Entecavir 1 mg for 24 weeks in addition to continued standard of care antiretroviral therapy containing tenofovir in addition to emtricitabine or lamivudine

continued standard of care antiretroviral therapy which will include tenofovir in addition to emtricitabine or lamivudine

Outcomes

Primary Outcome Measures

Hepatitis B Virus (HBV) DNA
HBV DNA carries the genetic blueprint of the virus. How many HBV DNA "particles" or "copies" are found in the blood indicates how rapidly the virus is reproducing in the liver.

Secondary Outcome Measures

Incidence of Permanent Discontinuation Due to Toxicity
Incidence of New Hepatic Decompensation( Ascites, Variceal Hemorrhage, Encephalopathy)
Incidence of ALT Flares
ALT flare: sudden increase in blood level of alanine transaminase (ALT)
HIV RNA < 75 Copies/ml

Full Information

First Posted
April 16, 2008
Last Updated
May 17, 2013
Sponsor
University of California, San Francisco
Collaborators
Bristol-Myers Squibb
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1. Study Identification

Unique Protocol Identification Number
NCT00662545
Brief Title
Entecavir Intensification for Persistent HBV Viremia in HIV-HBV Infection
Official Title
Entecavir Intensification for Persistent Hepatitis B Virus (HBV) Viremia in HIV-HBV Infection
Study Type
Interventional

2. Study Status

Record Verification Date
May 2013
Overall Recruitment Status
Completed
Study Start Date
April 2008 (undefined)
Primary Completion Date
February 2010 (Actual)
Study Completion Date
May 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of California, San Francisco
Collaborators
Bristol-Myers Squibb

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will evaluate HIV-HBV infected individuals who have evidence of HBV replication in the blood after taking 48 weeks of more of the HBV active medication tenofovir in combination with emtricitabine or lamivudine. Eligible participants will be randomized to receive 24 weeks of entecavir (ETV) 1 mg versus continued standard of care antiretroviral therapy. After 24 weeks, individuals on entecavir or who remain HBV viremic on standard of care will receive ETV o for an additional 24 weeks. The hypothesis is that intensification with entecavir will reduce HBV DNA at 24 weeks more than continued antiretroviral therapy without entecavir.
Detailed Description
Design: This is a randomized, controlled pilot study of open-label entecavir for the treatment of persistent HBV viremia in HIV-HBV coinfected individuals who have failed to suppress HBV replication after 48 weeks on tenofovir containing therapy. Primary Objective: To evaluate the mean log reduction of HBV DNA with entecavir(ETV) intensification in comparison to continued standard therapy with tenofovir and lamivudine/emtricitabine at 24 weeks of therapy Study Population: HIV-HBV co-infected individuals with detectable HBV DNA after 48 weeks of therapy with tenofovir and lamivudine/emtricitabine whose HIV viremia is well controlled ( < 75 copies at time of enrollment) Treatment: Subjects will be randomized to continue with standard therapy or to receive intensification with 1 mg daily of open label entecavir for the 24 week duration of the study. Sample Size: 24 subjects will be enrolled. Duration 24 weeks of treatment Primary Endpoint: Mean log10 reduction of HBV DNA at 24 weeks of standard therapy vs. entecavir intensification.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections, Hepatitis B
Keywords
HIV, Hepatitis B, treatment experienced

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
10 (Actual)

8. Arms, Groups, and Interventions

Arm Title
A
Arm Type
Experimental
Arm Description
Entecavir 1 mg for 24 weeks in addition to continued standard of care antiretroviral therapy containing tenofovir in addition to emtricitabine or lamivudine
Arm Title
B
Arm Type
Active Comparator
Arm Description
continued standard of care antiretroviral therapy which will include tenofovir in addition to emtricitabine or lamivudine
Intervention Type
Drug
Intervention Name(s)
Entecavir with continued standard of care antiretroviral therapy
Other Intervention Name(s)
Baraclude, Tenofovir, Truvada, Viread, 3TC, FTC, Epivir, Emtriva
Intervention Description
1 mg by mouth daily
Intervention Type
Drug
Intervention Name(s)
continued standard of care with tenofovir in addition to emtricitabine or lamivudine
Other Intervention Name(s)
Tenofovir, Truvada, Viread, 3TC, FTC, Epivir, Emtriva
Intervention Description
continued standard of care with tenofovir in addition to emtricitabine or lamivudine
Primary Outcome Measure Information:
Title
Hepatitis B Virus (HBV) DNA
Description
HBV DNA carries the genetic blueprint of the virus. How many HBV DNA "particles" or "copies" are found in the blood indicates how rapidly the virus is reproducing in the liver.
Time Frame
week 24
Secondary Outcome Measure Information:
Title
Incidence of Permanent Discontinuation Due to Toxicity
Time Frame
24 weeks
Title
Incidence of New Hepatic Decompensation( Ascites, Variceal Hemorrhage, Encephalopathy)
Time Frame
every 4 weeks for 24 weeks
Title
Incidence of ALT Flares
Description
ALT flare: sudden increase in blood level of alanine transaminase (ALT)
Time Frame
every 4 weeks for 24 weeks
Title
HIV RNA < 75 Copies/ml
Time Frame
entry, week 12, and week 24

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Ability and willingness to provide written informed consent HIV infection, documented in patient medical record. Acceptable forms of documentation include positive HIV antibody or detectable HIV RNA. Chronic HBV infection, defined as HBsAg positivity. Both hepatitis B "e" antigen (HBeAg) positive and negative subjects will be eligible. Detectable HBV DNA ( > 160 copies/ml) after 48 weeks of therapy with TDF in conjunction with either 3TC or FTC Compensated liver disease, defined as a Child-Pugh-Turcot(CPT) Score <7 at the time of enrollment. Note: If Bilirubin in elevated, direct and indirect bilirubin levels will be evaluated. If only indirect bilirubin elevated, direct bilirubin will be used for CPT score. If BOTH direct and indirect bilirubin are elevated, total bilirubin will be used for the CPT score. Stable antiretroviral therapy with no changes in the prior 8 weeks due to antiretroviral failure. HIV therapy modification for reasons other than virologic failure and without change in the tenofovir(TDF), lamivudine(3TC) or emtricitabine(FTC) moiety of the antiretroviral therapy will be permitted. HIV therapy must include TDF in conjunction with 3TC or FTC, and at least one other anti-HIV agent. HIV RNA of <75 copies/ml within 8 weeks of study enrollment. Estimated creatinine clearance by Cockcroft-Gault of ≥ 50 ml/min Serum alpha-fetoprotein (AFP) of ≤50 ng/ml within 8 weeks of study entry, or if elevated > 50 ng/ml, an imaging study demonstrating no evidence of hepatic tumor within 8 weeks of enrollment. Female study volunteers must not participate in a conception process (e.g., active attempt to become pregnant). If participating in sexual activity that could lead to pregnancy, the female study volunteer must use the following forms of contraception while receiving study-specific medication(s) and for 30 days after stopping the medication. One of the following methods MUST be used appropriately: Condoms1 (male or female) with or without a spermicidal agent Diaphragm or cervical cap with spermicide intrauterine device(IUD) Hormonal-based method Condoms are recommended because their appropriate use is the only contraception method effective for preventing HIV transmission. Note: Subjects with concomitant Hepatitis C infection will be permitted to enroll. Exclusion Criteria: Allergy or sensitivity to study drug Pregnancy, breastfeeding or unwillingness/inability to adhere to contraceptive methods for the duration of the study Prisoners or subjects who are incarcerated. Evidence of malignancy that would make the subject, in the opinion of the investigator, unsuitable for the study. This includes any systemic antineoplastic or immunomodulatory treatment or radiation within 24 weeks prior to study entry or the expectation that such treatment will be needed at any time during the study. Receipt of systemic corticosteroids within 90 days prior to study entry (as this medication may increase HBV replication). Investigational anti-HIV agents will be allowed on a case-by-case basis with the approval of the protocol team. Active drug or alcohol use or dependence that, in the opinion of the investigator, would interfere with adherence to study requirements. Any active medical, psychiatric or social circumstance that in the opinion of the investigator puts the subject at potential risk from study participation or makes adherence to the study protocol unlikely. Receipt of the following drugs with anti-HBV activity within 90 days prior to study entry or anticipated receipt during the course of the study including: adefovir(ADV), telbivudine, alpha interferon, penciclovir (Denavir) (except if given for < 4 weeks), famciclovir (Famvir), diaminopurine dioxolane (DAPD), clevudine (L-FMAU), thymosin alpha 1, ganciclovir (treatment limited to < 7 days is acceptable) (Cytovene), L-deoxythymidine, and L-deoxythymidine compounds and other investigational agents with anti-HBV activity. Receipt of nephrotoxic drugs (e.g., aminoglycosides, amphotericin B, vancomycin, cidofovir [Vistide], foscarnet [Foscavir], cisplatin, intravenous pentamidine [Pentam], oral tacrolimus [Prograf], cyclosporine [Sandimmune]) or the competitor of renal excretion, probenecid (Benemid), within 8 weeks prior to study entry or expected use of these agents during the course of the study. (Topical tacrolimus is allowed.)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Anne F Luetkemeyer, MD
Organizational Affiliation
HIV/AIDS Division, San Francisco General Hospital, University of California, San Francisco
Official's Role
Principal Investigator
Facility Information:
Facility Name
San Francisco General HIV Clinical Trials Group
City
San Francisco
State/Province
California
ZIP/Postal Code
94110
Country
United States

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Entecavir Intensification for Persistent HBV Viremia in HIV-HBV Infection

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