Raltegravir in Patients With End Stage Liver Disease and in Transplant Recipients (LIVERAL)
HIV Infection, Liver Failure, Evidence of Liver Transplantation
About this trial
This is an interventional treatment trial for HIV Infection focused on measuring Pharmacokinetics, Raltegravir, Immunosuppressive Agents, Severe hepatic insufficiency, Liver Transplantation, Additional Keywords, HIV Infection, Hepatocarcinoma, Hepatitis C, Hepatitis B
Eligibility Criteria
Inclusion Criteria:
- Age ≥ 18
- Documented HIV-1 infection, hepatitis B or C co-infection is allowed
- Plasma viral load at screening visit below 50 copies per mL for at least 6 months
- Patient with severe liver failure (Meld Score ≥ 15 and/or refractory ascites and/or haemorrhage of digestive tract and/or hepatic encephalopathy) for taking part into period 1
- Patient eligible for the liver transplant waiting list or immediate post transplantation for taking part into period 2
- Abstinence from alcohol intake for at least 6 months (WHO norm)
- Withdrawal from intravenous drug use for at least 6 months (methadone substitution is permitted)
- No ongoing class C opportunistic infection (1993 CDC classification)
- Patient whose clinical and immunovirological condition allows triple therapy with raltegravir + 2 NRTI or raltegravir + NRTI + enfuvirtide
Patient whose HIV population, according to cumulative genotypes carried out on viral RNA together with treatment history (if available and interpreted as per the ANRS-AC11 algorithm version no.19) does not present a profile of mutations associated with resistance to raltegravir and is sensitive to at least two fully active* agents selected among nucleoside/nucleotide reverse transcriptase analogs NRTI (abacavir, lamivudine, emtricitabine, tenofovir) or enfuvirtide
*An ARV agent is considered to be fully active if the cumulative genotypes do not show any mutation associated with resistance or any mutation associated with "possible resistance"
- Patient not having experienced viral escape during treatment combining 3TC, FTC or raltegravir
- Patient registered with or covered by a social security scheme
- For women of child-bearing potential, use of a barrier contraceptive method during sexual intercourse and negative pregnancy test (plasma ß-HCG ) at screening visit
- Informed consent form signed at screening visit at the latest
Exclusion Criteria:
- More than two virological failures during antiretroviral treatment
- Currently receiving treatment with an agent in development (apart from an authorization for temporary use)
- Plasma viral load at screening visit ≥ 50 copies per mL during at least the last 6 months
- Pregnant women, or women liable to become pregnant, breast-feeding women, no contraception, or refusal to use contraception
- All conditions (including but not limited to alcohol intake and drug use) liable to compromise, in the investigator's opinion, the safety of treatment and/or the patient's compliance with the protocol
- Patient not having any effective options for NRTI +/- enfuvirtide (defined in the inclusion criteria)
- Ongoing treatment with interferon-alpha or ribavirin for hepatitis C
Concomitant medication including one or more agents liable to induce UGT1A1 and reduce raltegravir concentrations:
- anti-infective agents: rifampicin/rifampin
- psychotropic/antiepileptic agents: phenytoin, phenobarbital, carbamazepine
- steroidal anti-inflammatory drug: dexamethasone
Sites / Locations
- Service de Médecine Interne, Hôpital de Bicêtre
Arms of the Study
Arm 1
Experimental
Raltegravir potassium
raltegravir 400 mg twice a day