HIV Drug Switch Followed by HCV Therapy in HIV-HCV Co-Infection

• Status: Unknown status
• Trial end date: 2017-12-01
• Target enrollment: 0
• Participant gender: All

Summary

This is an prospective open label pilot study conducted over 32 weeks.

A total of 25 eligible participants who are infected with HCV and HIV will be recruited from 2 Canadian HIV Trials Network (CTN) sites (Ottawa Hospital Research Institute and McGill University Health Centre)

This study is looking into the effectiveness of a combination of Elvitegravir/Cobicistat/Emtricitabine/ Tenofovir Alafenamide Single Tablet Regimen (E/C/F/TAF STR) for HIV treatment and Harvoni for HCV treatment .

This study will assess the effect that the study drug has on the metabolism of sugar, the changes in fat in the bloodstream and other metabolic changes. Metabolism is the process your body uses to get or make energy from the food you eat.

This study may provide information on the impact of liver fibrosis (scarring of liver tissues) on metabolic changes before, during and after HCV antiviral therapy.

Drug-drug interactions (DDI) DDI between E/C/F/TAF and LPV-SOF have been well evaluated and no clinically significant interactions have been identified.

A switch to E/C/F/TAF in the context of LPV-SOF HCV antiviral treatment preparation may be particularly beneficial because of its:

1. favorable side effect profile

2. once daily STR formulation

3. known DDI profile with LPV-SOF

4. neutral effect on liver fibrosis

5. improved kidney and bone safety profile with the use of TAF

Conduct of this study is justified as it:

1. Assesses a minimal pill count and dosing frequency strategy of co-treatment of HIV and HCV using well tolerated medications with an excellent safety profile and known DDI profile.

2. Provides additional safety data for TAF in the HIV-HCV co-infected population.

3. Quantifies adherence and identifies obstacles to full adherence in this population. There is a paucity of data related to DAA adherence in licensing studies.

4. Provides real-world safety and efficacy data to support the public funding for LPV-SOF DAA therapy in HIV-HCV co-infected populations.

5. Provides preliminary data on the immunologic and metabolic consequences of HCV clearance in HIV-HCV co-infection

6. As a pilot study, the information gathered will inform the feasibility of future clinical trials evaluating novel treatment strategies for HIV-HCV co-infected patients.

• Phase: Phase 3
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Ottawa Hospital Research Institute
• Collaborators: CIHR Canadian HIV Trials Network; Gilead Sciences
• Treatments: Antiviral Agents; Cobicistat; Emtricitabine; Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination; Ledipasvir; Ledipasvir, sofosbuvir drug combination; Rilpivirine; Sofosbuvir; Tenofovir

Criteria

Inclusion

• HIV infected (ELISA with western blot confirmation)

• HCV RNA positive for minimum of 6 months / Genotype 1

• Prescribed cART that may include any DHHS recommended or alternative regimens, which the treating physician considers, is appropriate for their patient. (We anticipate that approximately 60% will be on HIV protease inhibitor-based regimens).

• HIV RNA BLLQ for minimum of 3 months

• Stage 0 - 4 fibrosis

• No evidence of liver decompensation defined as past or current ascites, bleeding varices or hepatic encephalopathy. Prior interferon, ribavirin and/or HCV protease inhibitor exposure will be allowed with the exception of cirrhotic with a past history of null response to interferon-based therapy.

• Ability to remain adherent to medications and study protocol as per investigator opinion

• For female subjects, not pregnant, planning or suspected to be pregnant or breast-feeding

• Willing to use acceptable methods of birth control, as defined in protocol

• Active substance use and/or mental health issues will not be exclusionary assuming other criteria are met. This inclusion will be restricted to those stably housed and engaged in harm reduction strategies. Our intent is to evaluate study participants who are representative of our clinical population and consider 'difficult to cure' compared to populations already evaluated in licensing studies

Exclusion:

• Concomitant use of drugs with contraindication drug interactions with E/C/F/TAF of SOF-LDV

• History of HIV integrase inihbitors or NRTI resistance mutations

• Platelets <50 x109/L