People With CHC Who Achieved a Sustained Virological Response Following Therapy With Direct Acting Antiviral Agents

• Status: Recruiting
• Trial end date: 2032-12-31
• Target enrollment: 0
• Participant gender: All

Summary

Background:

Chronic hepatitis C infects the liver. It may scar the liver. This is called cirrhosis and may lead to liver cancer or death. Current chronic hepatitis C treatments cure most people. But some keep getting complications even after it is cured. Researchers want to study why.

Objective:

To study the course and complications of liver disease after cure of hepatitis C infection.

Eligibility:

Adults 18 years and older infected with chronic hepatitis C virus who were never treated or were treated and not cured and those who were cured

Design:

Participants will be screened with:

Blood and urine tests

Questionnaires

Liver ultrasound

Fibroscan. A probe vibrates the liver, testing stiffness.

In Phase 1, people with chronic hepatitis C will:

Have a 3-day hospital admission to repeat some screening tests and have a liver biopsy. A small piece of liver is removed by needle passed through the skin.

Take 1 tablet containing 2 hepatitis C drugs once a day for 12 weeks.

Repeat some blood tests at 3 visits in those 12 weeks while on treatment, then 4 additional visits in the next 24 weeks with more blood work collected.

Phase 1 participants who test negative for hepatitis C and all other eligible participants will enter Phase 2.

Phase 2 participants will have a visit every 24 weeks for 10 years. These may include:

Repeats of screening tests

Questionnaires

Scans

Stool tests

Chest x-ray

Heart function test

Endoscopy. A tube guides a camera into the upper digestive system.

At about 5 years, participants will have another liver biopsy.

Some participants will give separate consent for genetic testing and a special blood procedure.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• Treatments: Sofosbuvir-velpatasvir drug combination

Criteria

• INCLUSION CRITERIA:

Phase I Treatment

• Male or female, >= 18 years of age

• Either treatment naive or experienced defined as failure of a prior course of interferon-based and ribavirin, DAA plus interferon and DAA only (except for NS5a failures)

• Confirmation of chronic HCV infection documented by either:

• A positive HCV RNA or positive HCV genotyping test at least 6-months prior to the Baseline/Day 1 visit, or

• A liver biopsy performed prior to screening visit showing evidence of chronic hepatitis.

• Subjects must have the following laboratory parameters at screening:

• ALT <= 10 x the upper limit of normal (ULN)

• AST <= 10 x ULN

• Total bilirubin <2.5 mg/dL, Direct bilirubin <= 1.5 ULN

• Platelets >= 50,000 K/mm3

• HbA1c <= 8.5%

• Hemoglobin >= 10g/dL

• Albumin >= 3g/dL

• INR <= 1.5 unless subject has known hemophilia or is stable on an anticoagulant regimen affecting INR.

• HCV RNA positive at screening.

• Subjects must be of generally good health, with the exception of chronic HCV infection, as determined by the Investigator.

Phase II Follow-up

• Male or female >= 18 years of age .

• SVR24 following therapy with a direct acting antiviral agent regimen and available liver biopsy performed prior to treatment.

• Subject must be of generally good health as determined by the Investigator.

EXCLUSION CRITERIA:

An individual who meets any of the following criteria will be excluded from participation in this study:

Phase I Treatment

• Pregnancy or lactation

• Inability to practice one form of adequate contraction for females of childbearing potential

• Current or prior history of any of the following:

• Clinically significant illness (other than HCV) or any other major medical disorder that may interfere with subject treatment, assessment, or compliance with the protocol; subjects currently under evaluation for a potentially clinically significant illness (other than HCV) are also excluded

• Gastrointestinal disorder or post-operative condition that could interfere with the absorption of the study drug

• Decompensated liver disease as defined by serum bilirubin >= 2.5 mg/dL (with direct bilirubin >= 1.5 mg/dL), INR >1.5 a serum albumin of less than 3 g/dL, or a history of ascites, hepatorenal syndrome, variceal bleeding, or hepatic encephalopathy

• Solid organ transplantation

• Significant pulmonary disease, significant cardiac disease, or porphyria

• History of malignancy or treatment for a malignancy within the past 3 years that is associated with a life expectancy <5 years (except adequately treated carcinoma in situ or basal cell carcinoma of the skin).

• Chronic liver disease of a non-HCV etiology with the exception of steatosis (e.g., chronic hepatitis B, hemochromatosis, Wilson s disease, alfa-1 antitrypsin deficiency, cholangitis).

• Evidence of harmful or hazardous drinking as defined as a score >= 8 on the AUDIT questionnaire.

• Co-infection with HIV defined as the presence of anti-HIV in serum.

• Clinically relevant drug abuse based on patient history within 12 months of screening.

• Use of any prohibited concomitant medications within 21 days of the Baseline/Day 1 visit; this washout period does not apply to proton pump inhibitors, which can be taken up to 7 days before baseline Day 1 for the following:

• Acid reducing Agents

• Antiarrhythmics

• Anticancer

• Antimycobacterial

• HIV antivirals

• Herbal supplements

• HMG-CoA Reductase Inhibitors

• Use of antiviral medications within the last 30 days.

• Chronic use of systemically administered immunosuppressive agents (e.g., prednisone equivalent >= 10 mg/day).

• Known hypersensitivity to sofosbuvir and velpatasvir, or formulation excipients.

• Hepatocellular carcinoma, or the presence of a mass on imaging studies of the liver that is suggestive of hepatocellular carcinoma, or an alpha-fetoprotein level of greater than 500 mg/mL

• Active psychiatric problems such as major depression, schizophrenia, bipolar illness, obsessive-compulsive disorder, severe anxiety, or personality disorder that, in the investigator s opinion, might interfere with participation in the study.

• Presence of conditions that, in the opinion of the investigators, would not allow the subject to n the current study for at least 1 year.

Phase II Follow-up

• Pregnancy

• Current or prior history of any of the following:

• Clinically significant illness (other than resolved HCV) or any other major medical disorder that may interfere with subject treatment, assessment, or compliance with the protocol; subjects currently under evaluation for a potentially clinically significant illness

(other than HCV) are also excluded

--Decompensated liver disease as defined by serum bilirubin >= 2.5 mg/dL (with direct

bilirubin >= 1.5 mg/dL), INR >1.5 a serum albumin of less than 3 g/dL, or a history of ascites, hepatorenal syndrome, variceal bleeding, or hepatic encephalopathy.

• Solid organ transplantation

• Significant pulmonary disease, significant cardiac disease, or porphyria

• History of malignancy or treatment for a malignancy within the past 3 years that is associated with a life expectancy <5 years (except adequately treated carcinoma in situ or basal cell carcinoma of the skin)

• Chronic liver disease with the exception of steatosis (e.g., chronic hepatitis B, hemochromatosis, Wilson s disease, alfa-1 antitrypsin deficiency, cholangitis)

• Evidence of harmful or hazardous drinking as defined as a score >= 8 on the AUDIT questionnaire

• Co-infection with HIV defined as the presence of anti-HIV in serum

• Clinically relevant drug abuse based on patient history within 12 months of screening

• Chronic use of systemically administered immunosuppressive agents (e.g., prednisone equivalent >= 10 mg/day)

• Hepatocellular carcinoma, or the presence of a mass on imaging studies of the liver that is suggestive of hepatocellular carcinoma, or an alpha-fetoprotein level of greater than 500 mg/mL

• Active psychiatric problems such as major depression, schizophrenia, bipolar illness, obsessive-compulsive disorder, severe anxiety, or personality disorder that, in the investigator s opinion, might interfere with participation in the study

• Presence of conditions that, in the opinion of the investigators, would not allow the patient to be followed in the current study for at least 1 year.