Hepatitis B, HIV Infections
Conditions
Keywords
HIV and Hepatitis B coinfection, Peg interferon, tenofovir, emtricitabine, Hepatitis B e Antigens, Treatment Experienced
Brief summary
HBe seroconversion is an important goal for anti-HBV treatment, since it is associated with a non progressive liver infection and a better clinical outcome. However, the rate of HBe seroconversion is low in HIV-HBV co-infected patients, mostly treated by tenofovir and emtricitabine. This study will evaluate the efficacy and the safety of a one-year Peg-interferon alpha 2a additional treatment in patients already treated by tenofovir and emtricitabine without reaching HBe seroconversion.
Detailed description
Many HBV-HIV co-infected patients are currently treated with dual activity drugs such as tenofovir and emtricitabine, often in combination. However, despite the potent antiviral activity of these drugs, the rate of HBe seroconversion is quite low, and not always sustained over time. HBe seroconversion is an important goal for anti-HBV treatment, since it is associated with a non progressive liver infection and a better clinical outcome. On the other hand, treatments with antiviral and immuno-modulator activity such as Peg-interferon, are infrequently used in co-infected patients, despite promising data in the field of HBV mono-infection with increased rates and sustained HBe seroconversions. This pilot study will evaluate the efficacy and the safety of a one-year Peg-interferon alpha 2a additional treatment (180 micro-g once a week, by injection), in 55 patients already treated by tenofovir and emtricitabine for at least 6 months, and who did not reached HBe seroconversion
Interventions
DRUGTRUVADA (EMTRICITABINE + TENOFOVIR DF)
Truvada ® (200 mg tablet of 300 mg of emtricitabine + tenofovir DF) Dosage 1 tablet taken orally once a day
BIOLOGICALPEGASYS 180μg (Interféron pégylé alpha -2a)
Pegasys ® injection 180μg Dosage: A subcutaneous injection per week
Sponsors
Gilead Sciences
Roche Pharma AG
French National Agency for Research on AIDS and Viral Hepatitis
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* HIV infection * Karnofsky above 80 per cent * Stable ARV since 4 months * CD4 above 200 per mm3 * ARN VIH below 10000 copies per ml * hepatitis B chronic with : positive antigenaemia HBe and negative antiHBe, positive DNA HBV before or under tenofovir treatment, DNA HBV negative or below 10000 copies per ml at W-8. * Previous treatment by tenofovir and lamivudine or emtricitabine more than 6 months
Exclusion criteria
* HIV 2 infection * Hepatitis C or D * Opportunistic infection * Alcool consummation more than 50g/d * Cirrhosis * Pregnancy or plan of pregnancy * Breastfeeding * Immunosuppressive or modulating of the immune response treatment * Other Hepatitis B treatments than tenofovir, lamivudine or emtricitabine since 6 months * Malabsorption * Exclusive HIV therapy with Truvada * Evolutive cancer under chemotherapy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| proportion of patients with seroconversion HBe (loose of HBe antigen and acquisition of HBe antibody) and HBV DNA below 2.3 log10 copies per ml | at Week 72 |
Secondary
| Measure | Time frame |
|---|---|
| proportion of patients with HBV DNA under 2.3 log 10 copies per ml. | at Week 72 and Week 144 |
| proportion of seroconversion HBs. | at Week 72 and Week 144 |
| proportion of patients with no more HBs antigen. | at Week 72 and Week 144 |
| proportion of patients with HBV DNA below 2.3 log 10 copies per ml in relation with 3TC resistance or not before tenofovir treatment; increased of ALT before tenofovir treatment;duration of tenofovir treatment before study. | before tenofovir treatment, duration of tenofovir treatment before study |
| Biological evolution and histological of hepatic activity and fibrosis. | at day 0 and Week 72 |
| Biochemical response (ALT at normal value). | at Week 72 and Week 144 |
| proportion of patients with negative HBe antigen. | at Week 72 and Week 144 |
| HBV and HIV resistance mutations to tenofovir DF and Emtricitabine. | at Week 72 |
| Immunological and virological evolution of HIV infection. | between Day 0 and Week 144 |
| Safety | between Day 0 and Week 144 |
| Quality of life | Day 0, Week 12, Week 24, Week 48, Week 72 |
| Treatment adherence | Day 0 to Week 144 |
| proportion of patients with :seroconversion HBe and HBV DNA below 2.3 log 10 copies per ml | at Week 48 |
Countries
France
Outcome results
None listed