Zidovudine Levels in HIV Infected Patients Being Treated for HCV

Study Overview
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Brief Summary
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This study will test the amount of anti-HIV drugs in the blood cells of HIV-infected patients who are also being treated for hepatitis C virus (HCV) infection.

Detailed Description
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An estimated 50,000 people in Puerto Rico are infected with HCV. HIV and HCV have similar routes of transmission, and HCV co-infection occurs in 8% to 23% of HIV infected patients. Researchers have shown that treatment for HCV with Rebetron (ribavirin plus interferon alfa-2b) significantly decreases HCV viral load without affecting HIV viral load. However, measurements of intracellular levels of the active forms of zidovudine (ZDV-MP and ZDV-TP) were not performed. Such measurements are needed to provide a more rational basis for dosing in HIV/HCV co-infected patients. This study will investigate the intracellular exposure to active ZDV metabolites prior to and after treatment with Rebetron or treatment with PEG-Intron (pegylated interferon) and ribavirin. Participants in this study will remain on their usual antiretroviral regimen; no changes may be made to that regimen for the first 4 weeks of the study. Upon study entry, participants will have intracellular pharmacokinetic studies. During Week 2, participants will start either Rebetron or PEG-Intron plus ribavirin therapy, will have intracellular pharmacokinetic studies, and will undergo liver biopsy. Additional intracellular pharmacokinetic studies will be performed at Weeks 12 and 24. Rebetron or PEG-Intron plus ribavirin will be given for 48 weeks. A second liver biopsy will be performed 24 weeks after discontinuing Rebetron or PEG-Intron plus ribavirin therapy. Participants will be followed for 72 weeks.

Official Title
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Pharmacological Interactions Between Zidovudine and Ribavirin in HCV-HIV Co-Infected Patients Treated With Rebetron or Peg-Intron Plus Ribavirin

Conditions
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HIV Infections, Hepatitis C

Intervention / Treatment
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* Drug: Ribavirin plus interferon alfa-2b
* Drug: Ribavirin
* Drug: Peginterferon alfa-2b


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria HCV-infected HIV-1 infection CD4 cell count > 200 cells/mm³ within 30 days prior to study entry HIV RNA < 400 copies/ml within 90 days of study entry Use of zidovudine, lamivudine, and any PI and/or NNRTI ANC value >= 1,500 ml³ within 30 days of study entry Weight > 50 kg (110 lbs) for women and > 60 kg (132 lbs) for men Acceptable methods of contraception Ability and willingness to complete the Baseline Adherence Questionnaire Documentation of adherence confirmed by the Baseline Adherence Questionnaire and certified by the study officials Exclusion Criteria Previous ribavirin therapy More than 2 months of interferon therapy Current use of any NRTI other than ZDV and 3TC Hepatitis B surface antigen positive Infectious, autoimmune, tumoral, biliary, or vascular liver disease Alcohol consumption of more than 50 g/day Current use of intravenous drugs Hemoglobin levels < 10 gm/dl Methadone use Chemotherapy Certain medications Acute opportunistic or bacterial infection requiring therapy at the time of enrollment Hemoglobinopathy (e.g., thalassemia) or any other cause of tendency to hemolysis Psychiatric disorders, severe depression, history of suicide attempts, or suicidal ideation Renal disease requiring dialysis Significant coronary diseases or two or more risk factors for coronary diseases, such as > 55 years old, hypertension, and cholesterol > 250 mg/dl Any clinically significant diseases (other than HIV and HCV infection) that, in the opinion of study officials, would compromise the outcome of this study Pregnancy Participation in blinded clinical trial

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br>Participants will begin receive either Rebetron or PEG-Intron plus ribavirin therapy from Weeks 2 through 48 | Drug: Ribavirin plus interferon alfa-2b<br>* Oral tablets taken daily<br>Drug: Ribavirin<br>* Oral tablet taken daily<br>Drug: Peginterferon alfa-2b<br>* Subcutaneous injection<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Steady state area under the concentration time curve (AUC) between 0 and 12 hours of zidovudine (ZDV)-MP, ZDV-TP, and dTTP in PBMCs from HIV and hepatitis C virus (HCV) coinfected patients before and after peginterferon alfa-2b with or without ribavirin |  | Throughout study | 
| Systemic exposure (AUC over 0 to 12 hours) of nelfinavir before and after peginterferon alfa-2b with or without ribavirin in HIV and HCV coinfected patients |  | Throughout study | 
| Effect of peginterferon alfa-2b with or without ribavirin in HCV RNA viral titers, alanine aminotransferase (ALT) levels, CD4+, and HIV-RNA viral titers in HIV and HCV coinfected patients |  | Through Week 48 | 
| Effect of peginterferon alfa-2b with or without ribavirin on liver histology |  | At Week 72 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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HIV, HCV, Ribavirin, Interferon, Co-infection, Treatment experienced