Study of Cerebral Function in Patients With Chronic Hepatitis C Infection (HCV/CNS)

January 10, 2013 updated by: Aarhus University Hospital

Study of Cerebral Function in Patients With Chronic Hepatitis C Infection Before and After Pegylated Interferon Alfa-2a and Ribavirin Therapy

Patients with HCV infection often suffer from chronic fatigue, depression and reduced cognition, even before evolving severe liver fibrosis, liver cirrhosis and hepatic encephalopathy.

It is currently unclear to what extent the symptoms er due to a direct pathological effects of the virus itself, or due to pre-existing psychiatric disease. There is a complex relationship between prior or existing drug abuse, psychiatric disease and HCV infection, that makes it difficult to establish cause-effect relationships.

A biological mechanism has been suggested to contribute to development of cerebral dysfunction in the patients. According to the prevailing Trojan Horses hypothesis circulating lymphocytes cross the blood brain barrier carrying HCV to the central nervous system and virus is subsequently replicated in the macrophages and the microglia in brain as a separate compartment. As part of the immunological response to viral replication, neurodegenerative processes takes place with a harmful effect on the neural circuit and cerebral function. Identification of HCV RNA negative strand, a replication product, in brain tissue from HCV patients, as part of autopsy studies, supports the hypothesis. Moreover, HCV patients have also been observed with abnormal metabolic concentrations in the frontal white substance and the basal ganglia by MRI spectroscopy compared to control groups.

The overall study objective is to assess cerebral function with particular emphasis on cognitive functions in HCV patients (genotypes 1,2,3 and 4) by use of a neuropsychiatric test battery. Furthermore, the patients will be examined by MRI, including magnetization transfer, diffusion tensor and contrast perfusion, in order to perform measurements of cerebral volumetric and microstructure. Finally, HCV analysis, including viral sequences and cytokine profiles, in serum and cerebrospinal fluid will be carried out in the study population.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

100

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Denmark
    • Jylland
      • Aarhus, Jylland, Denmark, 8200
        • Department of Infectious Diseases, Aarhus University Hospital, Skejby

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 60 years (Adult)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Chronic HCV infection with genotype 1, 2, 3 or 4.
  • Age > 18 and <60
  • Liver biopsy or fibroscan performed within last 5 years
  • Signed informed consent form.

Exclusion Criteria:

  • Liver biopsy showing liver pathology not due to HCV infection.
  • Liver cirrhosis or severe liver fibrosis
  • Former antiviral HCV treatment (for included HCV patients).
  • HIV and/or Hepatitis B virus infection.
  • Alcohol or drug abuse within the last 2 years.
  • Neutropenia, anemia or thrombocytopenia.
  • Clinical signs of non-compensated liver pathology.
  • Moderate to severe cardiopulmonary disease (NYHA score 1 or above)
  • Creatinine clearance < 80mL/min.
  • Pregnancy.
  • Ferromagnetic implants
  • Significant somatic disease affecting the central nervous system (somatic/neurologic disease)
  • Head trauma resulting in unconsciousness > 5min
  • Schizophrenia or other psychotic disorders

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Allocation: Non-Randomized
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Chronic hepatitis C treatment
30 Chronic HCV patients with pending antiviral treatment. A majority will have pending treatment with interferon and ribavirin, and the treated patients will be assessed 8-12 weeks after starting treatment for interferon-induced depression.
Drug: Interferon and ribavirin
Interferon 180 microgram weekly s.c. and ribavirin (800/100/1200 mg daily) p.o.
Other Names:
  • Pegasys (ATC Code: L03AB11) and Copegus (ATC Code: J05AB04)
No Intervention: Healthy Controls
50 age, sex and education matched controls (matched 1:1 to participants in the HCV patient groups (+/- treatment)
No Intervention: Former HCV infected
20 Subjects with prior HCV infection identified through positive HCV antibodies, but negative HCV RNA.
No Intervention: Chronic HCV patient - no treatment
20 chronic HCV patients without pending antiviral treatment.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Neuropsychological test results, cytokine profile and MRI findings
Time Frame: 8 weeks before starting IFN+RIB therapy
Assessment performed before starting antiviral treatment in patients with chronic hepatitis C who awaits treatment. HCV patients without pending treatment will be tested in conjunction with their outpatient controls.
8 weeks before starting IFN+RIB therapy

Secondary Outcome Measures

Outcome Measure
Time Frame
Interferon-induced depression
Time Frame: 8-12 weeks after treatment inititation
8-12 weeks after treatment inititation

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Aarhus University Hospital

Investigators

  • Principal Investigator: Peter Leutscher, MD, PhD, Aarhus University Hospital, Dept. Infectious Diseases

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

November 1, 2008

Primary Completion (Actual)

November 1, 2012

Study Completion (Actual)

November 1, 2012

Study Registration Dates

First Submitted

November 10, 2008

First Submitted That Met QC Criteria

November 10, 2008

First Posted (Estimate)

November 11, 2008

Study Record Updates

Last Update Posted (Estimate)

January 11, 2013

Last Update Submitted That Met QC Criteria

January 10, 2013

Last Verified

January 1, 2013

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • SKS-0078-HCVCNS
  • EudraCT 2007-005707-18

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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