- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01654939
Impact of an Antibiotic (Rifaximin) on Liver Scarring in HIV-Infected Patients With Liver Disease
September 25, 2015 updated by: Douglas T. Dieterich
Impact of Rifaximin on Liver Fibrosis in HIV-Infected Patients With Liver Disease
For HIV-infected patients who have access to treatment, liver diseases are a major cause of morbidity and mortality.
Hepatitis C is the most frequently encountered liver condition in this population.
Both diseases allow a higher level of poisonous substances (toxins) normally produced by the bacteria present in the gut to enter the bloodstream.
This leads to a chronic inflammatory state, which results in faster development of liver scars (fibrosis) and ultimately, end stage disease (cirrhosis).
To prevent this from happening, the use of antibiotics has been attempted to reduce the quantity of gut flora in the hopes of lowering the amount of toxins produced.
These trials have shown promising results, but the antibiotics studied had major side effects and were not designed for continuous use.
Rifaximin is a non absorbable antibiotic with very few side effects.
It is already used for long periods of time in cirrhotic patients to treat the effects of cirrhosis on the brain (encephalopathy).
This project will try to determine if rifaximin, by reducing the level of toxins produced by the bacteria in the gut, can improve the evolution of liver fibrosis in HIV-infected patients with hepatitis C. In this pilot study, ten patients with HIV and HCV infection will be followed for one year.
In addition, 10 patients with HCV mono infection will also be followed.
Both populations will be included if they are starting on rifaximin, for its currently approved FDA indication (hepatic encephalopathy).
Study Overview
Detailed Description
Many studies have already proved the deleterious effects of LPS on HIV and hepatic diseases evolution.
There has never been a concerted effort to prevent the progression of liver disease in these patients.
To date, the only treatment is initiation of antiretroviral therapy.
Rifaximin could be an easy and well tolerated way to improve the outcome of liver disease in HIV-infected patients.
We hypothesize that it could help to slow down the progression of liver disease at any stage in these patients.
This is a pilot study.
A total of twenty patients placed on rifaximin by their physician for a mild hepatic encephalopathy will be monitored over a period of one year.
The evaluation of the fibrosis will be done through transient elastography every 3 months.
Bacterial translocation will be evaluated through the dosing of soluble CD14.
The safety of the prolonged use of rifaximin in patients will also be assessed.
Study Type
Interventional
Phase
- Phase 4
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 and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Patients aged over 18 years old that can give an informed consent
- HIV-infected patients with hepatitis C associated liver disease demonstrated by a fibroscan score above 8 kiloPascals
- HCV infected patients with liver disease demonstrated by a fibroscan score above 8 kiloPascals
- Patients placed on rifaximin by their physician for a mild hepatic encephalopathy
Exclusion Criteria:
- Any patient unable to give informed consent.
- Patients on hepatitis C treatment
- Patients allergic to rifaximin or rifamycin
- Patients on any prolonged antibiotic treatment including patients on tuberculosis treatment.
- Patients with history of Clostridium difficile infection
- Uncontrolled HIV infection: CD4 less than 200 or detectable viral load Patients need to be on a stable ART regimen for at least one month.
- Patient on a HIV regimen including an unboosted protease inhibitor.
- Acute hepatitis of any cause.
- Child C cirrhosis
- Patients on dialysis
- Pregnant women or childbearing age women not accepting to use an effective contraceptive method Acceptable methods are double barrier methods (condom with spermicide jelly or diaphragm with spermicide), hormonal methods (oral contraceptives, patches or medroxyprogesterone acetate), or an intrauterine device with a documented failure rate of less than 1% per year. Females who have been surgically sterilized (e.g., hysterectomy or bilateral tubal ligation) or who are postmenopausal (total cessation of menses for >1 year) will not be considered "females of childbearing potential."
- Usual exclusion criteria for FibroScan (pregnancy, BMI over 40, ascites, pacemaker or defibrillator).
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
- Primary Purpose: Prevention
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: rifaximin
All patients will be taking rifaximin 550 mg twice daily
|
All patients will be taking rifaximin 550 mg twice daily for one year for a diagnosis of hepatic encephalopathy
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Liver fibrosis progression as measured by transient elastography
Time Frame: Baseline
|
Transient elastography is a non invasive way to measure liver stiffness.
It is not FDA-approved and is used as a research tool in this study.
|
Baseline
|
Liver fibrosis progression as measured by transient elastography
Time Frame: 3 months
|
Transient elastography is a non invasive way to measure liver stiffness.
It is not FDA-approved and is used as a research tool in this study.
|
3 months
|
Liver fibrosis progression as measured by transient elastography
Time Frame: 6 months
|
Transient elastography is a non invasive way to measure liver stiffness.
It is not FDA-approved and is used as a research tool in this study.
|
6 months
|
Liver fibrosis progression as measured by transient elastography
Time Frame: 9 months
|
Transient elastography is a non invasive way to measure liver stiffness.
It is not FDA-approved and is used as a research tool in this study.
|
9 months
|
Liver fibrosis progression as measured by transient elastography
Time Frame: 12 months
|
Transient elastography is a non invasive way to measure liver stiffness.
It is not FDA-approved and is used as a research tool in this study.
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Levels of sCD14 in HIV-infected patients with liver disease and HCV infected patients taking rifaximin
Time Frame: Baseline
|
sCD14 is a surrogate marker of bacterial translocation
|
Baseline
|
Levels of sCD14 in HIV-infected patients with liver disease and HCV infected patients taking rifaximin
Time Frame: 1 month
|
sCD14 is a surrogate marker of bacterial translocation
|
1 month
|
Levels of sCD14 in HIV-infected patients with liver disease and HCV infected patients taking rifaximin
Time Frame: 3 months
|
sCD14 is a surrogate marker of bacterial translocation
|
3 months
|
Levels of sCD14 in HIV-infected patients with liver disease and HCV infected patients taking rifaximin
Time Frame: 6 months
|
sCD14 is a surrogate marker of bacterial translocation
|
6 months
|
Levels of sCD14 in HIV-infected patients with liver disease and HCV infected patients taking rifaximin
Time Frame: 12 months
|
sCD14 is a surrogate marker of bacterial translocation
|
12 months
|
Safety of prolonged use of rifaximin in HIV patients taking many other medications
Time Frame: up to 12 months
|
up to 12 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Douglas T Dieterich, MD, Icahn School of Medicine at Mount Sinai
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
October 1, 2012
Primary Completion (Actual)
September 1, 2014
Study Completion (Anticipated)
September 1, 2015
Study Registration Dates
First Submitted
July 30, 2012
First Submitted That Met QC Criteria
July 31, 2012
First Posted (Estimate)
August 1, 2012
Study Record Updates
Last Update Posted (Estimate)
September 28, 2015
Last Update Submitted That Met QC Criteria
September 25, 2015
Last Verified
September 1, 2015
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- GCO 12-0794
- HSM# 12-00436
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
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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