- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03988725
Nonalcoholic Steatohepatitis in HIV Mono-infection: Exploring Non-invasive Methods for Diagnosis and the Therapeutic Role of Vitamin E
June 14, 2019 updated by: Giada Sebastiani, McGill University Health Centre/Research Institute of the McGill University Health Centre
Effective combination antiretroviral therapy (cART) has resulted in a dramatic reduction in AIDS mortality.
Over the last decade, the proportion of deaths caused by liver-related etiologies, including co-infection with hepatitis C (HCV) and hepatitis B (HBV) viruses, alcohol abuse, and fatty liver, has increased between 8 to 10 fold in the post-cART era while AIDS-related mortality has fallen more than 90-fold.
HIV infection without viral hepatitis is also at risk for liver disease.
Indeed, HIV mono-infected persons experience common conditions, such as obesity, diabetes and dyslipidemia, which are risk factors for non-alcoholic fatty liver disease (NAFLD).
NAFLD is the most common liver disease in Canada.
It is a fatty infiltration of the liver that is not evolutive per se, but it is the first histopathological step for non-alcoholic steatohepatitis (NASH), a progressive disease characterized by much inflammation leading to liver fibrosis and cirrhosis.
NASH may be frequent in the setting of HIV mono-infection due to excess of metabolic risk factors, long-term cART, HIV itself and lipodystrophy.
An early diagnosis of NASH is essential to establish a prognosis and initiate interventions to reduce progression of liver disease towards cirrhosis.
Early diagnosis of NASH is critical for targeting metabolic and hepatologic interventions, which can impact on progression to cirrhosis and end-stage complications.
Non-invasive tools for liver fibrosis and NASH, including Fibroscan/CAP and CK-18, are accurate and ideal for screening and serial monitoring.
No study has specifically targeted the non-invasive diagnosis of NASH in HIV mono-infected patients.
There has been no study about the use of CK-18 as a biomarker for NASH in the setting of HIV mono-infection.
Furthermore, CAP has never been applied to this specific population.
Finally, there is no data about the potential beneficial therapeutic effect of vitamin E on NASH associated to HIV infection.
The investigators hypothesize that CK-18 and Fibroscan/CAP can be used as non-invasive tests to diagnose NASH in HIV mono-infected persons.
Likewise, the investigators hypothesize that there will be a significant prevalence of NASH diagnosed by non-invasive tools among patients with HIV mono-infection.
The investigators further hypothesize that a 6 months treatment trial with vitamin E supplementation will improve non-invasive diagnostic tests, and/or the metabolic and hepatic profile in HIV mono-infected patients with a non-invasive diagnosis of NASH.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
27
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
-
-
Quebec
-
Montréal, Quebec, Canada
- Chronic Viral Illness Center at Royal Victoria Hospital in McGill university Health Center
-
-
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:
- Confirmed positive serology for HIV mono-infection and 18 years or older; valid Fibroscan/CAP;
- Able to provide informed consent, signing forms available in French or English.
- Fatty liver (CAP>237.8 dB/m) AND CK-18 levels > 246 U/L OR
- Fatty liver (CAP>237.8 dB/m) AND CK-18 149 U/L + chronically elevated liver function tests (transaminases) + at least 1 metabolic risk factor (among diabetes, insulin resistance, dyslipidemia or overweight).
Exclusion Criteria:
- Co-infection with HCV or HBV (presence of serum HCV-Ab or HbsAg); HCC, liver transplantation
- Significant alcohol consumption, as per AASLD guidelines on NAFLD: "ongoing or recent alcohol consumption > 21 drinks on average per week in men and > 14 drinks on average per week in women"
- Patients taking anticoagulants (warfarin, heparin)
- Patients undergoing chemotherapy or radiotherapy for cancer
- History of diagnosis of prostate cancer
- Planning to become, suspected to be, pregnant or breastfeeding
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: TREATMENT
- Allocation: NA
- Interventional Model: SINGLE_GROUP
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Vitamin E intervention
All study participants receive Vitamin E 800 IU once daily for 6 months
|
Vitamin E 800 IU once daily
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Improvement of NASH diagnosed by non-invasive methods
Time Frame: 6 months
|
Assessed by i) difference in AST and/or ALT
|
6 months
|
Improvement of NASH diagnosed by non-invasive methods
Time Frame: 6 months
|
Assessed by ii) difference in Fibroscan/CAP measurements
|
6 months
|
Improvement of NASH diagnosed by non-invasive methods
Time Frame: 6 months
|
Assessed by iii) difference in CK-18 levels
|
6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in metabolic markers
Time Frame: 6 months
|
HOMA
|
6 months
|
Change in metabolic markers
Time Frame: 6 months
|
Cholesterol or triglyceride levels
|
6 months
|
Change in metabolic markers
Time Frame: 6 months
|
Weight and height will be combined to report BMI in kg/m^2
|
6 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: Giada Sebastiani, Chronic Viral Illness Service, MUHC
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 (ACTUAL)
November 11, 2014
Primary Completion (ACTUAL)
March 11, 2019
Study Completion (ACTUAL)
March 11, 2019
Study Registration Dates
First Submitted
June 12, 2019
First Submitted That Met QC Criteria
June 14, 2019
First Posted (ACTUAL)
June 17, 2019
Study Record Updates
Last Update Posted (ACTUAL)
June 17, 2019
Last Update Submitted That Met QC Criteria
June 14, 2019
Last Verified
June 1, 2019
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Pathologic Processes
- Disease Attributes
- Liver Diseases
- Infections
- Communicable Diseases
- Fatty Liver
- Non-alcoholic Fatty Liver Disease
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Protective Agents
- Micronutrients
- Vitamins
- Antioxidants
- Vitamin E
Other Study ID Numbers
- CTNPT 024
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
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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