Analysis of the Impact of HCV Treatment by Last Generation Direct Antiviral Agents (DAA) on Antiviral Immunity and HIV DNA Reservoir in Coinfected HIV-HCV Patients

NCT ID: NCT03244371

Last Updated: 2017-08-09

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 20 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2016-08-31
• Study Completion Date: 2019-02-28

Brief Summary

Spontaneous recovery of patients infected with HCV is related to the development of a cytotoxic immune response that is executed by specialized white blood cells, the CD8+ T cells, which develop a virus-specific response. In addition, the natural killer (NK) cells provide a first-line innate cytotoxic response, which is pivotal for the spontaneous clearing of HCV. In patients where HCV infection settles chronically, CD8+ T lymphocytes and NK cells fall into a state of anergy induced by chronic viral challenge. This anergic state is also found in the case of HIV infection and exacerbated by HIV-HCV coinfection. The first therapeutic strategies against HCV were based on a treatment with interferon alpha, which had an antiviral but also immunosuppressive effect. In fact, this therapeutic strategy was unable to help the recovery of the patient's immune system that would be expected after HCV cure. However, interferon-free therapeutic strategies combining first generation direct antiviral agents (DAA) showed a positive effect on HCV antiviral immunity, by enhancing the proliferative response of CD8+ T cells and the cytotoxic and proinflammatory responses of NK cells in HCV monoinfected patients (4, 5). Since HCV-targeted therapies based on combinations of the latest generation of DAA have nearly 100% cure rates and enable faster viral suppression over shorter treatment times, a positive impact of these regimens on antiviral immunity is plausible. This possibility would be particularly interesting in HIV-HCV co-infected patients, where reactivation of the innate antiviral immunity may contribute to immune defenses against both viruses. Moreover, it has been previously reported a moderate but significant and sustained decline of HIV-1 DNA in CD4 T cells from HIV-1/hepatitis C virus-coinfected patients receiving highly active antiretroviral therapy and treated with IFN alpha/ribavirin.

To date, the real impact on antiviral immunity of treatment as well as on HIV reservoir with the latest generation of DAA was not measured in HIV-HCV co-infected patients.

The aim of this study is to analyze the impact of the cure of hepatitis C on the HIV DNA reservoir and antiviral function of CD8+ and NK cells in a subgroup of patients receiving the latest generation DAAs for treatment of HCV infection, as part of a program for a reduction of the prevalence of chronic hepatitis C patients co-infected HIV-HCV set up within the Immuno-Hematology Service of the Sainte Marguerite Hospital (Research in routine care-Ethics committee Approval Sud- Méditerranée I ID RCB 2015-A01913-46/ Principal Investigator: Dr I Poizot-Martin).

The analysis of HIV DNA, NK and CD8+ T lymphocyte antiviral immune response prior, during and after anti-HCV treatment will need the collection of a biobank. Indeed, 25 mL peripheral blood will be collected at treatment initiation, during an interim assessment, at the end of treatment and six months post-treatment, for a total of 100 ml of additional blood collection. These analyzes will be performed by Dr C Tamalet for HIV DNA IHU-Méditerranée Infection, and the team of Prof. E Vivier, DHU- Marseille Immunopole for NK and CD8+ T lymphocyte antiviral immune response.

Conditions

HIV Associated HCV

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: PREVENTION
• Blinding Strategy: NONE

Study Groups

Co infected HIV and HCV patients

Group Type: EXPERIMENTAL

blood draw

Intervention Type: OTHER

4 blood draws of 25 mls of blood will be performed at 4 differents time points (before treatment, 4 weeks later, at the end of the treatment and 6 months after the end of the treatment)

Interventions

blood draw

4 blood draws of 25 mls of blood will be performed at 4 differents time points (before treatment, 4 weeks later, at the end of the treatment and 6 months after the end of the treatment)

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• HIV1 infected patient
• HCV positive serologie and RNA-HCV positive
• Starting an anti-HCV traitment with direct antiviral agent
• With an hepatic fibrosis score < 12,5KPa measured through elastometry or with a score < F4 from liver biopsy

Exclusion Criteria

• HIV2 infected patients par le VIH2
• Positive for HBsAg,
• Cirrohtic patient (elastométry >12,5kPa or métavir score F4)

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Assistance Publique Hopitaux De Marseille

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Urielle DESALBRES

Role: STUDY_DIRECTOR

AP-HM

Locations

Assistance Publique Hôpitaux de Marseille

Marseille, , France

Site Status: RECRUITING

Countries

France

Central Contacts

Isabelle POIZOT-MARTIN, MD

Role: CONTACT

isabelle.poizot@ap-hm.fr

+33491746163

Facility Contacts

Isabelle POIZOT-MARTIN, MD

Role: primary

isabelle.poizot@ap-hm.fr

+33491746163

Other Identifiers

2016-A01028-43

Identifier Type: OTHER

Identifier Source: secondary_id

2016-31

Identifier Type: -

Identifier Source: org_study_id