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Probiotic Visbiome for Inflammation and Translocation in HIV II (PROOV IT II)

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ClinicalTrials.gov Identifier: NCT02441231
Recruitment Status : Recruiting
First Posted : May 12, 2015
Last Update Posted : April 18, 2018
Sponsor:
Collaborator:
CIHR Canadian HIV Trials Network
Information provided by (Responsible Party):
University Health Network, Toronto

Study Description
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Brief Summary:

Modern antiretroviral therapy (ART) has transformed the clinical care and lived experience of HIV infection. However, increased rates of adverse health conditions that are related to immune activation, such as cardiovascular disease (CVD) and neurodegenerative disease in ART-treated individuals persist. An important cause of this inflammation is the gut CD4 T cell loss and the "leaking" or translocation of luminal gut bacteria and other microbes across the bowel wall and into the bloodstream.

The use of complementary and alternative therapies is very common among people living with HIV, with estimates ranging from 16-60%. However, their efficacy has generally not been well demonstrated. Probiotics are live microbes that may provide a health benefit to the host and the investigators believe that the simultaneous use of probiotics along with ART will improve gut CD4 T cell restoration and function and therefore reduce microbial translocation and immune activation.

A major challenge to HIV treatment is the suboptimal CD4 T cell count despite successful HIV suppression on ART in immunologic non-responders (INRs). These individuals are at increased risk of AIDS-related deaths and non-AIDS related comorbidities that may be associated with increased immune activation and microbial translocation from the gut mucosa. With limited treatment options, alternative therapies to reduce inflammation and restore gut immunology will be important. Probiotic Visbiome consists of a high potency blend of eight different probiotics. The precise mechanism of action of Visbiome is unknown,but preclinical studies have shown that Visbiome may modulate the immune response towards an immunoregualtory phenotype with increased the levels of IL-10 and reduced levels of proinflammatory cytokines (TNFα, IL1β and IL-8). Therefore,the investigators believe that the "beneficial" bacteria from Visbiome will accelerate the normalization of gut immune cells and function in HIV-infected INRs. It is hypothesized consumption of Visbiome for 48 weeks will help restore the immune system in INRs who have suboptimal immune reconstitution to currently available ART. Resolution of gut immune cells will mean that microbial translocation and immune activation will be normalized and will reduce the rates of HIV-associated comorbidities.


Condition or disease Intervention/treatment Phase
HIV-1 Infection Drug: Visbiome Other: Placebo Phase 2

Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 36 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Probiotic Visbiome for Inflammation and Translocation in HIV II (PROOV IT II)
Actual Study Start Date : November 2015
Estimated Primary Completion Date : May 2019
Estimated Study Completion Date : May 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS

Arms and Interventions
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Arm Intervention/treatment
Experimental: Probiotic Group
Visbiome probiotic group (900 billion bacteria daily; 2 sachets daily)
 Drug: Visbiome
Visbiome probiotic
Placebo Comparator: Placebo Group
Placebo comparator group
 Other: Placebo
Placebo


Outcome Measures
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Primary Outcome Measures :
  1. Percent change in blood immune activation [ Time Frame: 48 weeks ]
    Percent change in blood immune activation (co-expression of CD38 and HLA-DR) on CD8 T cells at week 48 in participants randomized to probiotic Visbiome versus the placebo arm


Secondary Outcome Measures :
  1. Level of microbial translocation (including LSP and sCD14) [ Time Frame: 48 weeks ]
  2. Plasma level of inflammation and coagulation (including IL-6, D-dimer and CRP) [ Time Frame: 48 weeks ]
  3. Number and function of gut immune cells (including CD4 T cell subsets) [ Time Frame: 48 weeks ]
  4. Intestinal permeability (Lac/Mac ratio) [ Time Frame: 48 weeks ]
  5. Bacterial community diversity, determined by 16s rRNA gene sequencing of penile swabs [ Time Frame: 48 weeks ]
  6. Bacterial community composition, determined by 16s rRNA gene sequencing of penile swabs [ Time Frame: 48 weeks ]
  7. Gut HIV DNA levels [ Time Frame: 48 weeks ]
  8. Canadian Diet History Questionnaire [ Time Frame: 48 weeks ]
  9. Safety assessed by AE monitoring and participant questionnaire [ Time Frame: 48 weeks ]
  10. Tolerability of Visbiome assessed by AE monitoring and participant questionnaire [ Time Frame: 48 weeks ]
  11. Adherence to Visbiome assessed by participant questionnaire and sachet count [ Time Frame: 48 weeks ]

Other Outcome Measures:
  1. Metabolomic measurements: vitamin D levels, glucose measurements, insulin levels and lipid profiling [ Time Frame: 48 weeks ]
  2. Microbiome analysis by 16s rRNA bacterial DNA isolated from penile swabs [ Time Frame: 48 weeks ]

Eligibility Criteria
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Ages Eligible for Study:   19 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Documented HIV-1 infection
  • Male adult (age >18 years)
  • Currently on ART (>2 years but <10 years)
  • Undetectable HIV-1 viral load <50 copies/ml for the past 2 years (1 viral blip below 500 copies/ml permitted in the past year)
  • Last CD4 count <350 cells/μl, and >70% over the past 2 years <350 cells/μl
  • Ability to provide informed consent

Exclusion Criteria:

  • Current alcohol or substance use judged by the Investigator to potentially interfere with subject study compliance
  • Taking pharmaceutical-grade probiotics

  • Any of the following abnormal laboratory results in screening:

    • Hemoglobin <85 g/L
    • Neutrophil count <750 cells/μl
    • Platelet count <50,000 cells/μL
    • AST or ALT >5X the upper limit of normal
  • Colitis
  • Liver fibrosis (decompensated cirrhosis), portal hypertension or clinical hepatitis
  • Other significant underlying disease (non-HIV-1) that might impinge upon disease progression or death
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02441231


Contacts
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Contact: Rupert Kaul, MD 416-978-8607 rupert.kaul@utoronto.ca
Contact: Rodney Rousseau 416-946-7054 r.rousseau@mail.utoronto.ca

Locations
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Canada, Ontario
Maple Leaf Medical Clinic Recruiting
Toronto, Ontario, Canada, M5G 1K2
Contact: Colin Kovacs, MD    416-465-3252    ckovacs@mlmedical.com   
Principal Investigator: Colin Kovacs, MD         
Toronto General Hospital, UHN Recruiting
Toronto, Ontario, Canada, M5G 2N2
Contact: Sharon Walmsley, MD    416-340-3871    sharon.walmsley@uhn.ca   
Principal Investigator: Sharon Walmsley, MD         
Sponsors and Collaborators
University Health Network, Toronto
CIHR Canadian HIV Trials Network
Investigators
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Principal Investigator: Rupert Kaul, MD University Health Network, Toronto
More Information
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Responsible Party: University Health Network, Toronto
ClinicalTrials.gov Identifier: NCT02441231     History of Changes
Other Study ID Numbers: CTNPT 022B
First Posted: May 12, 2015    Key Record Dates
Last Update Posted: April 18, 2018
Last Verified: April 2018
Additional relevant MeSH terms:
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Inflammation
Pathologic Processes