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

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ClinicalTrials.gov Identifier: NCT02441244
Recruitment Status : Terminated (Recruitment potential impaired by shift in clinical care whereby practically all HIV patients receive standard treatment as soon as possible after HIV diagnosis)
First Posted : May 12, 2015
Last Update Posted : March 1, 2018
Sponsor:
Collaborator:
CIHR Canadian HIV Trials Network
Information provided by (Responsible Party):
University Health Network, Toronto

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 common among people living with HIV, 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 antiretroviral therapy (ART) will improve gut CD4 T cell restoration and function and therefore reduce microbial translocation and immune activation.

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 a phenotype that is associated with reduce inflammation, and Visbiome was also protective in a non-human primate model of SIV infection. Therefore, we believe that the "beneficial" bacteria from Visbiome will accelerate the normalization of gut immune cells and function in HIV-infected individuals as they start ART. Early resolution of gut immune cells may normalize microbial translocation and immune activation 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 Type : Interventional  (Clinical Trial)
Actual Enrollment : 1 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 I (PROOV IT I)
Actual Study Start Date : November 15, 2015
Actual Primary Completion Date : December 19, 2016
Actual Study Completion Date : December 19, 2016

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS

Arm Intervention/treatment
Experimental: Probiotic Group
Visbiome experimental group (900 billion bacteria daily; 2 sachets daily)
Drug: Visbiome
Visbiome probiotic

Placebo Comparator: Placebo Group
Placebo comparator group
Other: Placebo
Placebo




Primary Outcome Measures :
  1. Blood immune activation [ Time Frame: 24 weeks ]
    Percent of blood immune activation (coexpression of CD38 and HLA-DR) on CD8 T cells at week 24 in participants randomized to probiotic Visbiome versus the placebo arm


Secondary Outcome Measures :
  1. Level of microbial translocation (including LPS and sCD14) [ Time Frame: 24 weeks ]
  2. Plasma level of inflammation and coagulation (including IL-6, D-dimer and CRP) [ Time Frame: 24 weeks ]
  3. Number and function of gut immune cells (including CD4 T cell subsets) [ Time Frame: 24 weeks ]
  4. Intestinal permeability (Lac/Mac ratio) [ Time Frame: 24 weeks ]
  5. Microbiome analysis by 16s rRNA bacterial DNA isolated from gut tissue and anal swabs [ Time Frame: 24 weeks ]
  6. Gut HIV DNA levels [ Time Frame: 24 weeks ]
  7. Canadian Diet History Questionnaire [ Time Frame: 24 weeks ]
  8. Safety assessed by AE monitoring and participant questionnaire [ Time Frame: 24 weeks ]
  9. Tolerability of Visbiome assessed by AE monitoring and participant questionnaire [ Time Frame: 24 weeks ]
  10. Adherence to probiotic Visbiome assessed by participant questionnaire and sachet count [ Time Frame: 24 weeks ]

Other Outcome Measures:
  1. Metabolomic measurements: vitamin D levels, glucose measurements, insulin levels and lipid profiling [ Time Frame: 24 weeks ]
  2. Bacterial community diversity, determined by 16s rRNA gene sequencing of penile swabs [ Time Frame: 24 weeks ]
  3. Bacterial community composition, determined by 16s rRNA gene sequencing of penile swabs [ Time Frame: 24 weeks ]
  4. Blood immune activation (open-label) [ Time Frame: 48 weeks ]
    Percent of blood immune activation (coexpression of CD38 and HLA-DR) on CD8 T cells at week 24 in participants randomized to probiotic Visbiome versus the placebo arm

  5. Level of microbial translocation (including LPS and sCD14) (open-label) [ Time Frame: 48 weeks ]
  6. Plasma levels of inflammation and coagulation (including IL-6, D-dimer and CRP) (open-label) [ Time Frame: 48 weeks ]
  7. Number and function of gut immune cells (including CD4 T cell subsets) (open-label) [ Time Frame: 48 weeks ]
  8. Intestinal permeability (Lac/Man) (open-label) [ Time Frame: 48 weeks ]
  9. Microbiome analysis by 16s rRNA bacterial DNA isolated from penile swabs (open-label) [ Time Frame: 48 weeks ]
  10. Gut HIV DNA levels (open-label) [ Time Frame: 48 weeks ]
  11. Canadian Diet History Questionnaire (open-label) [ Time Frame: 48 weeks ]
  12. Safety (open-label) assessed by AE monitoring and participant questionnaire [ Time Frame: 48 weeks ]
  13. Tolerability of Visbiome (open-label) assessed by AE monitoring and participant questionnaire [ Time Frame: 48 weeks ]
  14. Adherence to probiotic Visbiome (open-label) assessed by participant questionnaire and sachet count [ Time Frame: 48 weeks ]


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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)
  • Antiretroviral therapy-naïve
  • Ability to provide informed consent
  • HIV-1 viral load ≥1,000 copies/ml

Exclusion Criteria:

  • Current alcohol or substance use judged by the Investigator to potentially interfere with participant 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
  • Malignancy
  • 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

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): NCT02441244


Locations
Canada, Ontario
Maple Leaf Medical Clinic
Toronto, Ontario, Canada, M5G 1K2
Toronto General Hospital, UHN
Toronto, Ontario, Canada, M5G 2N2
Sponsors and Collaborators
University Health Network, Toronto
CIHR Canadian HIV Trials Network
Investigators
Principal Investigator: Rupert Kaul, MD University Health Network, Toronto

Responsible Party: University Health Network, Toronto
ClinicalTrials.gov Identifier: NCT02441244     History of Changes
Other Study ID Numbers: CTNPT 022A
First Posted: May 12, 2015    Key Record Dates
Last Update Posted: March 1, 2018
Last Verified: February 2018

Additional relevant MeSH terms:
Inflammation
Pathologic Processes