The Effect of Probiotics in HIV-1 Infection (ProGut)

• ClinicalTrials.gov Identifier: NCT01439841
• Recruitment Status: Completed
• First Posted: September 23, 2011
• Last Update Posted: September 28, 2017
• Sponsor: Oslo University Hospital
• Collaborators: Karolinska University Hospital; Tine
• Information provided by (Responsible Party): MariusTrøseid, Oslo University Hospital

Study Description

Brief Summary:

HIV progression is closely associated with chronic immune activation driven by leakage of bacterial products from a damaged gut, the investigators largest immunological organ. Notably, the degree of immune activation has been suggested to be a better predictor of disease progression than plasma viral load, and markers of immune activation and gut damage have been identified as therapeutic targets per se. The major damage by HIV to the immune system is an initial massacre of gut mucosal CD4+ Th17 cells. Interestingly, a normal gut flora has been shown to induce the maturation of Th17 cells in the small intestine mucosa. Preliminary reports have shown that the gut flora is altered in HIV-1 infection compared to controls. In this project, the investigators will characterize microbial composition of gut flora in chronic HIV infection with ultradeep sequencing. Gut flora composition will be related to clinical data as well as quantitative data of circulating microbial products and activation markers. Second, in a randomized clinical trial (RCT) the effect of probiotic lactobacilli on HIV pathogenesis and progression will be tested. This Gram-positive strain is clinically tested and is able to colonize the gut.

Condition or disease	Intervention/treatment	Phase
HIV-1 Infection	Dietary Supplement: Multi-strain probiotic; Dietary Supplement: Placebo	Not Applicable

Detailed Description:

Objectives:

To explore (i) the safety and tolerability, and (ii) the efficacy of probiotics on HIV-associated microbial translocation, systemic immune activation, disease progression and composition of gut microbiota in chronic HIV-1 infection.

Methodology/Study design:

Approximately 50 patients without current indication for antiretroviral treatment (ART) and 50 patients receiving ART without normalised CD4 counts will be included. A controlled clinical trial will be carried out within each stratum randomised in a 2:1:1 fashion to double blinded intervention and placebo arms as well as an open, untreated control arm, respectively.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 32 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Triple (Participant, Care Provider, Investigator)
• Primary Purpose: Treatment
• Official Title: The Effect of Probiotics on Microbial Translocation and Immune Activation in HIV-1 Infection. A Randomised Placebo-controlled Trial
• Study Start Date: October 2011
• Actual Primary Completion Date: April 2013
• Actual Study Completion Date: June 2013

Arms and Interventions

Arm	Intervention/treatment
Experimental: Probiotics; A multi-strain Probiotic consisting of Lactobacillus rhamnosus GG, Lactobacillus acidophilus La-5 and Bifidobacterium animalis subsp. lactis Bb-12 added to fermented skimmed milk (Biola®, TINE SA, Oslo), 250 mL/day for 8 weeks.	Dietary Supplement: Multi-strain probiotic; The product consists of Lactobacillus rhamnosus GG, Lactobacillus acidophilus La-5 and Bifidobacterium animalis subsp. lactis Bb-12 added to fermented skimmed milk; Other Name: Brand name Biola®
Placebo Comparator: Placebo; Fermented and subsequently heat-treated, sterile skimmed milk (TINE SA) as active placebo.	Dietary Supplement: Placebo; Fermented and subsequently heat-treated, sterile skimmed milk
No Intervention: Control; No intervention

Outcome Measures

Primary Outcome Measures :

1. Safety [ Time Frame: 2 months ]
   Adverse events monitoring during the study period of 2 months
2. Changes in measures of microbial translocation [ Time Frame: 2 months ]
   Changes in plasma leves of lipopolysaccharide (LPS) and soluble CD14 from baseline to 2 months (end of study)
3. Changes in markers of immune activation [ Time Frame: 2 months ]
   Changes in CD38, HLA-DR and PD-1 on CD8+ and CD4+ T cells from baseline to 2 months (end of study)

Secondary Outcome Measures :

1. Disease progression in untreated patients [ Time Frame: 2 months ]
   Changes in CD4 count, viral load, clinical events and indication for ART from baseline to 2 months (end of study)
2. Immune reconstitution in ART treated patients [ Time Frame: 2 months ]
   Changes in CD4 count from baseline to 2 months (end of study)
3. Gut microbiota composition [ Time Frame: 2 months ]
   Changes in gut microbiota (454 pyrosequencing of fecal samples) from baseline to 2 months (end of study)

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• For patients without ART: Confirmed diagnosis of HIV infection > 6 months and CD4+ T cell count < 900
• For patients on stable, effective ART: HIV RNA < 50 copies/ml > 6 months and CD4+ T cell count > 500
• Signed informed consent.

Exclusion Criteria:

• Severe illness requiring hospitalization
• Systemic antibiotics or probiotics the last two months
• Current immune modulating therapy
• Infectious diarrhea
• Inflammatory bowel disease
• Acute primary HIV infection
• Patients immigrating from Africa, Asia or Latin-America within the last 6 months.

Contacts and Locations

Locations

Norway

Oslo University Hospital

Oslo, Norway, 0407

Sweden

Karolinska University Hospital Huddinge

Stockholm, Sweden, 14186

Sponsors and Collaborators

Oslo University Hospital

Karolinska University Hospital

Tine

Investigators

• Study Director: Geir Gokstad, MD, PhD; Oslo University Hospital
• Principal Investigator: Marius Trøseid, MD, PhD; Oslo University Hospital

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Stiksrud B, Nowak P, Nwosu FC, Kvale D, Thalme A, Sonnerborg A, Ueland PM, Holm K, Birkeland SE, Dahm AE, Sandset PM, Rudi K, Hov JR, Dyrhol-Riise AM, Troseid M. Reduced Levels of D-dimer and Changes in Gut Microbiota Composition After Probiotic Intervention in HIV-Infected Individuals on Stable ART. J Acquir Immune Defic Syndr. 2015 Dec 1;70(4):329-37. doi: 10.1097/QAI.0000000000000784.

• Responsible Party: MariusTrøseid, Marius Trøseid, MD, PhD, Oslo University Hospital
• ClinicalTrials.gov Identifier: NCT01439841
• Other Study ID Numbers: ProGut1.0
• First Posted: September 23, 2011
• Last Update Posted: September 28, 2017
• Last Verified: September 2017

Keywords provided by MariusTrøseid, Oslo University Hospital:

HIV; microbial translocation; immune activation; probiotics

Additional relevant MeSH terms:

Infections; Communicable Diseases; HIV Infections; Disease Attributes; Pathologic Processes; Blood-Borne Infections; Sexually Transmitted Diseases, Viral; Sexually Transmitted Diseases; Lentivirus Infections; Retroviridae Infections; RNA Virus Infections; Virus Diseases; Immunologic Deficiency Syndromes; Immune System Diseases