HIV Infection
Conditions
Keywords
HIV infection, Probiotics
Brief summary
This is a randomized placebo-controlled trial to examine if once daily probiotic therapy will lower serum LPS levels and immune activation among HIV-infected youth.
Detailed description
This is a double masked randomized placebo-controlled trial to examine if once daily probiotic therapy will lower serum lipopolysaccharide (LPS) levels and immune activation among HIV-infected youth. The study will enroll two cohorts: (1) a cohort of subjects who are not receiving antiretroviral therapy (ART) and have absolute CD4 T-cell count greater than 350 cells/ul and quantitative HIV-1 plasma RNA (viral load) less than 50,000 copies/ml; and (2) a cohort of subjects who are receiving ART and have absolute CD4 T-cell count greater than 350 cells/ul and and quantitative HIV-1 plasma RNA (viral load) less than 400 copies/ml.
Interventions
DIETARY_SUPPLEMENTProbiotics
Probiotic is a live microorganism that when administered in adequate amounts confer a health benefit on the host. It is classified by the FDA as generally recognized as safe (GRAS)
DIETARY_SUPPLEMENTPlacebo
The placebo sticks will contain approximately 1 g maltodextrin
Sponsors
National Institute on Drug Abuse (NIDA)
National Institute of Mental Health (NIMH)
University of North Carolina, Chapel Hill
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
13 Years to 24 Years
Healthy volunteers
No
Inclusion criteria
To be considered eligible for enrollment, an individual must meet the criteria listed below. * Age 13 years and 0 days to 24 years and 364 days at the time of consent * Confirmed or suspected to have acquired HIV infection at age 10 years or older * HIV-1 infection as documented by any FDA-approved ELISA test kit and confirmed by Western blot, HIV-1 culture, HIV-1 antigen, HIV-1 DNA, plasma HIV-1 RNA, or a second antibody test by a method other than ELISA at any time prior to pre-entry * Absolute CD4 T-cell count greater than 350 cells/ul at pre-entry * Cohort 1 - Not receiving ART and no exposure to ART in the 24 weeks prior to pre-entry: Quantitative HIV-1 plasma RNA (viral load) less than 50,000 copies/ml on two consecutive determinations at least 8 weeks apart in the 24 weeks prior to and including pre-entry * Cohort 2 - Currently receiving ART and received ART for at least the 24 weeks prior to pre-entry: Quantitative HIV-1 plasma RNA (viral load) less than 400 copies/ml on two consecutive determinations at least 8 weeks apart in the 24 weeks prior to and including pre-entry * Willingness to refrain from regular use of foods/supplements containing probiotics other than that supplied by the study during the course of study participation
Exclusion criteria
To be considered eligible for enrollment, an individual must not meet any of the criteria listed below. * Known hypersensitivity to probiotics * Active AIDS-defining condition or acute serious illness * Cohort 1 - Not receiving ART and no exposure to ART in the 24 weeks prior to pre-entry: Any quantitative HIV-1 plasma RNA (viral load) equal to or greater than 50,000 copies/ml during the 24 weeks prior or at pre-entry. * Cohort 2 - Currently receiving ART and received ART for at least the 24 weeks prior to pre-entry: Any quantitative HIV-1 plasma RNA (viral load) equal to or greater than 400 copies/ml during the 24 weeks prior or at pre-entry * Known history of inflammatory bowel disease or similar disorder of the GI tract * Current treatment with immune-modulating or immune-suppressive therapy * Active malignancy at pre-entry * Pregnancy * Grade 3 or higher clinical or laboratory toxicities at the time of randomization * Regular use of foods or supplements containing probiotics within the 2 weeks prior to randomization (see Appendix V) * Concurrent participation in the ATN 061, 071, 081, and/or 101 protocols
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Plasma LPS levels | 32 Weeks | To determine if once daily probiotic therapy decreases microbial translocation in HIV-infected youth as measured by changes in plasma LPS. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Plasma pro-inflammatory cytokines and macrophage activation | 32 Weeks | To determine if probiotic colonization of the gastrointestinal (GI) tract with Lactobacillus plantarum decreases levels of plasma pro-inflammatory cytokines and macrophage activation by measuring tumor necrosis factor alpha (TNFα), interferon alpha (IFNα), interleukin-1 beta (IL-1β), interleukin-6 (IL-6), interleukin-12p70 (IL-12p70), interleukin-10 (IL-10), and soluble CD14 (sCD14) as well as other markers of microbial translocation. |
| Lymphocyte activation markers | 32 Weeks | To determine if probiotic colonization of the GI tract with Lactobacillus plantarum results in decreased levels of T-cell activation markers as measured by shedding of soluble CD27 (sCD27), proportion of CD4 Th17 subsets, and expression of CD38 and HLA DR on CD8 T cells within ART treated and untreated HIV-infected youth. |
| Quantitative HIV-1 plasma RNA (viral load) and CD4 T-cell count | 32 Weeks | To examine if probiotics have any impact on quantitative HIV-1 plasma RNA (viral load) and CD4 T-cell count among the study cohort. |
| Stool colonization with Lactobacillus plantarum | 32 Weeks | To quantify the extent that Lactobacillus plantarum populates fecal samples obtained over time in HIV-infected youth receiving probiotics. |
| Safety labs and adverse events as a measure of acceptability and tolerability of probiotics | 32 Weeks | To examine the acceptability and tolerability of probiotics when administered to HIV-infected youth. |
| Food frequency and probiotics and lifestyle questionnaires | 32 Weeks | To explore the effect of diet, smoking, and dietary supplements on plasma pro-inflammatory cytokine levels. |
| Stool microbial composition and genetic diversity | 32 Weeks | To molecularly characterize changes in overall bacteria diversity within the stool specimens of youth treated with probiotics. |
Outcome results
None listed