Microbiome Metabolites and Alcohol in HIV to Reduce CVD RCT

HIV Infections Clinical Trial

— META HIV CVD  

Official title:

Microbiome Metabolites and Alcohol in HIV to Reduce CVD RCT

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05288790
• Other study ID #: P01AA029542
• Status: Recruiting
• Phase: Phase 2
• Start date: September 18, 2023
• Est. completion date: August 31, 2026

Study information

• Verified date: May 2024
• Source: Vanderbilt University Medical Center
• Contact: Grace Wallace, BS
• Phone: 615-936-5356
• Email: grace.wallace[@]vumc.org
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Among people living with HIV, heavy drinking increases the risk of heart disease and death. Studies suggest that alcohol changes the number and kind of bacteria in your gut and these changes increase the risk of heart disease and death. This randomized controlled trial will determine whether a pill containing healthy gut bacteria can increase the number good bacteria in the gut, lower levels of inflammation, and lower the risk of heart disease and death.

Description:

Among people living with HIV (PLWH), heavy drinking increases the risk of cardiovascular disease (CVD) and death. Data suggest that alcohol-associated gut dysbiosis partially drives this risk. Whether interventions targeting alcohol-associated gut dysbiosis among PLWH improve dysbiosis, lower levels of microbial translocation, inflammation, and harmful metabolites (e.g., trimethylamine N-oxide [TMAO)]) is unknown. The investigators' hypothesis for this P01 application is that among PLWH, a probiotic can mitigate or reduce alcohol associated gut dysbiosis and lower levels of microbial translocation, inflammation, and improve metabolite profiles (Project 1); and that harmful levels of these metabolites will be associated with higher CVD and death risk (Project 2). This team, with expertise in alcohol, HIV, gut microbiome, and biomarker research has conducted two NIAAA funded trials, a metabolite study, and a gut microbiome study among Russian PLWH who are heavy drinkers. Data from these studies show that among PLWH: (1) heavy drinking is associated with incident CVD, death and gut dysbiosis (characterized by a reduction in butyrate producing bacteria); and (2) this gut dysbiosis is associated with inflammation, altered bile acids, and high TMAO levels. Given these data and reports from pilot studies showing that probiotics are safe, may improve gut dysbiosis and reduce inflammation among PLWH, the investigators propose an RCT among 250 PLWH with heavy alcohol consumption who are on antiretroviral therapy and have CD4+ counts≥350 cells/mm3 to compare the effects of a probiotic tailored to alcohol associated gut dysbiosis vs. placebo to: (1) improve GI dysbiosis; (2) reduce plasma metabolite (e.g., TMAO) and biomarker levels of microbial translocation and inflammation; and (3) lower CVD and mortality risk. All participants will receive evidenced-based counseling for alcohol use. The specific aims will compare the effects of a tailored probiotic vs. placebo at 6 months on (Aim 1) dysbiosis (fecal Firmicutes to Bacteroidetes (F/B) ratio, primary study outcome; fecal Lachnospiraceae-family of butyrate producers) and plasma metabolites (plasma butyrate, deoxycholic acid:cholic acid ratio, and TMAO) (Aim 2) biomarkers of inflammation plasma, IL-6, D-dimer, sCD14), microbial translocation [Lipopolysaccharide binding protein], (Aim 3) cardiovascular risk (Reynolds risk score), mortality risk (VACS index); (Aim 4 exploratory) alcohol consumption (% heavy drinking days in past month) and HIV disease progression (CD4 cell count). The investigators hypothesize that as compared with placebo, the probiotic arm will have significantly: (1) higher F/B ratio and levels of fecal Lachnospiraceae, plasma butyrate, deoxycholic acid: cholic acid ratio and lower levels of TMAO; (2) lower plasma biomarker levels of microbial translocation and inflammation; (3) lower Reynolds risk score and VACS index; (4) lower % heavy drinking days in the past month and higher CD4 cell counts. The findings from this RCT, Microbiome, mETabolites, and Alcohol in HIV to reduce CVD (META HIV CVD RCT), will inform probiotics' role as standard adjunctive therapy complementing alcohol interventions among PLWH who are heavy drinkers.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 250
• Est. completion date: August 31, 2026
• Est. primary completion date: March 31, 2026
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 89 Years

Eligibility

Inclusion Criteria:

• HIV infected

Exclusion Criteria:

• Not fluent in English

Related Conditions & MeSH terms

• Alcohol Drinking
• Cardiovascular Diseases
• Dysbiosis
• HIV Infections
• Microtia

Intervention

Dietary Supplement:
• Probiotic
Dietary supplement
• Placebo
Placebo sachet

Locations

Country	Name	City	State
United States	Vanderbilt University Medical Center	Nashville	Tennessee

Sponsors (3)

Lead Sponsor	Collaborator
Vanderbilt University Medical Center	Boston University, University of Louisville

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Mortality	Veterans Aging Cohort Study Index Score (lower scores are better and higher scores are worse) (ranges from 0-164)	6 and 12 months
Other	CVD risk	Reynolds Risk Score (the higher the score the higher the risk) (ranges from 100-400 mg/dL)	6 and 12 months
Primary	Firmicutes to Bacteroidetes ratio	Dysbiosis	6 months
Secondary	Intestinal permeability	measuring levels of butyrate, deoxycholic acid:cholic acid ratio, and TMAO	6, 12 months
Secondary	Firmicutes to Bacteroidetes ratio	Dysbiosis measurement	12 months
Secondary	Microbial Translocation	measuring plasma lipopolysaccharide binding protein	6, 12 months
Secondary	Inflammation	measuring plasma for interleukin 6 [IL-6], D-dimer, and sCD14	6, 12 months