Study Results
Results pending
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Basic Information
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Recruitment Status
COMPLETED
Clinical Phase
PHASE2
Total Enrollment
50 participants
Study Classification
INTERVENTIONAL
Study Start Date
2011-04-30
Study Completion Date
2012-07-31
Brief Summary
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Along with its effects on bone metabolism, vitamin D is an important modulator of the immune system. Experimental studies have shown that the active metabolite of vitamin D \[1,25(OH)2D\] is able to skew the T cell compartment into a more anti-inflammatory state, with inhibition of Th1 and Th17 cells and promotion of Th2 and T regulatory subsets.
In the context of HIV infection, in which Th1 subpopulations are devoted to inhibit viral replication, any alteration of the Th1/Th2 balance would be of concern.
The aim of this Randomized Controlled Trial is to test wether oral supplementation with cholecalciferol could be able: 1) to improve vitamin D status and, 2) to play an immunomodulatory role, in vertically HIV-infected children and young adults with hypovitaminosis D.
In the context of HIV infection, in which Th1 subpopulations are devoted to inhibit viral replication, any alteration of the Th1/Th2 balance would be of concern.
The aim of this Randomized Controlled Trial is to test wether oral supplementation with cholecalciferol could be able: 1) to improve vitamin D status and, 2) to play an immunomodulatory role, in vertically HIV-infected children and young adults with hypovitaminosis D.
Detailed Description
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There is increasing evidence that hypovitaminosis D is common in the general population.
Low dietary intake of vitamin D and reduced exposure to sunlight are probably the major risk factors. A high prevalence of hypovitaminosis D has been described in HIV-infected adults, and children. HIV infection itself and antiretroviral (ARV) treatment may be responsible for alteration of vitamin D metabolism. For instance, studies have shown a significant decrease in serum 25-hydroxyvitamin-D \[25(OH)D\] concentration in adults receiving non-nucleoside reverse transcriptase inhibitors (NNRTIs). Whatever the cause(s) of hypovitaminosis D, because of the importance of vitamin D in bone health, randomized controlled trials (RCT) have been performed to test whether vitamin D supplementation can improve vitamin D status and bone mineral metabolism in HIV-infected children and adolescents.
Along with its effects on bone metabolism, vitamin D is an important modulator of the immune system. The vitamin D receptor (VDR) is found in high concentrations in activated T lymphocytes, in small amounts in monocyte/macrophage cells while B lymphocytes do not contain detectable amounts of VDR.
Experimental studies have shown that the active di-hydroxylated metabolite of vitamin D \[1,25(OH)2D\] is able to skew the T cell compartment into a more anti-inflammatory state, with inhibition of Th1 and Th17 cells and promotion of Th2 and T regulatory (Treg) subsets.
In the context of HIV infection, in which Th1 subpopulations are devoted to inhibit viral replication, 16 any alteration of the Th1/Th2 balance would be of concern.
Although all the biological effects of vitamin D are mediated by the 1,25(OH)2D, it is the 25(OH)D to be routinely quantified because of its longer half-life.17 However, HIV-infected subjects may have a defective 1α-hydroxylation of 25(OH)D. Thus, it is important to evaluate the effects of vitamin D supplementation both in terms of 25(OH)D and 1,25(OH)2D responses.
This repeated-measures parallel-group RCT is aimed to test wether a 12-month oral supplementation with cholecalciferol (vitamin D3) is able: 1) to increase serum 25(OH)D and 1,25(OH)2D levels and, 2) to affect T-cell phenotype in vertically HIV-infected children and young adults with hypovitaminosis D and stable HIV-disease.
Main outcome: to determine the frequency of hypovitaminosis D at 12-month of follow-up among subjects supplemented with oral cholecalciferol versus subjects receiving placebo.
Secondary outcome: to investigate correlations - if any - between serum vitamin D concentration and markers of immune activation (i.e. Th1-, Th2-, Th17- and Treg-lymphocytes count, T-lymphocyte VDR expression)
Low dietary intake of vitamin D and reduced exposure to sunlight are probably the major risk factors. A high prevalence of hypovitaminosis D has been described in HIV-infected adults, and children. HIV infection itself and antiretroviral (ARV) treatment may be responsible for alteration of vitamin D metabolism. For instance, studies have shown a significant decrease in serum 25-hydroxyvitamin-D \[25(OH)D\] concentration in adults receiving non-nucleoside reverse transcriptase inhibitors (NNRTIs). Whatever the cause(s) of hypovitaminosis D, because of the importance of vitamin D in bone health, randomized controlled trials (RCT) have been performed to test whether vitamin D supplementation can improve vitamin D status and bone mineral metabolism in HIV-infected children and adolescents.
Along with its effects on bone metabolism, vitamin D is an important modulator of the immune system. The vitamin D receptor (VDR) is found in high concentrations in activated T lymphocytes, in small amounts in monocyte/macrophage cells while B lymphocytes do not contain detectable amounts of VDR.
Experimental studies have shown that the active di-hydroxylated metabolite of vitamin D \[1,25(OH)2D\] is able to skew the T cell compartment into a more anti-inflammatory state, with inhibition of Th1 and Th17 cells and promotion of Th2 and T regulatory (Treg) subsets.
In the context of HIV infection, in which Th1 subpopulations are devoted to inhibit viral replication, 16 any alteration of the Th1/Th2 balance would be of concern.
Although all the biological effects of vitamin D are mediated by the 1,25(OH)2D, it is the 25(OH)D to be routinely quantified because of its longer half-life.17 However, HIV-infected subjects may have a defective 1α-hydroxylation of 25(OH)D. Thus, it is important to evaluate the effects of vitamin D supplementation both in terms of 25(OH)D and 1,25(OH)2D responses.
This repeated-measures parallel-group RCT is aimed to test wether a 12-month oral supplementation with cholecalciferol (vitamin D3) is able: 1) to increase serum 25(OH)D and 1,25(OH)2D levels and, 2) to affect T-cell phenotype in vertically HIV-infected children and young adults with hypovitaminosis D and stable HIV-disease.
Main outcome: to determine the frequency of hypovitaminosis D at 12-month of follow-up among subjects supplemented with oral cholecalciferol versus subjects receiving placebo.
Secondary outcome: to investigate correlations - if any - between serum vitamin D concentration and markers of immune activation (i.e. Th1-, Th2-, Th17- and Treg-lymphocytes count, T-lymphocyte VDR expression)
Conditions
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HIV Disease
Vitamin D Deficiency
Hypovitaminosis D
Hyperparathyroidism
Keywords
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HIV
children
adolescents
Vitamin D
immunity
T cell phenotype
Study Design
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Allocation Method
RANDOMIZED
Intervention Model
PARALLEL
Primary Study Purpose
TREATMENT
Blinding Strategy
DOUBLE
Participants
Outcome Assessors
Study Groups
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Vitamin D
oral cholecalciferol 1000000 UI (vitamin D3).
At 0, 3, 6 and 9 months, the vitamin D group received orally 100000 IU of cholecalciferol suspended in 2 mL of olive oil in sealed plastic syringes labeled with the unique identification numbers.
Group Type
EXPERIMENTAL
oral cholecalciferol 1000000 UI (vitamin D3)
Intervention Type
DRUG
placebo
placebo
At 0, 3, 6 and 9 months, the placebo group received 2 mL of olive oil, in sealed plastic syringes labeled with the unique identification numbers.
Group Type
PLACEBO_COMPARATOR
Placebo
Intervention Type
DRUG
Interventions
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oral cholecalciferol 1000000 UI (vitamin D3)
Intervention Type
DRUG
Placebo
Intervention Type
DRUG
Other Intervention Names
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DIBASE - ABIOGEN PHARMA Spa
Eligibility Criteria
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Inclusion Criteria
* Vertically acquired HIV infection
* age \< 30 years
* serum 25(OH)D concentration \< 30 ng/mL
* signed written informed consent
* age \< 30 years
* serum 25(OH)D concentration \< 30 ng/mL
* signed written informed consent
Exclusion Criteria
* hyperparathyroidism, as detected by an intact serum parathyroid hormone (PTH) ≥ 65 pg/mL
* Black ethnic group
* any supplementation with vitamin D in the previous 12 months
* use of any treatment known to alter vitamin D status in the previous 6 months (excluding ARV)
* any concomitant severe illness.
* Black ethnic group
* any supplementation with vitamin D in the previous 12 months
* use of any treatment known to alter vitamin D status in the previous 6 months (excluding ARV)
* any concomitant severe illness.
Maximum Eligible Age
30 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
No
Sponsors
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University of Milan
OTHER
Sponsor Role
lead
Responsible Party
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Gian Vincenzo Zuccotti
Gian Vincenzo Zuccotti, Associate Professor of Pediatrics, Chief of Department of Pediatrics at L. Sacco Hospital
Responsibility Role
PRINCIPAL_INVESTIGATOR
Principal Investigators
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Gian Vincenzo Zuccotti, Professor
Role: PRINCIPAL_INVESTIGATOR
Department of Paediatrics, L. Sacco Hospital, University of Milan, Milan, Italy
Locations
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Department of Paediatrics - L. Sacco Hospital
Milan, , Italy
Site Status
Countries
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Italy
References
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Zadshir A, Tareen N, Pan D, Norris K, Martins D. The prevalence of hypovitaminosis D among US adults: data from the NHANES III. Ethn Dis. 2005 Autumn;15(4 Suppl 5):S5-97-101.
Reference Type
BACKGROUND
Bischoff-Ferrari HA. "Vitamin D - why does it matter?" - defining vitamin D deficiency and its prevalence. Scand J Clin Lab Invest Suppl. 2012;243:3-6. doi: 10.3109/00365513.2012.681938.
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BACKGROUND
Kuehn EW, Anders HJ, Bogner JR, Obermaier J, Goebel FD, Schlondorff D. Hypocalcaemia in HIV infection and AIDS. J Intern Med. 1999 Jan;245(1):69-73. doi: 10.1046/j.1365-2796.1999.00407.x.
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BACKGROUND
Rodriguez M, Daniels B, Gunawardene S, Robbins GK. High frequency of vitamin D deficiency in ambulatory HIV-Positive patients. AIDS Res Hum Retroviruses. 2009 Jan;25(1):9-14. doi: 10.1089/aid.2008.0183.
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BACKGROUND
Stephensen CB, Marquis GS, Kruzich LA, Douglas SD, Aldrovandi GM, Wilson CM. Vitamin D status in adolescents and young adults with HIV infection. Am J Clin Nutr. 2006 May;83(5):1135-41. doi: 10.1093/ajcn/83.5.1135.
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BACKGROUND
Rutstein R, Downes A, Zemel B, Schall J, Stallings V. Vitamin D status in children and young adults with perinatally acquired HIV infection. Clin Nutr. 2011 Oct;30(5):624-8. doi: 10.1016/j.clnu.2011.02.005. Epub 2011 Jun 8.
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BACKGROUND
Van Den Bout-Van Den Beukel CJ, Fievez L, Michels M, Sweep FC, Hermus AR, Bosch ME, Burger DM, Bravenboer B, Koopmans PP, Van Der Ven AJ. Vitamin D deficiency among HIV type 1-infected individuals in the Netherlands: effects of antiretroviral therapy. AIDS Res Hum Retroviruses. 2008 Nov;24(11):1375-82. doi: 10.1089/aid.2008.0058.
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BACKGROUND
Mueller NJ, Fux CA, Ledergerber B, Elzi L, Schmid P, Dang T, Magenta L, Calmy A, Vergopoulos A, Bischoff-Ferrari HA; Swiss HIV Cohort Study. High prevalence of severe vitamin D deficiency in combined antiretroviral therapy-naive and successfully treated Swiss HIV patients. AIDS. 2010 May 15;24(8):1127-34. doi: 10.1097/QAD.0b013e328337b161.
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Allavena C, Delpierre C, Cuzin L, Rey D, Viget N, Bernard J, Guillot P, Duvivier C, Billaud E, Raffi F. High frequency of vitamin D deficiency in HIV-infected patients: effects of HIV-related factors and antiretroviral drugs. J Antimicrob Chemother. 2012 Sep;67(9):2222-30. doi: 10.1093/jac/dks176. Epub 2012 May 15.
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Conesa-Botella A, Florence E, Lynen L, Colebunders R, Menten J, Moreno-Reyes R. Decrease of vitamin D concentration in patients with HIV infection on a non nucleoside reverse transcriptase inhibitor-containing regimen. AIDS Res Ther. 2010 Nov 23;7:40. doi: 10.1186/1742-6405-7-40.
Reference Type
BACKGROUND
Arpadi SM, McMahon D, Abrams EJ, Bamji M, Purswani M, Engelson ES, Horlick M, Shane E. Effect of bimonthly supplementation with oral cholecalciferol on serum 25-hydroxyvitamin D concentrations in HIV-infected children and adolescents. Pediatrics. 2009 Jan;123(1):e121-6. doi: 10.1542/peds.2008-0176.
Reference Type
BACKGROUND
Arpadi SM, McMahon DJ, Abrams EJ, Bamji M, Purswani M, Engelson ES, Horlick M, Shane E. Effect of supplementation with cholecalciferol and calcium on 2-y bone mass accrual in HIV-infected children and adolescents: a randomized clinical trial. Am J Clin Nutr. 2012 Mar;95(3):678-85. doi: 10.3945/ajcn.111.024786. Epub 2012 Jan 18.
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BACKGROUND
Veldman CM, Cantorna MT, DeLuca HF. Expression of 1,25-dihydroxyvitamin D(3) receptor in the immune system. Arch Biochem Biophys. 2000 Feb 15;374(2):334-8. doi: 10.1006/abbi.1999.1605.
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BACKGROUND
Sloka S, Silva C, Wang J, Yong VW. Predominance of Th2 polarization by vitamin D through a STAT6-dependent mechanism. J Neuroinflammation. 2011 May 24;8:56. doi: 10.1186/1742-2094-8-56.
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BACKGROUND
Baeke F, Takiishi T, Korf H, Gysemans C, Mathieu C. Vitamin D: modulator of the immune system. Curr Opin Pharmacol. 2010 Aug;10(4):482-96. doi: 10.1016/j.coph.2010.04.001. Epub 2010 Apr 27.
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Klein SA, Dobmeyer JM, Dobmeyer TS, Pape M, Ottmann OG, Helm EB, Hoelzer D, Rossol R. Demonstration of the Th1 to Th2 cytokine shift during the course of HIV-1 infection using cytoplasmic cytokine detection on single cell level by flow cytometry. AIDS. 1997 Jul 15;11(9):1111-8. doi: 10.1097/00002030-199709000-00005.
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BACKGROUND
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30. doi: 10.1210/jc.2011-0385. Epub 2011 Jun 6.
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BACKGROUND
Haug CJ, Aukrust P, Haug E, Morkrid L, Muller F, Froland SS. Severe deficiency of 1,25-dihydroxyvitamin D3 in human immunodeficiency virus infection: association with immunological hyperactivity and only minor changes in calcium homeostasis. J Clin Endocrinol Metab. 1998 Nov;83(11):3832-8. doi: 10.1210/jcem.83.11.5270.
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Ryan P. Random allocation of treatments in blocks. Stata Journal;8:594, 2008
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Rabe-Hesketh S, Skrondal A. Multilevel and longitudinal modeling using Stata. Volume 1: Continuous responses. College Station, TX: Stata Press; 2012.
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Jacobson DL, Spiegelman D, Duggan C, Weinberg GA, Bechard L, Furuta L, Nicchitta J, Gorbach SL, Miller TL. Predictors of bone mineral density in human immunodeficiency virus-1 infected children. J Pediatr Gastroenterol Nutr. 2005 Sep;41(3):339-46. doi: 10.1097/01.mpg.0000174468.75219.30.
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BACKGROUND
Signorello LB, Shi J, Cai Q, Zheng W, Williams SM, Long J, Cohen SS, Li G, Hollis BW, Smith JR, Blot WJ. Common variation in vitamin D pathway genes predicts circulating 25-hydroxyvitamin D Levels among African Americans. PLoS One. 2011;6(12):e28623. doi: 10.1371/journal.pone.0028623. Epub 2011 Dec 21.
Reference Type
BACKGROUND
Haug C, Muller F, Aukrust P, Froland SS. Subnormal serum concentration of 1,25-vitamin D in human immunodeficiency virus infection: correlation with degree of immune deficiency and survival. J Infect Dis. 1994 Apr;169(4):889-93. doi: 10.1093/infdis/169.4.889.
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BACKGROUND
Teichmann J, Stephan E, Lange U, Discher T, Friese G, Lohmeyer J, Stracke H, Bretzel RG. Osteopenia in HIV-infected women prior to highly active antiretroviral therapy. J Infect. 2003 May;46(4):221-7. doi: 10.1053/jinf.2002.1109.
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Kakalia S, Sochett EB, Stephens D, Assor E, Read SE, Bitnun A. Vitamin D supplementation and CD4 count in children infected with human immunodeficiency virus. J Pediatr. 2011 Dec;159(6):951-7. doi: 10.1016/j.jpeds.2011.06.010. Epub 2011 Aug 4.
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Boonstra A, Barrat FJ, Crain C, Heath VL, Savelkoul HF, O'Garra A. 1alpha,25-Dihydroxyvitamin d3 has a direct effect on naive CD4(+) T cells to enhance the development of Th2 cells. J Immunol. 2001 Nov 1;167(9):4974-80. doi: 10.4049/jimmunol.167.9.4974.
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Fazekas de St Groth B, Landay AL. Regulatory T cells in HIV infection: pathogenic or protective participants in the immune response? AIDS. 2008 Mar 30;22(6):671-83. doi: 10.1097/QAD.0b013e3282f466da. No abstract available.
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Sousa AE, Carneiro J, Meier-Schellersheim M, Grossman Z, Victorino RM. CD4 T cell depletion is linked directly to immune activation in the pathogenesis of HIV-1 and HIV-2 but only indirectly to the viral load. J Immunol. 2002 Sep 15;169(6):3400-6. doi: 10.4049/jimmunol.169.6.3400.
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Bang U, Kolte L, Hitz M, Dam Nielsen S, Schierbeck LL, Andersen O, Haugaard SB, Mathiesen L, Benfield T, Jensen JE. Correlation of increases in 1,25-dihydroxyvitamin D during vitamin D therapy with activation of CD4+ T lymphocytes in HIV-1-infected males. HIV Clin Trials. 2012 May-Jun;13(3):162-70. doi: 10.1310/hct1303-162.
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D'Ambrosio D, Cippitelli M, Cocciolo MG, Mazzeo D, Di Lucia P, Lang R, Sinigaglia F, Panina-Bordignon P. Inhibition of IL-12 production by 1,25-dihydroxyvitamin D3. Involvement of NF-kappaB downregulation in transcriptional repression of the p40 gene. J Clin Invest. 1998 Jan 1;101(1):252-62. doi: 10.1172/JCI1050.
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Shearer GM, Clerici M. Cytokine profiles in HIV type 1 disease and protection. AIDS Res Hum Retroviruses. 1998 Jun;14 Suppl 2:S149-52. No abstract available.
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Clerici M, Seminari E, Maggiolo F, Pan A, Migliorino M, Trabattoni D, Castelli F, Suter F, Fusi ML, Minoli L, Carosi G, Maserati R; Master Group. Early and late effects of highly active antiretroviral therapy: a 2 year follow-up of antiviral-treated and antiviral-naive chronically HIV-infected patients. AIDS. 2002 Sep 6;16(13):1767-73. doi: 10.1097/00002030-200209060-00009.
Reference Type
BACKGROUND
Other Identifiers
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2011-000593-54
Identifier Type: EUDRACT_NUMBER
Identifier Source: secondary_id
HLS02/2011-1.0-09-11-2010
Identifier Type: -
Identifier Source: org_study_id