Randomized, Blinded, Placebo-Controlled Trial of De Simone Formulation Probiotic During HIV-Associated Suboptimal CD4+ T Cell Recovery.

Autor:	Rousseau RK; Departments of Immunology, Medicine, and Internal Medicine, University of Toronto, Toronto, Ontario, Canada., Walmsley SL; Departments of Immunology, Medicine, and Internal Medicine, University of Toronto, Toronto, Ontario, Canada.; University Health Network, Toronto General Hospital Immunodeficiency Clinic, Toronto, Ontario, Canada.; Toronto General Hospital Research Institute, Toronto, Ontario, Canada., Lee T; CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada.; Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada., Rosenes R; Community Health Advocate and Consultant (Independent), Toronto, Ontario, Canada., Reinhard RJ; Public/Global Health Consultant (Independent), San Francisco, CA; and., Malazogu F; Departments of Immunology, Medicine, and Internal Medicine, University of Toronto, Toronto, Ontario, Canada., Benko E; Maple Leaf Medical Clinic, Toronto, Ontario, Canada., Huibner S; Departments of Immunology, Medicine, and Internal Medicine, University of Toronto, Toronto, Ontario, Canada., Kovacs CM; Departments of Immunology, Medicine, and Internal Medicine, University of Toronto, Toronto, Ontario, Canada.; Maple Leaf Medical Clinic, Toronto, Ontario, Canada., Singer J; CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada.; Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada., Kim CJ; Departments of Immunology, Medicine, and Internal Medicine, University of Toronto, Toronto, Ontario, Canada., Kaul R; Departments of Immunology, Medicine, and Internal Medicine, University of Toronto, Toronto, Ontario, Canada.; University Health Network, Toronto General Hospital Immunodeficiency Clinic, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2022 Feb 01; Vol. 89 (2), pp. 199-207.
DOI:	10.1097/QAI.0000000000002840
Abstrakt:	Objective: To assess whether probiotic supplementation may reduce disease-linked systemic immune activation in people living with HIV with the immunologic nonresponder phenotype. Design: Phase 2b, randomized, double-blind, placebo-controlled pilot trial. Methods: HIV-positive individuals with blood CD4+ T-cell counts <350/mm3 despite viral suppression were randomized to 2:1 to receive De Simone Formulation Probiotic (DSFP; "Visbiome" commercially) or placebo for 48 weeks; target enrollment was 36 patients. The primary endpoint was the change in blood CD8+ T-cell coexpression of human leukocyte antigen-DR isotype and CD38 ("CD8 activation"). Secondary endpoints included biomarkers of inflammation, immune reconstitution, bacterial translocation, and gut permeability. Adjusted linear regression and linear mixed regression methods evaluated the differences between study arms from baseline to week 48. Study monitoring was performed by the CIHR Canadian HIV Trials Network Data Safety Monitoring Committee. Results: Nineteen patients received DSFP, whereas 10 received placebo. One probiotic arm patient withdrew early. Blood CD8 activation increased 0.82 percentage points (pp) in the probiotic arm (95% confidence interval: -1.23 to 2.87;) and decreased by 2.06 pp in the placebo arm (-4.81 to 0.70; between arms P = 0.097). CD4+ T-cell activation (%HLA-DR+) decreased in the placebo arm [-3.79 pp (-7.32 to -0.26)] but increased in the probiotic arm [1.64 (-0.98 to 4.26); between arms P = 0.018]. No differences were observed in plasma or urine biomarkers of inflammation or microbial translocation. Conclusions: Blood immune activation markers in immunologic nonresponder individuals on effective antiretroviral treatment were not reduced by supplementation with DSFP; CD4+ T-cell activation may have been increased. Competing Interests: The authors have no conflicts of interest to disclose. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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