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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT03426592
Registration number
NCT03426592
Ethics application status
Date submitted
1/02/2018
Date registered
8/02/2018
Titles & IDs
Public title
Effect of High Dose Vitamin D Supplementation on HIV Latency
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Scientific title
Effect of High Dose Vitamin D Supplementation on HIV Latency: A Pilot Randomized Controlled Trial
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Secondary ID [1]
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2016.362
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Universal Trial Number (UTN)
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Trial acronym
VIVA
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Human Immunodeficiency Virus
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Condition category
Condition code
Infection
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Acquired immune deficiency syndrome (AIDS / HIV)
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Vitamin D3, 10000 Intl Units Oral Capsule
Treatment: Drugs - Placebo oral capsule
Active comparator: Vitamin D3, 10000 Intl Units Oral Capsule - Vitamin D3, 10000 Intl Units Oral Capsule, daily for 6 months
Placebo comparator: Placebo oral capsule - Oleic acid capsule by mouth, daily for 6 months
Treatment: Drugs: Vitamin D3, 10000 Intl Units Oral Capsule
Vitamin D capsule. Over-encapsulated to mimic placebo oral capsule.
Eligible study participants will be randomized 1:1 to vitamin D or placebo one capsule daily from week 0 to week 24. All participants will be advised to achieve 1 gram daily dietary calcium intake whilst on study.
Blood and urine will be taken at 0, 12, 24 and 36 weeks to evaluate the primary and secondary endpoints.
Rectal swabs will be taken at 0, 24 and 36 weeks.
All participants will continue antiretroviral therapy throughout the study.
Treatment: Drugs: Placebo oral capsule
Capsule containing oleic acid. Over-encapsulated to mimic vitamin D3 capsule.
Eligible study participants will be randomized 1:1 to vitamin D or placebo one capsule daily from week 0 to week 24. All participants will be advised to achieve 1 gram daily dietary calcium intake whilst on study.
Blood and urine will be taken at 0, 12, 24 and 36 weeks to evaluate the primary and secondary endpoints.
Rectal swabs will be taken at 0, 24 and 36 weeks.
All participants will continue antiretroviral therapy throughout the study.
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Change in total HIV DNA level
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Assessment method [1]
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The difference between the vitamin D and placebo arms in the mean change in frequency of total HIV DNA within CD4+ T cells from week 0 to week 24
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Timepoint [1]
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weeks 0 and 24
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Secondary outcome [1]
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Change in other DNA markers of HIV persistence
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Assessment method [1]
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Total HIV DNA, integrated HIV DNA and 2-LTR circles in peripheral blood CD4+ T cells using PCR
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Timepoint [1]
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Weeks 0, 12, 24, 36
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Secondary outcome [2]
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Change in cell-associated HIV RNA
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Assessment method [2]
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Cell-associated unspliced and multiply spliced HIV RNA in peripheral blood CD4+ T cells using RT-PCR and Tat/rev Induced Limiting Dilution Assay (TILDA)
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Timepoint [2]
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Weeks 0, 12, 24, 36
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Secondary outcome [3]
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Change in proportion of immune cells
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Assessment method [3]
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T helper and T cytotoxic subsets, monocytes, dendritic cells and natural killer cells using flow cytometry
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Timepoint [3]
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Weeks 0, 12, 24, 36
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Secondary outcome [4]
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Change in T cell subset phenotype
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Assessment method [4]
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T cell subset activation and exhaustion marker and chemokine receptor expression using flow cytometry
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Timepoint [4]
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Weeks 0, 12, 24, 36
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Secondary outcome [5]
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Change in HIV-specific immunity
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Assessment method [5]
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HIV-specific CD4+ and CD8+ T cell frequency and polyfunctionality using HIV peptides and flow cytometry
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Timepoint [5]
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Weeks 0, 12, 24, 36
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Secondary outcome [6]
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Change in CD4+ T cell transcriptional profile
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Assessment method [6]
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CD4+ T cell transcriptional profile using RNA Seq
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Timepoint [6]
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Weeks 0, 12, 24, 36
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Secondary outcome [7]
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Change in high sensitivity C-reactive protein (hsCRP)
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Assessment method [7]
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hsCRP levels
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Timepoint [7]
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Weeks 0, 12, 24, 36
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Secondary outcome [8]
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Change in gut barrier permeability
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Assessment method [8]
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Gut barrier permeability using plasma lipopolysaccharide (LPS), soluble CD14 and intestinal fatty acid binding protein (I-FABP)
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Timepoint [8]
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Weeks 0, 12, 24, 36
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Secondary outcome [9]
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Change in gut microbiome diversity
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Assessment method [9]
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Gut microbiome diversity using 16S rRNA sequencing and metagenomics
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Timepoint [9]
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Weeks 0, 24, 36
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Secondary outcome [10]
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Change in plasma microbiome abundance and diversity
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Assessment method [10]
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Plasma microbiome abundance and diversity using deep sequencing
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Timepoint [10]
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Weeks 0, 24, 36
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Secondary outcome [11]
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25-hydroxyvitamin D levels
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Assessment method [11]
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Serum 25-hydroxyvitamin D levels and correlation between level achieved and each of the other endpoints (efficacy analysis)
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Timepoint [11]
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Weeks 0, 12, 24, 36
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Secondary outcome [12]
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Serum calcium levels
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Assessment method [12]
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Serum calcium corrected for albumin
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Timepoint [12]
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Weeks 0, 12, 24, 36
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Secondary outcome [13]
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Urinary calcium levels
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Assessment method [13]
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Urinary calcium:creatinine ratios and, where these are abnormal, 24 hour urinary calcium levels
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Timepoint [13]
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Weeks 0, 12, 24, 36
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Secondary outcome [14]
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Adverse events
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Assessment method [14]
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Incidence and severity of adverse events
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Timepoint [14]
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Weeks 0, 12, 24, 36
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Secondary outcome [15]
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Study protocol adherence
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Assessment method [15]
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Adherence to study drug and 1g daily dietary calcium intake as measured by pill count and participant report
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Timepoint [15]
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Weeks 0 to 24
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Eligibility
Key inclusion criteria
* Written informed consent obtained
* At least 18 years of age
* Documented HIV-1 infection
* Receiving combination antiretroviral therapy continuously for at least 3 years
* Viral load suppressed below 40 copies/mL, or below assay limit of quantification where limit of quantification is above 40 copies/mL, for at least 3 years (excluding single episodes of HIV viral load 40-500 copies/mL where subsequent viral load was below 40 copies/mL or below assay limit of quantification where limit of quantification is above 40 copies/mL)
* Viral load < 40 copies/ml at screening
* Screening 25-hydroxyvitamin D level within 12 months prior to recruitment between 50nM and 125nM
* Agreement not to take any vitamin D containing compounds other than study drug between screening and conclusion of the study
* Agreement not to have vitamin D level checked by a treating doctor during the study unless medically required
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* Any planned change to ART regimen within next 12 months (other than switching tenofovir disoproxil fumarate to tenofovir alafenamide)
* Known current acute or chronic hepatitis B, known current acute or chronic hepatitis C or positive HBsAg or HCV PCR in blood at screening
* Completion of curative treatment for HCV within 6 months prior to screening
* HIV-2 infection
* Any vitamin D supplementation from 6 months prior to the screening 25(OH) vitamin D test until study commencement (including multivitamins containing vitamin D and cod liver oil)
* Any medical indication for vitamin D supplementation, eg osteoporosis, renal impairment (estimated glomerular filtration rate < 60ml/minute), liver cirrhosis
* Chronic diarrhoea or fat malabsorption
* Body mass index (BMI >= 35)
* Current hypercalcaemia (corrected calcium greater than 2.60mM), current primary hyperparathyroidism or any history of nephrolithiasis
* Current hyperthyroidism
* History of sarcoidosis or active tuberculosis
* Grade 3 or 4 abnormalities in screening pathology laboratory tests not already excluded by the above criteria at the discretion of the Principal Investigator
* Hypersensitivity to vitamin D preparations
* Concurrent medication with adverse interactions with vitamin D (eg oral glucocorticoids, phenytoin, carbamazepine, barbiturates, rifampicin, rifabutin, St John's wort, thiazide diuretics, digoxin, ketoconazole, itraconazole, nefazodone, isoniazid, cholestyramine, aluminium hydroxide, aripiprazole, danazol, orlistat, perhexiline or sucralfate use) or possible such use within next 12 months
* Current interferon, immune checkpoint blocker, histone deacetylase inhibitor, oral vitamin A or other oral vitamin A analogue (eg acitretin, isotretinoin or tretinoin, also known as all-trans retinoic acid or ATRA) usage or possible use within next 12 months
* Current participation in another interventional HIV cure study
* Pregnancy or breast-feeding
* Participants of child-bearing potential unwilling to use at least one form of effective contraception (with failure rate <1%, eg hormonal contraception, intrauterine device, abstinence, tubal ligation or partner with vasectomy) from at least 2 weeks prior to study commencement until at least 4 weeks after discontinuation of all study medication
* Inability to consent
* Inability to speak English
* Medicare ineligibility
* Major medical or psychiatric illness or substance misuse that could in the opinion of the investigator impair adherence to the study protocol
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 2
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
29/01/2018
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
21/05/2019
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Sample size
Target
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Accrual to date
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Final
30
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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The Peter Doherty Institute for Infection and Immunity - Melbourne
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Recruitment hospital [2]
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The Alfred Hospital - Department of Infectious Diseases - Melbourne
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Recruitment hospital [3]
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Royal Melbourne Hospital - Melbourne
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Recruitment hospital [4]
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Melbourne Sexual Health Centre - Melbourne
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Recruitment postcode(s) [1]
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3000 - Melbourne
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Recruitment postcode(s) [2]
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3004 - Melbourne
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Recruitment postcode(s) [3]
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3050 - Melbourne
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Recruitment postcode(s) [4]
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3053 - Melbourne
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Funding & Sponsors
Primary sponsor type
Other
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Name
University of Melbourne
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Address
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Country
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Other collaborator category [1]
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Other
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Name [1]
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Melbourne Health
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Address [1]
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Country [1]
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Other collaborator category [2]
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Other
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Name [2]
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The Alfred
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Address [2]
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Country [2]
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Other collaborator category [3]
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Other
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Name [3]
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Melbourne Sexual Health Centre
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Address [3]
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Country [3]
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Other collaborator category [4]
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Other
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Name [4]
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University of Illinois at Chicago
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Address [4]
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Country [4]
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Other collaborator category [5]
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Government body
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Name [5]
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National Institute of Allergy and Infectious Diseases (NIAID)
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Address [5]
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Country [5]
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Ethics approval
Ethics application status
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Summary
Brief summary
HIV persists despite antiretroviral therapy (ART) and is associated with chronic inflammation. This inflammation is thought to prevent an effective immune response against the virus and is mediated at least in part by gut epithelial permeability and microbial translocation. HIV accumulates preferentially within Th17 cells with time on ART; these memory CD4+ T cells are highly susceptible to HIV infection and are concentrated within the gut. Vitamin D promotes gut epithelial integrity in animal models and exerts anti-inflammatory effects on the human immune system including down-modulation of Th17 cell frequency. This study will evaluate whether high dose vitamin D is able to reduce immune activation and Th17 cell frequency, to improve gut barrier integrity and the gut microbiome and reduce HIV persistence in participants on long-term suppressive ART.
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Trial website
https://clinicaltrials.gov/study/NCT03426592
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Sharon Lewin, FRACP PhD
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Address
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The Peter Doherty Institute for Infection and Immunity, University of Melbourne
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Address
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Phone
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Fax
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Email
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT03426592