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Study terminated early due to lack of funding and the COVID-19 pandemic.
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Supplementation with vitamin D improves HIV+ macrophages phagocytosis in vitro. There is evidence to suggest that administering vitamin D can in fact improve immune function in individuals. The study will evaluate the impact of high dose vitamin D in HIV+ smokers' and HIV- smokers' in vivo. The primary goal is to improve innate immune host response to infection in patients already at high risk by virtue of HIV and smoking status.
Tobacco smoke suppresses the lung's ability to fight infection. Smoking is three times more prevalent in the HIV+ compared to HIV- patients. Viral load was found to be significantly increased in HIV+ smokers compared to HIV+ non-smokers, suggesting that smoking enhances HIV-1 viral replication in macrophages, which contributes to disease progression. Vitamin D deficiency has been associated with increased mortality in HIV+ persons, but there is limited research on how this is impacting the health of these highest risk patients and if aggressive repletion with vitamin D can improve overall health.The study team hypothesizes that vitamin D administration will increase pathogen clearance and improve innate immune function.
The proposed pre and post interventional study is designed to characterize alveolar macrophage function and lung immunity according to tobacco use and HIV status, and determine the impact of high dose oral vitamin D3 on AM phagocytic function and innate immunity.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| HIV+ smokers | Experimental | Vitamin D3 450,000 IU orally |
|
| HIV- non-smokers | Active Comparator | Vitamin D3 450,000 IU orally |
|
| HIV+ non-smokers | Active Comparator | Vitamin D3 450,000 IU orally |
|
| HIV- smokers | Active Comparator | Vitamin D3 450,000 IU orally |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Vitamin D3 450,000 IU orally | Drug | Study subjects will receive 2 tablets of vitamin D3 for a total of 450,000 IU by mouth. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Difference in alveolar macrophage (AM) phagocytic index between HIV+ smokers compared to HIV- non-smokers. | A phagocytic index will be determined by challenging AM isolated from bronchoalveolar lavage (BAL) to Staph. Aureus in vitro. | Day 1 of the study prior to vitamin D administration. |
| Difference in phagocytosis percent positive between HIV+ smokers compared to HIV- non-smokers, prior to vitamin D administration. | Difference in phagocytosis percent positive between HIV+ smokers compared to HIV- non-smokers will be calculated. | Day 1 of the study prior to vitamin D administration. |
| Difference in alveolar macrophage (AM) phagocytic index before and after vitamin D administration. | A phagocytic index will be determined by challenging AM isolated from bronchoalveolar lavage (BAL) to Staph. Aureus in vitro. | Day 1 of the study prior to vitamin D administration, Day 7 after vitamin D administration |
| Measure | Description | Time Frame |
|---|---|---|
| Difference in total and free vitamin D (25(OH) D) between HIV+ smokers compared to HIV- non-smokers, prior to vitamin D administration. | Difference in total and free 25(OH) D between HIV+ smokers compared to HIV- non-smokers will be measure by ELISA (enzyme-linked immunosorbent assay) levels. | Day 1 of the study prior to vitamin D administration. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jenny E Han, MD, MSc | Emory University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Atlanta VA Medical center | Atlanta | Georgia | 30303 | United States | ||
| Grady Health System (non-CRN), Grady Health System (CRN), Ponce Center |
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| ID | Term |
|---|---|
| D000163 | Acquired Immunodeficiency Syndrome |
| D014808 | Vitamin D Deficiency |
| D008171 | Lung Diseases |
| D012907 | Smoking |
| ID | Term |
|---|---|
| D015658 | HIV Infections |
| D000086982 | Blood-Borne Infections |
| D003141 | Communicable Diseases |
| D007239 | Infections |
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| ID | Term |
|---|---|
| D002762 | Cholecalciferol |
| ID | Term |
|---|---|
| D002782 | Cholestenes |
| D002776 | Cholestanes |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
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A total of 44 subjects (11 per group, smokers and non-smokers, HIV+, HIV-) will be enrolled.
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| Difference in peptide LL-37 between HIV+ smokers compared to HIV- non-smokers, prior to vitamin D administration. | Difference in an antimicrobial and immunostimulating/-modulating peptide LL-37 between HIV+ smokers compared to HIV- non-smokers will be calculated. | Day 1 of the study prior to vitamin D administration. |
| Difference in tumor necrosis factor alpha (TNF-α) between HIV+ smokers compared to HIV- non-smokers, prior to vitamin D administration. | Difference in tumor necrosis factor alpha (TNF-α) - cytokine involved in systemic inflammation - between HIV+ smokers compared to HIV- non-smokers will be calculated . | Day 1 of the study prior to vitamin D administration. |
| Difference in messenger ribonucleic acid (mRNA) expression of LL-37 between HIV+ smokers compared to HIV- non-smokers, prior to vitamin D administration. | Difference in mRNA expression of antimicrobial peptide LL-37 between HIV+ smokers compared to HIV- non-smokers will be calculated. | Day 1 of the study prior to vitamin D administration. |
| Difference in alveolar oxidative stress between HIV+ smokers compared to HIV- non-smokers, prior to vitamin D administration. | Difference in alveolar oxidative stress between HIV+ smokers compared to HIV- non-smokers will be measured using AM isolated from bronchoalveolar lavage (BAL) . | Day 1 of the study prior to vitamin D administration. |
| Difference in total and free vitamin D (25(OH) D) before and after vitamin D administration. | Difference in total and free vitamin D (25(OH) D) will be measure by ELISA (enzyme-linked immunosorbent assay) | Day 1 of the study prior to vitamin D administration, Day 7 after vitamin D administration |
| Difference in peptide LL-37 before and after vitamin D administration. | Difference in peptide LL-37 levels will be calculated. | Day 1 of the study prior to vitamin D administration, Day 7 after vitamin D administration |
| Difference in tumor necrosis factor alpha (TNF-α) before and after vitamin D administration. | Difference in tumor necrosis factor alpha (TNF-α) will be calculated. | Day 1 of the study prior to vitamin D administration, Day 7 after vitamin D administration |
| Difference in mRNA expression of LL-37 before and after vitamin D administration. | Difference in mRNA expression of LL-37 will be calculated. | Day 1 of the study prior to vitamin D administration, Day 7 after vitamin D administration |
| Difference in alveolar oxidative stress before and after vitamin D administration. | Difference in alveolar oxidative stress will be measured using AM isolated from bronchoalveolar lavage (BAL) . | Day 1 of the study prior to vitamin D administration, Day 7 after vitamin D administration |
| Atlanta |
| Georgia |
| 30303 |
| United States |
| D015229 |
| Sexually Transmitted Diseases, Viral |
| D012749 | Sexually Transmitted Diseases |
| D016180 | Lentivirus Infections |
| D012192 | Retroviridae Infections |
| D012327 | RNA Virus Infections |
| D014777 | Virus Diseases |
| D012897 | Slow Virus Diseases |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D007153 | Immunologic Deficiency Syndromes |
| D007154 | Immune System Diseases |
| D001361 | Avitaminosis |
| D003677 | Deficiency Diseases |
| D044342 | Malnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
| D012140 | Respiratory Tract Diseases |
| D001519 | Behavior |
| D011083 |
| Polycyclic Compounds |
| D013261 | Sterols |
| D014807 | Vitamin D |
| D012632 | Secosteroids |
| D008563 | Membrane Lipids |
| D008055 | Lipids |