Mediterranean Diet and Bacterial Translocation and Immune-activation in Patients With HIV

Study Overview
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Brief Summary
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Evaluate if a change to a Mediterranean diet supplemented with nuts and olive oil decreases bacterial translocation and immune activation by a change in the microbiome in successfully treated HIV-1 infected patients with CD4> 500cells/ml.

Detailed Description
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Mediterranean diet supplemented by nuts and extra virgin olive oil has shown to reduce mortality, cardiovascular diseases, and breast cancer in HIV uninfected individuals. It is likely that changes in the microbiome could play a role in this effect. The goal of the study is to evaluate if a change to a Mediterranean diet supplemented with nuts and olive oil decreases bacterial translocation and immune activation by a change in the microbiome in successfully treated HIV-1 infected patients with CD4> 500cells/ml. One hundred and two patients who will be randomized to continues usual diet or to a Mediterranean diet supplemented with 50 g / day of olive oil and 15g / day of nuts for three months. Throughout the study a specialized dietician will monitor the patients. Blood samples will be collected to assess parameters of bacterial translocation, inflammation and immune activation. To assess compliances with diet, urine samples will be collected too, and stool samples to study changes in gut microbiota. All the samples will be collected at the beginning and 90 days after the inclusion in the study.

Official Title
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Changes in Bacterial Translocation and Immune Activation in Patients Infected With HIV After Change to a Supplemented Mediterranean Diet: Two Arms Randomized Prospective Trial.

Conditions
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Hiv

Intervention / Treatment
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* Dietary Supplement: mediterranean diet


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient ≥ 18 years of age; To sign voluntary informed consent; Male or female patients with a negative pregnancy test before inclusion in the study; Proven HIV infection (with HIV-1 positive antibodies); Patient should be on stable treatment with cART for at least 1 year The mean of all CD4 measurements during the year prior to the initiation of cART should be equal to greater than 350 cells / mm3 The number of CD4 + at the time of recruitment must be equal to or greater than 500 cells / mm3; HIV viral load should be undetectable at least 6 months prior to study inclusion, and less determinations (occasional blips above the undetectable level are allowed). Exclusion Criteria: Acquired Immunodeficiency Syndrome. Active opportunistic diseases. Patients coinfected with HCV or HBV Coagulopathy Renal insufficiency (creatinine> 1.5 mg / dL) Pregnancy or breastfeeding Inability to sign informed consent Active opportunistic infections, or any active infection or cancer within 30 days prior to the screening visit; Therapy with immunomodulatory agents, including cytokines (eg IL-2) and gammaglobulins or chemotherapy within 90 days prior to the screening visit; Use of anticoagulant medication; Use of any type of experimental medication during the 90 days prior to study entry; Uncontrolled psychiatric disorder; Patients with uncontrolled active autoimmune diseases; Usual use of antibiotics

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: . One hundred and two patients who will be randomized to continues usual diet or to a Mediterranean diet supplemented with 50 g / day of olive oil and 15g / day of nuts for three months. Throughout the study a specialized dietician will monitor the patients. Blood samples will be collected to assess parameters of bacterial translocation, inflammation and immune activation. To assess compliances with diet, urine samples will be collected too, and stool samples to study changes in gut microbiota. All the samples will be collected at the beginning and 90 days after the inclusion in the study.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: mediterranean diet<br>Patients do Mediterranean diet supplemented with 50 g / day of olive oil and 15g / day of nuts for three months | Dietary Supplement: mediterranean diet<br>* a Mediterranean diet supplemented with 50 g / day of olive oil and 15g / day of nuts for three months<br>|
| No Intervention: Usual diet<br>Patients do usual diet for three months | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Differences in levels of sCD14 at baseline and month 3 between groups | parameters of bacterial translocation | 2 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in EndocAB and LBP levels at baseline and month 3 between groups. | other parameters of bacterial translocation. | 2 year | 
| Changes in microbiota (fecal 16s rRNA) at baseline and month 3 between groups | Microbioma | 2 years | 
| Changes in ultrasensitive PCR, TNF-alpha, IL-6 and Dimer-D at baseline and month 3 between groups | inflammatory markers | 2 years | 
| Changes in lipids at baseline and month 3 between groups | Lipids | 2 years | 
| Changes in expression of CD38, HLA DR in CD4 and CD8 T cells at baseline and month 3 between groups | immune-activation markers | 2 years | 
| Changes in total and integrated DNA | Marker of HIV reservoir | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Microbiota., Mediterranean Diet, Bacterial Traslocation