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Vitamin D Absorption in HIV Infected Young Adults Being Treated With Tenofovir Containing cART

Primary Purpose

HIV Infection

Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Vitamin D3 50,000 IU
Vitamin D3 placebo
Sponsored by
University of North Carolina, Chapel Hill
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for HIV Infection

Eligibility Criteria

16 Years - 24 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

To be considered eligible for enrollment, an individual must meet the criteria listed below at the time of randomization:

NOTE: If the DXA scan is scheduled prior to randomization, all eligibility criteria must be met prior to performing the DXA scan.

  • Age 16 years and 0 days to 24 years and 364 days;
  • Behaviorally infected with HIV (e.g., sexual contact, injection drug use; not infected by perinatal transmission, blood transfusion, or at age younger than 9 years);
  • HIV-1 infection as documented in subject's medical record by at least one of the following criteria:

    • reactive HIV screening test result with an antibody based FDA-licensed assay followed by a positive supplemental assay (e.g., HIV-1 Western Blot, HIV-1 Indirect Immunofluorescence, Antibody Differentiation Assay (Multispot)); or
    • positive HIV-1 DNA polymerase chain reaction (PCR) assay; or
    • plasma HIV-1 quantitative RNA assay >1,000 copies/mL; or
    • positive plasma HIV-1 RNA qualitative assay
  • Subjects must have at least one documented HIV viral load that is below 200 copies/mL collected following initiation of TDF containing cART and greater than 90 days prior to randomization; no HIV viral load above 200 copies/mL if measured within the 90 days prior to randomization; and an HIV viral load obtained at screening that is below 200 copies/mL.
  • Currently being treated for at least 180 days by the time of randomization with a TDF containing cART with at least 2 other FDA approved ARVs (NOTE: This may include a TDF-containing fixed drug combination medication);
  • Negative serum hepatitis B surface antigen (HBsAg) at screening or by history within 4 weeks prior to screening (see section 7.1.3);
  • Willingness and ability to remain on the same cART regimen for the duration of study participation;
  • Willingness and ability to participate in the study, follow all study procedures for the duration of study participation, and provide written informed consent or assent with parental permission, if applicable; and
  • For females of child-bearing potential, agreement to use a minimum of one proven-effective method of birth control and willingness to postpone pregnancy for the duration of study participation (see section 5.3.2 for permitted hormonal contraceptives)

Exclusion Criteria:

To be considered eligible for enrollment, an individual must not meet any of the criteria listed below at the time of randomization:

NOTE: If the DXA scan is scheduled prior to randomization, all eligibility criteria must be met prior to performing the DXA scan.

  • Prior hypersensitivity to vitamin D;
  • History of sarcoidosis, arteriosclerosis, renal stones, glomerulonephritis, interstitial kidney disease, nephrotic syndrome, hypercalcemia, osteoporosis and/or other bone diseases, clinical diagnosis of hypoparathyroidism or hyperparathyroidism;
  • Lactation or pregnancy currently or within the past 24 weeks;
  • Chemotherapy or radiation therapy for malignancy within the past 12 months;
  • Known presence of GI disease that, in the opinion of the clinician, would interfere with study agent administration or absorption (e.g. Crohn's, Colitis);
  • For subjects ≥ 18 years, confirmed creatinine clearance < 70 ml/min (estimated glomerular filtration rate (GFR) from SCr using Cockcroft and Gault (CG) equation) and for subjects <18 years, confirmed creatinine clearance < 70ml/min/1.73m2 (estimated GFR from SCr using Schwartz formula (see section 3.5). (Estimated GFR may be calculated using the formulae programmed on the ATN website);
  • SCa > Upper Limit Normal (ULN) for local laboratory values (see section 7.1.3);
  • Active Grade 3 or higher clinical or laboratory toxicity except atazanavir (ATV) associated indirect hyperbilirubinemia (see section 9.5.2.2);
  • Weight is > 350 pounds (lbs) or 159 kilograms (kgs);
  • Positive hepatitis C antibody by history or at screening (see section 7.1.3); and
  • Use of any medications as specified in sections 5.3.1, 5.3.3 and 5.4.
  • Females Only: Use of certain hormonal contraceptives as specified in the protocol.

Sites / Locations

  • Children's Hopsital of Los Angeles
  • University of Southern California - NICHD Westat Site
  • Childrens National Medical Center
  • Children's Diagnostic and Treatment Center - NICHD Westat Site
  • University of Miami School of Medicine
  • University of South Florida
  • Stroger Hospital and the CORE Center
  • Tulane Medical Center
  • Johns Hopkins University - NICHD Westat Site
  • Johns Hopkins University
  • Fenway Institute
  • Wayne State University
  • Montefiore Medical Center
  • Children's Hospital of Philadelphia
  • St. Jude Childrens Research Hospital
  • Baylor College of Medicine
  • San Juan City Hospital (Puerto Rico) - NICHD Westat Site

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Group A: Vitamin D3 50,000 IU

Group B: Vitamin D3 placebo

Arm Description

Subjects randomized to Group A will receive Vitamin D3 50,000 IU orally every four weeks by directly observed therapy (DOT). In addition all subjects receive a multivitamin (MVI) that contains ingredients not to exceed 600 IU of vitamin D3 and 200 mg of Calcium (Ca). Subjects will self-administer one MVI tablet orally once daily.

Subjects randomized to Group B will receive Vitamin D3 placebo orally every four weeks by DOT. In addition all subjects receive a MVI that contains ingredients not to exceed 600 IU of vitamin D3 and 200 mg of Ca. Subjects will self-administer one MVI tablet orally once daily.

Outcomes

Primary Outcome Measures

Percent Change From Baseline to Week 48 in Dual Energy X-ray Absorptiometry (DXA)-Measured BMD at the Spine for the Randomized Study Groups
Percent change from baseline to week (wk) 48 in DXA-measured BMD at the spine for the randomized study groups. Lumbar spine BMD (L1 - L4) (g/cm2) change from Baseline to wk 48 visit.

Secondary Outcome Measures

Percent Change From Baseline to Week 24 of BMC of Whole Body for the Randomized Study Groups
Percent Change From Baseline to Week 48 of BMC of Whole Body for the Randomized Study Groups
Percent Change From Baseline to Week 24 of Lumbar Spine (L1-L4) BMD for the Randomized Study Groups
Change From Baseline to Week 24 of Lumbar Spine (L1-L4) BMD Z-score for the Randomized Study Groups
The Z-score is the standard deviation around mean bone mineral density in the lumbar spine, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Change From Baseline to Week 48 of Lumbar Spine (L1-L4) BMD Z-score for the Randomized Study Groups
The Z-score is the standard deviation around mean bone mineral density in the lumbar spine, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Percent Change From Baseline to Week 24 of Femoral Neck BMD for the Randomized Study Groups
Percent Change From Baseline to Week 48 of Femoral Neck BMD for the Randomized Study Groups
Change From Baseline to Week 24 of Femoral Neck BMD Z-score for the Randomized Study Groups
The Z-score is the standard deviation around mean bone mineral density in the femoral neck, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Change From Baseline to Week 48 of Femoral Neck BMD Z-score for the Randomized Study Groups
The Z-score is the standard deviation around mean bone mineral density in the femoral neck, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Percent Change From Baseline to Week 24 of Total Hip BMD for the Randomized Study Groups
Percent Change From Baseline to Week 48 of Total Hip BMD for the Randomized Study Groups
Change From Baseline to Week 24 of Total Hip BMD Z-score for the Randomized Study Groups
The Z-score is the standard deviation around mean bone mineral density in the total hip, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Change From Baseline to Week 48 of Total Hip BMD Z-score for the Randomized Study Groups
The Z-score is the standard deviation around mean bone mineral density in the total hip, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Change in SCr From Baseline to Week 12.
To assess renal glomerular safety by measuring change in SCr from baseline to week 12 by randomized study group;
Change in SCr From Baseline to Week 24.
To assess renal glomerular safety by measuring change in SCr from baseline to week 24 by randomized study group;
Change in SCr From Baseline to Week 48.
To assess renal glomerular safety by measuring change in SCr from baseline to week 48 by randomized study group;
Change From Baseline to Week 48 in Glucose Homeostasis (Fasting Insulin)
Change From Baseline to Week 48 in Glucose Homeostasis (Fasting Glucose)
Change From Baseline to Week 48 in Glucose Homeostasis (Homeostasis Model Assessment of Insulin Resistance (HOMA-IR))
HOMA-IR is calculated as fasting glucose (mg/dL) X fasting glucose (uIU/mL) / 405. An increase in HOMA-IR means that an individual has become more resistant (less sensitive) to the effects of insulin and thus would be a negative outcome. A reduction in HOMA-IR means that an individual has become more sensitive to the effects of insulin and would be considered a positive outcome.There are no set minimum or maximum scores for HOMA-IR, since it is based on measurements of insulin and glucose, the assays for which may vary. Several studies suggest a cut-off of >2 for any insulin resistance, but "normal" values appear to vary greatly by population (https://www.mdcalc.com/homa-ir-homeostatic-model-assessment-insulin-resistance).
Change From Baseline to Week 12 in Serum Calcium (SCa)
Change From Baseline to Week 24 in Serum Calcium (SCa)
Change From Baseline to Week 48 in Serum Calcium (SCa)
Change From Baseline to Week 12 in CTX
Change From Baseline to Week 24 in CTX
Change From Baseline to Week 48 in CTX
Change From Baseline to Week 12 in OC
Change From Baseline to Week 24 in OC
Change From Baseline to Week 48 in OC
Change From Baseline to Week 12 in BAP
Change From Baseline to Week 24 in BAP
Change From Baseline to Week 48 in BAP
Change From Baseline to Week 12 in FGF23
Change From Baseline to Week 24 in FGF23
Change From Baseline to Week 48 in FGF23
Change From Baseline to Week 12 in PTH
Change From Baseline to Week 24 in PTH
Change From Baseline to Week 48 in PTH
Change From Baseline to Week 12 in Actual Free 1,25-OHD
Vitamin D serum concentration (1,25 (OH)DTotal) (pmol/L) multiplied by F times 1,000, where F is defined as F = 1/(1 + Kd * [VDBP] + Ka *[albumin]) where the binding constant for VDBP = Kd = 4.2 x 107 M-1, and for albumin is Ka = 5.4 x 104 M-1 and the concentrations of VDBP and albumin are in moles/L
Change From Baseline to Week 24 in Actual Free 1,25-OHD
Vitamin D serum concentration (1,25 (OH)DTotal) (pmol/L) multiplied by F times 1,000, where F is defined as F = 1/(1 + Kd * [VDBP] + Ka *[albumin]) where the binding constant for VDBP = Kd = 4.2 x 107 M-1, and for albumin is Ka = 5.4 x 104 M-1 and the concentrations of VDBP and albumin are in moles/L
Change From Baseline to Week 48 in Actual Free 1,25-OHD
Vitamin D serum concentration (1,25 (OH)DTotal) (pmol/L) multiplied by F times 1,000, where F is defined as F = 1/(1 + Kd * [VDBP] + Ka *[albumin]) where the binding constant for VDBP = Kd = 4.2 x 107 M-1, and for albumin is Ka = 5.4 x 104 M-1 and the concentrations of VDBP and albumin are in moles/L
Change From Baseline to Week 12 in 1,25-OHD
Change From Baseline to Week 24 in 1,25-OHD
Change From Baseline to Week 48 in 1,25-OHD
Change From Baseline to Week 12 in 25-OHD
Change From Baseline to Week 24 in 25-OHD
Change From Baseline to Week 48 in 25-OHD
Change From Baseline to Week 12 in TRP %
Change From Baseline to Week 24 in TRP %
Change From Baseline to Week 48 in TRP %
Change From Baseline to Week 12 in SPO4
Change From Baseline to Week 24 in SPO4
Change From Baseline to Week 48 in SPO4
Change From Baseline to Week 12 in UCa/Ucr
Change From Baseline to Week 24 in UCa/Ucr
Change From Baseline to Week 48 in UCa/Ucr
Change in Estimated GFR From Baseline to Week 12.
To assess renal glomerular safety by measuring change in estimated GFR from baseline to week 12 by randomized study group. eGFR calculated by the CKD-Epi equation for subjects >=18 years of age, and by bedside Schwartz formula for subjects <18 years of age
Change in Estimated GFR From Baseline to Week 24.
To assess renal glomerular safety by measuring change in estimated GFR from baseline to week 24 by randomized study group;
Change in Estimated GFR From Baseline to Week 48.
To assess renal glomerular safety by measuring change in estimated GFR from baseline to week 48 by randomized study group;
Change in UGluc From Baseline to Week 48
To assess renal tubular function by measuring change in urine glucose (UGluc) by randomized study group;
Change in URBP/UCr Ratio From Baseline to Week 48
To assess renal tubular function by measuring change in urine retinol binding protein to urine creatinine (URBP/UCr) ratio by randomized study group;
Change in UB2MG From Baseline to Week 48
To assess renal tubular function by measuring change in urine beta-2 microglobulin (UB2MG) by randomized study group;
Change in UProt/ UCr Ratio From Baseline to Week 48
To assess renal tubular function by measuring change in urinary protein to creatinine ratio by randomized study group;
25-OHD Serum Concentration by Randomized Study Group at Week 12
25-OHD Serum Concentration by Randomized Study Group at Week 24
25-OHD Serum Concentration by Randomized Study Group at Week 48
Effect of Concurrent Treatment With Efavirenz on 25-OHD Serum Concentration: Concentration at Baseline by Efavirenz Use
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with efavirenz use vs. those without efavirenz use
Effect of Concurrent Treatment With Efavirenz on 25-OHD Serum Concentration: Concentration at Week 48 by Efavirenz Use
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with efavirenz use vs. those without efavirenz use
Effect of Concurrent Treatment With Efavirenz on 25-OHD Serum Concentration: Change in Concentration From Baseline to Week 48 by Efavirenz Use
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with efavirenz use vs. those without efavirenz use
Effect of Concurrent Treatment With Ritonavir on 25-OHD Serum Concentration: Concentration at Baseline by Ritonavir Use
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with ritonavir use vs. those without ritonavir use
Effect of Concurrent Treatment With Ritonavir on 25-OHD Serum Concentration: Concentration at Week 48 by Ritonavir Use
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with ritonavir use vs. those without ritonavir use
Effect of Concurrent Treatment With Ritonavir on 25-OHD Serum Concentration: Change in Concentration From Baseline to Week 48 by Ritonavir Use
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with ritonavir use vs. those without ritonavir use

Full Information

First Posted
December 14, 2012
Last Updated
March 25, 2019
Sponsor
University of North Carolina, Chapel Hill
Collaborators
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institute on Drug Abuse (NIDA), National Institute of Mental Health (NIMH)
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1. Study Identification

Unique Protocol Identification Number
NCT01751646
Brief Title
Vitamin D Absorption in HIV Infected Young Adults Being Treated With Tenofovir Containing cART
Official Title
A Randomized, Double-Blind, Placebo-Controlled Trial of the Safety and Effectiveness of Vitamin D3 50,000 IU Every 4 Weeks to Increase Bone Mineral Density and Decrease Tenofovir-Induced Hyperparathyroidism in Youth With HIV Infection Being Treated With Tenofovir-Containing Combination Antiretroviral Therapy (cART)
Study Type
Interventional

2. Study Status

Record Verification Date
November 2018
Overall Recruitment Status
Completed
Study Start Date
October 2012 (undefined)
Primary Completion Date
June 2016 (Actual)
Study Completion Date
June 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of North Carolina, Chapel Hill
Collaborators
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institute on Drug Abuse (NIDA), National Institute of Mental Health (NIMH)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a 48 week randomized double-blind, placebo-controlled prospective cohort study of adolescents and young adults with HIV infection in the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) who are currently being treated with cART that includes tenofovir disoproxil fumarate (TDF) as one component of the regimen that includes at least three Food and Drug Administration (FDA)-approved antiretroviral (ARV) drugs for at least 180 days.
Detailed Description
This is a 48 week randomized double-blind, placebo-controlled prospective cohort study of adolescents and young adults with HIV infection in the ATN who are currently being treated with cART that includes TDF as one component of the regimen that includes at least three Food and Drug Administration (FDA)-approved ARVs for at least 180 days. Subjects must have at least one documented viral load that is below 200 copies/mL that is collected following initiation of TDF containing cART and greater than 90 days prior to randomization; no viral load above 200 copies/mL if measured within the 90 days prior to randomization; and an HIV viral load obtained at screening that is below 200 copies/mL. Treatment assignments will be balanced by subject sex at birth, age (<20 years vs. >=20 years), and race (African American vs. other). Enrolled subjects will be randomized to receive vitamin D3 50000 IU or matching placebo, given orally every four weeks by DOT. In addition to the randomized study agent, all subjects will receive a MVI to be taken orally once daily. This "standard" MVI will contain ingredients not to exceed 600 IU of vitamin D3 and 200 mg Ca. Dual energy x-ray absorptiometry (DXA) measurement of bone mineral content (BMC)/bone mineral density (BMD) of whole body, spine, and hip, will be performed at baseline and study weeks 24 and 48. Blood and urine sampling to assess the Ca-phosphorous (PO4) axis, parathyroid hormone (PTH)-FGF23-vitamin D signaling, bone turnover, and renal glomerular and tubular function will occur at baseline and study weeks 12, 24, and 48. Blood samples to measure Gluc homeostasis will be drawn at baseline and week 48, and will be run by batch analysis. Safety, measured by serum calcium (SCa) and serum creatinine (SCr), will be monitored by subject's record review at study sites since these labs will generally be measured as a part of routine clinical care. The Adolescent Medicine Trials Network for HIV/AIDS Interventions 109 (ATN 109) study will use the SCa and SCr values obtained within 10 weeks at the time of the visit beginning at the baseline visit. If these evaluations were not performed within the prior 10 weeks they will be drawn at the time of each visit. Viral load and cluster of differentiation 4 (CD4) cell count results will be recorded for this study, ATN 109, at screening, baseline and study weeks 12, 24, 48, and Post-Week 48 provided the evaluations were done within the protocol specified timeframe. If the evaluations were not performed within the protocol specified timeframes they will be drawn at the time of the visit.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infection

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
214 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group A: Vitamin D3 50,000 IU
Arm Type
Experimental
Arm Description
Subjects randomized to Group A will receive Vitamin D3 50,000 IU orally every four weeks by directly observed therapy (DOT). In addition all subjects receive a multivitamin (MVI) that contains ingredients not to exceed 600 IU of vitamin D3 and 200 mg of Calcium (Ca). Subjects will self-administer one MVI tablet orally once daily.
Arm Title
Group B: Vitamin D3 placebo
Arm Type
Placebo Comparator
Arm Description
Subjects randomized to Group B will receive Vitamin D3 placebo orally every four weeks by DOT. In addition all subjects receive a MVI that contains ingredients not to exceed 600 IU of vitamin D3 and 200 mg of Ca. Subjects will self-administer one MVI tablet orally once daily.
Intervention Type
Dietary Supplement
Intervention Name(s)
Vitamin D3 50,000 IU
Other Intervention Name(s)
Vitamin D3
Intervention Description
Group A: Vitamin D3 50,000 IU orally every four weeks by DOT
Intervention Type
Dietary Supplement
Intervention Name(s)
Vitamin D3 placebo
Other Intervention Name(s)
Placebo
Intervention Description
Group B: Vitamin D3 placebo orally every four weeks by DOT
Primary Outcome Measure Information:
Title
Percent Change From Baseline to Week 48 in Dual Energy X-ray Absorptiometry (DXA)-Measured BMD at the Spine for the Randomized Study Groups
Description
Percent change from baseline to week (wk) 48 in DXA-measured BMD at the spine for the randomized study groups. Lumbar spine BMD (L1 - L4) (g/cm2) change from Baseline to wk 48 visit.
Time Frame
Baseline and wk 48
Secondary Outcome Measure Information:
Title
Percent Change From Baseline to Week 24 of BMC of Whole Body for the Randomized Study Groups
Time Frame
Baseline and week 24
Title
Percent Change From Baseline to Week 48 of BMC of Whole Body for the Randomized Study Groups
Time Frame
Baseline and week 48
Title
Percent Change From Baseline to Week 24 of Lumbar Spine (L1-L4) BMD for the Randomized Study Groups
Time Frame
Baseline and week 24
Title
Change From Baseline to Week 24 of Lumbar Spine (L1-L4) BMD Z-score for the Randomized Study Groups
Description
The Z-score is the standard deviation around mean bone mineral density in the lumbar spine, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Time Frame
Baseline and week 24
Title
Change From Baseline to Week 48 of Lumbar Spine (L1-L4) BMD Z-score for the Randomized Study Groups
Description
The Z-score is the standard deviation around mean bone mineral density in the lumbar spine, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Time Frame
Baseline and week 48
Title
Percent Change From Baseline to Week 24 of Femoral Neck BMD for the Randomized Study Groups
Time Frame
Baseline and week 24
Title
Percent Change From Baseline to Week 48 of Femoral Neck BMD for the Randomized Study Groups
Time Frame
Baseline and week 48
Title
Change From Baseline to Week 24 of Femoral Neck BMD Z-score for the Randomized Study Groups
Description
The Z-score is the standard deviation around mean bone mineral density in the femoral neck, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Time Frame
Baseline and week 24
Title
Change From Baseline to Week 48 of Femoral Neck BMD Z-score for the Randomized Study Groups
Description
The Z-score is the standard deviation around mean bone mineral density in the femoral neck, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Time Frame
Baseline and week 48
Title
Percent Change From Baseline to Week 24 of Total Hip BMD for the Randomized Study Groups
Time Frame
Baseline and week 24
Title
Percent Change From Baseline to Week 48 of Total Hip BMD for the Randomized Study Groups
Time Frame
Baseline and week 48
Title
Change From Baseline to Week 24 of Total Hip BMD Z-score for the Randomized Study Groups
Description
The Z-score is the standard deviation around mean bone mineral density in the total hip, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Time Frame
Baseline and week 24
Title
Change From Baseline to Week 48 of Total Hip BMD Z-score for the Randomized Study Groups
Description
The Z-score is the standard deviation around mean bone mineral density in the total hip, adjusted for sex, age, and race/ethnicity. An average Z-score of zero would be expected to be seen in healthy populations. A negative Z-score indicates lower than average bone mineral density. Low bone mineral density is a frequent finding in HIV-infected individuals, including adolescents and young adults.
Time Frame
Baseline and week 48
Title
Change in SCr From Baseline to Week 12.
Description
To assess renal glomerular safety by measuring change in SCr from baseline to week 12 by randomized study group;
Time Frame
Baseline and week 12
Title
Change in SCr From Baseline to Week 24.
Description
To assess renal glomerular safety by measuring change in SCr from baseline to week 24 by randomized study group;
Time Frame
Baseline and week 24
Title
Change in SCr From Baseline to Week 48.
Description
To assess renal glomerular safety by measuring change in SCr from baseline to week 48 by randomized study group;
Time Frame
Baseline and week 48
Title
Change From Baseline to Week 48 in Glucose Homeostasis (Fasting Insulin)
Time Frame
Baseline and 48 weeks
Title
Change From Baseline to Week 48 in Glucose Homeostasis (Fasting Glucose)
Time Frame
Baseline and week 48
Title
Change From Baseline to Week 48 in Glucose Homeostasis (Homeostasis Model Assessment of Insulin Resistance (HOMA-IR))
Description
HOMA-IR is calculated as fasting glucose (mg/dL) X fasting glucose (uIU/mL) / 405. An increase in HOMA-IR means that an individual has become more resistant (less sensitive) to the effects of insulin and thus would be a negative outcome. A reduction in HOMA-IR means that an individual has become more sensitive to the effects of insulin and would be considered a positive outcome.There are no set minimum or maximum scores for HOMA-IR, since it is based on measurements of insulin and glucose, the assays for which may vary. Several studies suggest a cut-off of >2 for any insulin resistance, but "normal" values appear to vary greatly by population (https://www.mdcalc.com/homa-ir-homeostatic-model-assessment-insulin-resistance).
Time Frame
Baseline and week 48
Title
Change From Baseline to Week 12 in Serum Calcium (SCa)
Time Frame
Baseline and wk 12
Title
Change From Baseline to Week 24 in Serum Calcium (SCa)
Time Frame
24 weeks
Title
Change From Baseline to Week 48 in Serum Calcium (SCa)
Time Frame
Baseline and wk 48
Title
Change From Baseline to Week 12 in CTX
Time Frame
Baseline and week 12
Title
Change From Baseline to Week 24 in CTX
Time Frame
Baseline and week 24
Title
Change From Baseline to Week 48 in CTX
Time Frame
Baseline and week 48
Title
Change From Baseline to Week 12 in OC
Time Frame
Baseline and week 12
Title
Change From Baseline to Week 24 in OC
Time Frame
Baseline and week 24
Title
Change From Baseline to Week 48 in OC
Time Frame
Baseline and wk 48
Title
Change From Baseline to Week 12 in BAP
Time Frame
Baseline and wk 12
Title
Change From Baseline to Week 24 in BAP
Time Frame
Baseline and wk 24
Title
Change From Baseline to Week 48 in BAP
Time Frame
Baseline and wk 48
Title
Change From Baseline to Week 12 in FGF23
Time Frame
Baseline and wk 12
Title
Change From Baseline to Week 24 in FGF23
Time Frame
Baseline and wk 24
Title
Change From Baseline to Week 48 in FGF23
Time Frame
Baseline and wk 48
Title
Change From Baseline to Week 12 in PTH
Time Frame
Baseline and wk 12
Title
Change From Baseline to Week 24 in PTH
Time Frame
Baseline and wk 24
Title
Change From Baseline to Week 48 in PTH
Time Frame
Baseline and wk 48
Title
Change From Baseline to Week 12 in Actual Free 1,25-OHD
Description
Vitamin D serum concentration (1,25 (OH)DTotal) (pmol/L) multiplied by F times 1,000, where F is defined as F = 1/(1 + Kd * [VDBP] + Ka *[albumin]) where the binding constant for VDBP = Kd = 4.2 x 107 M-1, and for albumin is Ka = 5.4 x 104 M-1 and the concentrations of VDBP and albumin are in moles/L
Time Frame
Baseline and wk 12
Title
Change From Baseline to Week 24 in Actual Free 1,25-OHD
Description
Vitamin D serum concentration (1,25 (OH)DTotal) (pmol/L) multiplied by F times 1,000, where F is defined as F = 1/(1 + Kd * [VDBP] + Ka *[albumin]) where the binding constant for VDBP = Kd = 4.2 x 107 M-1, and for albumin is Ka = 5.4 x 104 M-1 and the concentrations of VDBP and albumin are in moles/L
Time Frame
Baseline and wk 24
Title
Change From Baseline to Week 48 in Actual Free 1,25-OHD
Description
Vitamin D serum concentration (1,25 (OH)DTotal) (pmol/L) multiplied by F times 1,000, where F is defined as F = 1/(1 + Kd * [VDBP] + Ka *[albumin]) where the binding constant for VDBP = Kd = 4.2 x 107 M-1, and for albumin is Ka = 5.4 x 104 M-1 and the concentrations of VDBP and albumin are in moles/L
Time Frame
Baseline and wk 48
Title
Change From Baseline to Week 12 in 1,25-OHD
Time Frame
Baseline and wk 12
Title
Change From Baseline to Week 24 in 1,25-OHD
Time Frame
Baseline and wk 24
Title
Change From Baseline to Week 48 in 1,25-OHD
Time Frame
Baseline and wk 48
Title
Change From Baseline to Week 12 in 25-OHD
Time Frame
Baseline and wk 12
Title
Change From Baseline to Week 24 in 25-OHD
Time Frame
Baseline and wk 24
Title
Change From Baseline to Week 48 in 25-OHD
Time Frame
Baseline and wk 48
Title
Change From Baseline to Week 12 in TRP %
Time Frame
Baseline and wk 12
Title
Change From Baseline to Week 24 in TRP %
Time Frame
Baseline and wk 24
Title
Change From Baseline to Week 48 in TRP %
Time Frame
Baseline and wk 48
Title
Change From Baseline to Week 12 in SPO4
Time Frame
Baseline and wk 12
Title
Change From Baseline to Week 24 in SPO4
Time Frame
Baseline and wk 24
Title
Change From Baseline to Week 48 in SPO4
Time Frame
Baseline and wk 48
Title
Change From Baseline to Week 12 in UCa/Ucr
Time Frame
Baseline and wk 12
Title
Change From Baseline to Week 24 in UCa/Ucr
Time Frame
Baseline and wk 24
Title
Change From Baseline to Week 48 in UCa/Ucr
Time Frame
Baseline and wk 48
Title
Change in Estimated GFR From Baseline to Week 12.
Description
To assess renal glomerular safety by measuring change in estimated GFR from baseline to week 12 by randomized study group. eGFR calculated by the CKD-Epi equation for subjects >=18 years of age, and by bedside Schwartz formula for subjects <18 years of age
Time Frame
Baseline and wk 12
Title
Change in Estimated GFR From Baseline to Week 24.
Description
To assess renal glomerular safety by measuring change in estimated GFR from baseline to week 24 by randomized study group;
Time Frame
Baseline and wk 24
Title
Change in Estimated GFR From Baseline to Week 48.
Description
To assess renal glomerular safety by measuring change in estimated GFR from baseline to week 48 by randomized study group;
Time Frame
Baseline and wk 48
Title
Change in UGluc From Baseline to Week 48
Description
To assess renal tubular function by measuring change in urine glucose (UGluc) by randomized study group;
Time Frame
Baseline and wk 48
Title
Change in URBP/UCr Ratio From Baseline to Week 48
Description
To assess renal tubular function by measuring change in urine retinol binding protein to urine creatinine (URBP/UCr) ratio by randomized study group;
Time Frame
Baseline and wk 48
Title
Change in UB2MG From Baseline to Week 48
Description
To assess renal tubular function by measuring change in urine beta-2 microglobulin (UB2MG) by randomized study group;
Time Frame
Baseline and wk 48
Title
Change in UProt/ UCr Ratio From Baseline to Week 48
Description
To assess renal tubular function by measuring change in urinary protein to creatinine ratio by randomized study group;
Time Frame
Baseline and wk 48
Title
25-OHD Serum Concentration by Randomized Study Group at Week 12
Time Frame
Week 12
Title
25-OHD Serum Concentration by Randomized Study Group at Week 24
Time Frame
Week 24
Title
25-OHD Serum Concentration by Randomized Study Group at Week 48
Time Frame
Week 48
Title
Effect of Concurrent Treatment With Efavirenz on 25-OHD Serum Concentration: Concentration at Baseline by Efavirenz Use
Description
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with efavirenz use vs. those without efavirenz use
Time Frame
Baseline
Title
Effect of Concurrent Treatment With Efavirenz on 25-OHD Serum Concentration: Concentration at Week 48 by Efavirenz Use
Description
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with efavirenz use vs. those without efavirenz use
Time Frame
Week 48
Title
Effect of Concurrent Treatment With Efavirenz on 25-OHD Serum Concentration: Change in Concentration From Baseline to Week 48 by Efavirenz Use
Description
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with efavirenz use vs. those without efavirenz use
Time Frame
Baseline and wk 48
Title
Effect of Concurrent Treatment With Ritonavir on 25-OHD Serum Concentration: Concentration at Baseline by Ritonavir Use
Description
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with ritonavir use vs. those without ritonavir use
Time Frame
Baseline
Title
Effect of Concurrent Treatment With Ritonavir on 25-OHD Serum Concentration: Concentration at Week 48 by Ritonavir Use
Description
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with ritonavir use vs. those without ritonavir use
Time Frame
Week 48
Title
Effect of Concurrent Treatment With Ritonavir on 25-OHD Serum Concentration: Change in Concentration From Baseline to Week 48 by Ritonavir Use
Description
Mean Vitamin D serum concentration (25-(OH)D) Total) in those with ritonavir use vs. those without ritonavir use
Time Frame
Baseline and wk 48

10. Eligibility

Sex
All
Minimum Age & Unit of Time
16 Years
Maximum Age & Unit of Time
24 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: To be considered eligible for enrollment, an individual must meet the criteria listed below at the time of randomization: NOTE: If the DXA scan is scheduled prior to randomization, all eligibility criteria must be met prior to performing the DXA scan. Age 16 years and 0 days to 24 years and 364 days; Behaviorally infected with HIV (e.g., sexual contact, injection drug use; not infected by perinatal transmission, blood transfusion, or at age younger than 9 years); HIV-1 infection as documented in subject's medical record by at least one of the following criteria: reactive HIV screening test result with an antibody based FDA-licensed assay followed by a positive supplemental assay (e.g., HIV-1 Western Blot, HIV-1 Indirect Immunofluorescence, Antibody Differentiation Assay (Multispot)); or positive HIV-1 DNA polymerase chain reaction (PCR) assay; or plasma HIV-1 quantitative RNA assay >1,000 copies/mL; or positive plasma HIV-1 RNA qualitative assay Subjects must have at least one documented HIV viral load that is below 200 copies/mL collected following initiation of TDF containing cART and greater than 90 days prior to randomization; no HIV viral load above 200 copies/mL if measured within the 90 days prior to randomization; and an HIV viral load obtained at screening that is below 200 copies/mL. Currently being treated for at least 180 days by the time of randomization with a TDF containing cART with at least 2 other FDA approved ARVs (NOTE: This may include a TDF-containing fixed drug combination medication); Negative serum hepatitis B surface antigen (HBsAg) at screening or by history within 4 weeks prior to screening (see section 7.1.3); Willingness and ability to remain on the same cART regimen for the duration of study participation; Willingness and ability to participate in the study, follow all study procedures for the duration of study participation, and provide written informed consent or assent with parental permission, if applicable; and For females of child-bearing potential, agreement to use a minimum of one proven-effective method of birth control and willingness to postpone pregnancy for the duration of study participation (see section 5.3.2 for permitted hormonal contraceptives) Exclusion Criteria: To be considered eligible for enrollment, an individual must not meet any of the criteria listed below at the time of randomization: NOTE: If the DXA scan is scheduled prior to randomization, all eligibility criteria must be met prior to performing the DXA scan. Prior hypersensitivity to vitamin D; History of sarcoidosis, arteriosclerosis, renal stones, glomerulonephritis, interstitial kidney disease, nephrotic syndrome, hypercalcemia, osteoporosis and/or other bone diseases, clinical diagnosis of hypoparathyroidism or hyperparathyroidism; Lactation or pregnancy currently or within the past 24 weeks; Chemotherapy or radiation therapy for malignancy within the past 12 months; Known presence of GI disease that, in the opinion of the clinician, would interfere with study agent administration or absorption (e.g. Crohn's, Colitis); For subjects ≥ 18 years, confirmed creatinine clearance < 70 ml/min (estimated glomerular filtration rate (GFR) from SCr using Cockcroft and Gault (CG) equation) and for subjects <18 years, confirmed creatinine clearance < 70ml/min/1.73m2 (estimated GFR from SCr using Schwartz formula (see section 3.5). (Estimated GFR may be calculated using the formulae programmed on the ATN website); SCa > Upper Limit Normal (ULN) for local laboratory values (see section 7.1.3); Active Grade 3 or higher clinical or laboratory toxicity except atazanavir (ATV) associated indirect hyperbilirubinemia (see section 9.5.2.2); Weight is > 350 pounds (lbs) or 159 kilograms (kgs); Positive hepatitis C antibody by history or at screening (see section 7.1.3); and Use of any medications as specified in sections 5.3.1, 5.3.3 and 5.4. Females Only: Use of certain hormonal contraceptives as specified in the protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Peter Havens, MD
Organizational Affiliation
MACC Fund Research Center
Official's Role
Study Chair
Facility Information:
Facility Name
Children's Hopsital of Los Angeles
City
Los Angeles
State/Province
California
ZIP/Postal Code
90027
Country
United States
Facility Name
University of Southern California - NICHD Westat Site
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033
Country
United States
Facility Name
Childrens National Medical Center
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20010
Country
United States
Facility Name
Children's Diagnostic and Treatment Center - NICHD Westat Site
City
Fort Lauderdale
State/Province
Florida
ZIP/Postal Code
33316
Country
United States
Facility Name
University of Miami School of Medicine
City
Miami
State/Province
Florida
ZIP/Postal Code
33101
Country
United States
Facility Name
University of South Florida
City
Tampa
State/Province
Florida
ZIP/Postal Code
33606
Country
United States
Facility Name
Stroger Hospital and the CORE Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
Facility Name
Tulane Medical Center
City
New Orleans
State/Province
Louisiana
ZIP/Postal Code
70112
Country
United States
Facility Name
Johns Hopkins University - NICHD Westat Site
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States
Facility Name
Johns Hopkins University
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States
Facility Name
Fenway Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Facility Name
Wayne State University
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201
Country
United States
Facility Name
Montefiore Medical Center
City
Bronx
State/Province
New York
ZIP/Postal Code
10467
Country
United States
Facility Name
Children's Hospital of Philadelphia
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
St. Jude Childrens Research Hospital
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38105
Country
United States
Facility Name
Baylor College of Medicine
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
San Juan City Hospital (Puerto Rico) - NICHD Westat Site
City
San Juan
ZIP/Postal Code
00936-5067
Country
Puerto Rico

12. IPD Sharing Statement

Citations:
PubMed Identifier
29020329
Citation
Havens PL, Stephensen CB, Van Loan MD, Schuster GU, Woodhouse LR, Flynn PM, Gordon CM, Pan CG, Rutledge B, Harris DR, Price G, Baker A, Meyer WA 3rd, Wilson CM, Hazra R, Kapogiannis BG, Mulligan K; Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) 109 Study Team. Vitamin D3 Supplementation Increases Spine Bone Mineral Density in Adolescents and Young Adults With Human Immunodeficiency Virus Infection Being Treated With Tenofovir Disoproxil Fumarate: A Randomized, Placebo-Controlled Trial. Clin Infect Dis. 2018 Jan 6;66(2):220-228. doi: 10.1093/cid/cix753.
Results Reference
result
PubMed Identifier
30260797
Citation
Havens PL, Long D, Schuster GU, Gordon CM, Price G, Wilson CM, Kapogiannis BG, Mulligan K, Stephensen CB; Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) 117 and 109 study teams. Tenofovir disoproxil fumarate appears to disrupt the relationship of vitamin D and parathyroid hormone. Antivir Ther. 2018;23(7):623-628. doi: 10.3851/IMP3269. Epub 2018 Sep 27.
Results Reference
derived

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Vitamin D Absorption in HIV Infected Young Adults Being Treated With Tenofovir Containing cART

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