In the Journals

Probiotic improves gut barrier function in patients with HIV

Probiotic supplementation improved the physical and immunological integrity of the intestinal mucosal barrier in HIV-1-positive patients being treated with antiretroviral therapy, according to new research.

These findings are significant as intestinal epithelial cells are often damaged by the virus in patients with HIV, even after treatment with antiretrovirals, and a compromised intestinal mucosal barrier “can result in a low-grade, long-term, systemic immune activation and inflammation which is commonly associated with a variety of HIV-related comorbidities, such as cardiovascular disease, kidney disease, diabetes, and bone fracture,” according to a press release.

The researchers sought to evaluate the effects of a high potency multistrain probiotic — marketed in the U.S. as Visbiome (ExeGi Pharma) and Vivomixx in Europe — on intestinal immunity in HIV-1 patients on antiretroviral therapy. They performed a sub-study of a pilot longitudinal, non-randomized, single arm trial of 10 patients who received the supplement twice daily for 6 months between May 2014 and February 2015. All patients were white men with a median age of 42 years, and were all on antiretroviral therapy for a median of 6 years.

Histological and immunohistochemical analyses of intestinal biopsies revealed a number of clinical and biochemical markers demonstrating improved integrity of the gastrointestinal epithelial cell wall and reduced systemic inflammation.

“We believe this is the first time a probiotic has been shown to clearly improve the integrity of the GI epithelial cell wall in HIV patients,” Giancarlo Ceccarelli, MD, PhD, clinical researcher and HIV treatment specialist at Sapienza University in Rome, said in the press release. “There appear to be multiple therapeutic mechanisms at work, but the improvement in Th17 immune cells in the GI tissue was of particular interest. In the HIV population, a depletion of Th17 in the gastrointestinal tract is common and is a significant driver of the loss of intestinal barrier function.”

Patients reported their adherence was excellent, and the supplement appeared to be safe with no related adverse reactions.

The investigators concluded that these findings demonstrate the potential benefits of probiotic supplementation for restoring mucosal intestinal barrier integrity in HIV-1 patients treated with antiretroviral therapy, but emphasized that the results should not be generalized to all probiotics, as “it is the probiotic strain itself which determines the efficacy of the product and hence the associated findings.” This is especially important in immunocompromised patients, they added.

Two large studies of Visbiome in HIV patients are ongoing in the U.S. and Canada, according to the press release. One, a multicenter study being led by the NIH-funded AIDS Clinical Trials Group, is evaluating whether the supplement can reduce systemic inflammation in these patients, with results expected early next year. – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.

Probiotic supplementation improved the physical and immunological integrity of the intestinal mucosal barrier in HIV-1-positive patients being treated with antiretroviral therapy, according to new research.

These findings are significant as intestinal epithelial cells are often damaged by the virus in patients with HIV, even after treatment with antiretrovirals, and a compromised intestinal mucosal barrier “can result in a low-grade, long-term, systemic immune activation and inflammation which is commonly associated with a variety of HIV-related comorbidities, such as cardiovascular disease, kidney disease, diabetes, and bone fracture,” according to a press release.

The researchers sought to evaluate the effects of a high potency multistrain probiotic — marketed in the U.S. as Visbiome (ExeGi Pharma) and Vivomixx in Europe — on intestinal immunity in HIV-1 patients on antiretroviral therapy. They performed a sub-study of a pilot longitudinal, non-randomized, single arm trial of 10 patients who received the supplement twice daily for 6 months between May 2014 and February 2015. All patients were white men with a median age of 42 years, and were all on antiretroviral therapy for a median of 6 years.

Histological and immunohistochemical analyses of intestinal biopsies revealed a number of clinical and biochemical markers demonstrating improved integrity of the gastrointestinal epithelial cell wall and reduced systemic inflammation.

“We believe this is the first time a probiotic has been shown to clearly improve the integrity of the GI epithelial cell wall in HIV patients,” Giancarlo Ceccarelli, MD, PhD, clinical researcher and HIV treatment specialist at Sapienza University in Rome, said in the press release. “There appear to be multiple therapeutic mechanisms at work, but the improvement in Th17 immune cells in the GI tissue was of particular interest. In the HIV population, a depletion of Th17 in the gastrointestinal tract is common and is a significant driver of the loss of intestinal barrier function.”

Patients reported their adherence was excellent, and the supplement appeared to be safe with no related adverse reactions.

The investigators concluded that these findings demonstrate the potential benefits of probiotic supplementation for restoring mucosal intestinal barrier integrity in HIV-1 patients treated with antiretroviral therapy, but emphasized that the results should not be generalized to all probiotics, as “it is the probiotic strain itself which determines the efficacy of the product and hence the associated findings.” This is especially important in immunocompromised patients, they added.

Two large studies of Visbiome in HIV patients are ongoing in the U.S. and Canada, according to the press release. One, a multicenter study being led by the NIH-funded AIDS Clinical Trials Group, is evaluating whether the supplement can reduce systemic inflammation in these patients, with results expected early next year. – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.