No adverse events for HIV patients taking probiotics; benefits still unconfirmed
A recent literature review suggested that probiotics could help manage HIV patients’ CD4 counts and medication-related diarrhea, although more studies are required to confirm these benefits and determine best practices.
The review also noted that patients taking probiotics experienced zero cases of bacteremia or fungemia associated with the dietary supplement, suggesting that the treatments are not responsible for any detrimental outcomes.
“HIV infects CD4+ T-lymphocytes and monocyte-derived–macrophages colonizing the gut-associated lymphoid tissue,” Henry S. Sacks, MD, PhD, professor of infectious diseases at Icahn School of Medicine at Mount Sinai, and colleagues wrote.
“Significant disruption to gut architecture can occur, with a concomitant release of lipopolysaccharide into peripheral blood, correlating with systemic immune activation, a hallmark of HIV disease progression. Probiotics may reduce immune activation and bacterial translocation and possibly reduce acquisition or transmission of infections.”
Sacks and colleagues conducted a systematic review of randomized control trials involving the use of probiotics, prebiotics or synbiotics among HIV patients. After grading identified studies for potential biases, they pooled data from patients with and without HIV to identify any differences in several relevant clinical outcomes, including diarrhea, sepsis, CD4, microbial translocation, microbicidal effects and bacterial vaginosis.
The researchers identified 2,068 related studies, and selected 27 for full review. These studies included patients on and off ART, and contained no evidence of selective reports or conflicts of interest.
While probiotics’ impact on patient diarrhea rates was mixed, the reviewed data indicated a modest improvement among patient CD4 counts. Sacks and colleagues also reported similar findings from studies investigating HIV-associated translocation, as well as those examining markers of inflammation and immune activation. Meta-analysis of probiotic safety suggested mild adverse events to be infrequent, if not rarer, among treatment patients, and there were no indications of other adverse events occurring more frequently among critically ill or high risk patients than control participants.
In light of this low risk and the potential benefits, the researchers advocated increased research to clarify the optimal balance of microbial strains and the true impact of probiotics on HIV outcomes.
“Given the paucity of evidence for adverse events, low cost and potential for economic value to people living in poverty, the use of probiotics seems practical and feasible,” they wrote. “Restoration of gut flora to a more healthful ecology may have several important clinical benefits particularly in conjunction with improved nutrition and access to micronutrient supplementation.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.