Abstract
Background: Micronutrient supplementation has been shown to reduce the progression of HIV but does not have an effect on the intestinal barrier or the intestinal microbiota of HIV patients. Studies have suggested that probiotics could potentially complement micronutrients in preserving the immune-function of HIV patients. Objective: Assess the impact of micronutrient supplemented probiotic yogurt on the immune function of HIV patients. Design:We performed a randomized, double blind, controlled trial with CD4 count as primary outcome among HIV patients naïve to anti-retroviral treatment. Secondary outcomes included hematological parameters, incidence of diarrhea and clinical symptoms. A total of 112 HIV patients were randomized to receive a micronutrient fortified yogurt with (n = 55) or without additional probiotic Lactobacillus rhamnosus GR-1 (n = 57) for four weeks. Results:An average decline in CD4 count of −70 cells/μL (95% CI: −154 to −15) was observed in the micronutrient, probiotic group versus a decrease of −63 cells/μL (95% CI: −157 to −30) in the micronutrient control group (p = 0.9). Additional probiotic supplementation was well tolerated and not associated with adverse events. No difference between groups was detected in incidence of diarrhea or clinical symptoms. An improvement of hemoglobin levels was observed for all subjects, based upon a mean difference from baseline of 1.4 g/L (SD = 6) (p = 0.02). Conclusion:The addition of probiotics to a micronutrient fortified yogurt was well tolerated by HIV patients but was not associated with a further increase in CD4 count after one month.
Highlights
Poor nutritional status among people living with HIV is a common problem [1] and has been associated with enhanced HIV progression in numerous observational studies [2,3]
Probiotics, defined as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host” [20], have been used with some success to preserve the immune-function of people living with HIV in the following studies
An observational study in Tanzania found that yogurt supplemented with Lactobacillus rhamnosus GR-1 increased the CD4 count with 0.28 cells/μL/day (p = 0.003) among HIV infected men and women in Tanzania [23]
Summary
Poor nutritional status among people living with HIV is a common problem [1] and has been associated with enhanced HIV progression in numerous observational studies [2,3]. Supplementation of micronutrients, most notably B-complex, vitamin C and E, can reduce the progression and mortality of HIV [13,14,15,16,17], but does not impact intestinal barrier impairment [18]. After the two month period, CD4 counts among the treatment group increased 118 cells/μL versus a decrease of 42 cells/μL among the placebo group (p = 0.05) [21] Another small pilot RCT in Nigeria discovered a small, but statistically significant effect, of four weeks of Lactobacillus rhamonus GR-1 and Lactobacillus reuteri RC-14 supplementation on the CD4 count of 24 HIV infected women. Objective: Assess the impact of micronutrient supplemented probiotic yogurt on the immune function of HIV patients.
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