Abstract
BackgroundHIV-infection results in damage and dysfunction of the gastrointestinal system. HIV enteropathy includes pronounced CD4+ T-cell loss, increased intestinal permeability, and microbial translocation that promotes systemic immune activation, which is implicated in disease progression. A synbiotic is the combination of probiotics and prebiotics that could improve gut barrier function. Our study goal was to determine whether the use of a synbiotic, probiotics or a prebiotic can recover immunological parameters in HIV-infected subjects through of a reduction of microbial translocation and pro-inflammatory cytokine production.MethodsA randomized, double-blind controlled study was performed; twenty Antiretroviral treatment-naïve HIV-infected subjects were subgrouped and assigned to receive a synbiotic, probiotics, a prebiotic, or a placebo throughout 16 weeks.ResultsWe had no reports of serious adverse-events. From baseline to week 16, the synbiotic group showed a reduction in bacterial DNA concentrations in plasma (p = 0.048). Moreover, the probiotic and synbiotic groups demonstrated a decrease in total bacterial load in feces (p = 0.05). The probiotic group exhibited a significant increment of beneficial bacteria load (such as Bifidobacterium; p = 0.05) and a decrease in harmful bacteria load (such as Clostridium; p = 0.063). In the synbiotic group, the CD4+ T-cells count increased (median: +102 cells/μL; p = 0.05) and the level of Interleukin 6 cytokine decreased significantly (p = 0.016).ConclusionsOur study showed a significant increase in CD4+ T lymphocyte levels in the synbiotic group, which could delay the initiation of antiretroviral therapy and decrease costs in countries with limited resources.
Highlights
A huge Gastrointestinal (GI) pathology is observed in patients infected with HIV even during primary infection
We employed Lactobacillus rhamnosus HN001 plus Bifidobacterium lactis Bi-07 at 109 cfu/mL, and the synbiotic was the combination of probiotics plus prebiotic, the placebo was a product of Biogel without the two types of probiotics and without the prebiotic, but with the same flavor and characteristics
Bacterial translocation and bacterial stool composition A reduction in bacterial DNA concentrations in plasma was observed in the probiotics, synbiotic, and prebiotic groups, but statistical significance was reached only in the synbiotic group (p = 0.048) (Figure 2)
Summary
A huge Gastrointestinal (GI) pathology is observed in patients infected with HIV even during primary infection. Gastrointestinal damage in HIV infection and microbial translocation Once HIV enters the mucosa of the gut, it finds a large pool of resting Ki67-CD4+ T cells; up to 60% of these cells are infected and are capable of produce the virus, constituting a dense network of cells in the intestinal mucosa, which is capable of spreading the infection to uninfected cells through cell-to-cell contact. This spread allows the maintenance of a continuous chain of viral transmission and forms part of a large reservoir that is currently impossible to eradicate. Our study goal was to determine whether the use of a synbiotic, probiotics or a prebiotic can recover immunological parameters in HIV-infected subjects through of a reduction of microbial translocation and pro-inflammatory cytokine production
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