Edward A. Rose, M.D.
Even in HIV treatment, you are what you eat. Intuitively we know that excellent nutrition helps in the treatment of chronic diseases such as HIV, although we tend to think of our ability to recreate inflammatory cytokines and T cells that help fight infection. But recent insights show that gut-mucosal immunity and intestinal microbiota are involved in the pathogenesis of HIV infection. When a person’s gut flora changes, there are far-reaching effects besides just having diarrhea. Alterations in the composition of intestinal flora (dysbiosis) is associated with an impaired intestinal epithelium barrier activity, so-called “leaky gut syndrome”, and an impaired mucosal immunity function. These changes contribute to an altered microbiome referred to as microbial translocation which is considered a major driver of chronic immune activation.1,2
Probiotics have been proposed to help with this microbial translocation by providing healthy bacteria that are known to stimulate the gut’s immune and barrier function. Several studies have documented the impact of probiotics on intestinal epithelial tight junctions and upregulation of defensive immune functions in the Peyer’s patches and mucosa-associated lymphoid tissue (MALT). Both of these activities work together to improve the protection of the HIV patient from opportunistic infections. The exact mechanism of action is still elusive. Other questions that remain unanswered are which bacteria are helpful as a supplement, what is the right dose, and can these probiotic bacteria be absorbed and cause bacteremia in this compromised population.3 For example, studies have recommended Saccharomyces boullardii, Lactobacilli, and others.
The use of probiotics appears to be a novel strategy for the treatment dysbiosis and gut-mucosal impairment. Probiotics help reduce immune activation and limit many non-AIDS-related disorders. The way they work, the right bacteria to choose, the right dose, and the right timing are still unclear. Given their excellent safety profile and low cost, probiotics in HIV are most likely a good idea.
1Ceccarelli G, Statzu M, Santinelli L, Pinacchio C, Bitossi C, Cavallari EN, Vullo V, Scagnolari C, d’Ettorre G. Challenges in the management of HIV infection: update on the role of probiotic supplementation as a possible complementary therapeutic strategy for cART treated people living with HIV/AIDS. Expert opinion on biological therapy. 2019 Oct 3.
2Villar-García J, Hernández JJ, Güerri-Fernández R, González A, Lerma E, Guelar A, Saenz D, Sorlí L, Montero M, Horcajada JP, Freud HK. Effect of probiotics (Saccharomyces boulardii) on microbial translocation and inflammation in HIV-treated patients: a double-blind, randomized, placebo-controlled trial. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2015 Mar 1;68(3):256-63.
3Haghighat L, Crum-Cianflone NF. The potential risks of probiotics among HIV-infected persons: bacteraemia due to Lactobacillus acidophilus and review of the literature. International journal of STD & AIDS. 2016 Nov;27(13):1223-30.