Effect of Probiotics (Saccharomyces boulardii) on Microbial Translocation and Inflammation in HIV-Treated Patients: A Double-Blind, Randomized, Placebo-Controlled Trial
What this study found
Saccharomyces boulardii improved inflammatory and microbial translocation markers in virologically suppressed HIV patients. Compared with placebo, the probiotic group showed decreases in LBP and IL-6, and some effects persisted after treatment discontinuation at Week 24 in intention-to-treat analysis. It did not significantly change CD4+/CD8+ cell counts or broader immune parameters, and no adverse events were associated with probiotic use. The authors concluded that the intervention was well tolerated but that longer treatment and larger studies are needed to define optimal dosing and…
- Study & population
- Single-center, double-blind, randomized, placebo-controlled pilot trial at Hospital Universitari del Mar in Barcelona, Spain.
- Intervention
- Saccharomyces boulardii was given orally as 2 capsules 3 times daily for 12 weeks, with 6 × 10^7 living bacteria per capsule.
- Key limitation
- This was a small single-center pilot study with 22 participants per arm, limiting precision and generalizability.
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Open PDFOriginal abstract
Background:Microbial translocation has been associated with an increase in immune activation and inflammation in HIV infection despite effective highly active antiretroviral therapy. It has been shown that some probiotics have a beneficial effect by reducing intestinal permeability and, consequently, microbial translocation. Objectives:To assess changes in microbial translocation and inflammation after treatment with probiotics (Saccharomyces boulardii) in HIV-1–infected patients with virologic suppression. Methods:A double-blind, randomized, placebo-controlled trial was conducted in 44 nonconsecutive HIV-1–infected patients with viral load of <20 copies per milliliter for at least 2 years. Patients were randomized to oral supplementation with probiotics or placebo during 12 weeks. Markers of microbial translocation (lipopolysaccharide-binding protein [LBP] and soluble CD14), inflammation (interleukin 6 [IL-6], tumor necrosis factor alpha, interferon gamma, high-sensitivity C-reactive protein), and immunological and clinical data were determined before and after the intervention and 3 months after treatment discontinuation. Quantitative variables were compared using the Mann–Whitney U test, and categorical variables were compared using the Fisher exact test. Results:After 12 weeks of treatment, differences between the probiotic arm and the placebo arm were observed in LBP values (−0.30 vs +0.70 pg/mL) and IL-6 (−0.60 vs +0.78 pg/mL). These differences were also noted at 3 months after treatment withdrawal. Qualitative analysis was performed, defining a variable as “decreased” or “increased” from baseline LBP. A significant decrease of LBP at 12 weeks of treatment was observed (57.9% patients in the probiotic group vs 6.2% in the placebo group, P = 0.002). Conclusions:Treatment with S. boulardii decreases microbial translocation (LBP) and inflammation parameters (IL-6) in HIV-1–infected patients with long-term virologic suppression.