Within the immunopathogenesis of HIV infection, there is a state of constant systemic immune activation that is attributed in part to the enteropathy caused by HIV itself and to the translocation of microbes and/or microbial products from the intestinal lumen into the circulation [8, 30].
We evaluated the efficacy and safety of Lactobacillus rhamnosus HN001 plus Bifidobacterium lactis Bi-07 at 109 cfu/mL as probiotics, 10 g of agave inulin as prebiotic, and the combination of both as synbiotic in antiretroviral-naïve, HIV-infected subjects.
There have been some studies in patients with HIV infection, using different probiotics in which mixed results have been obtained; this is perhaps secondary to the use of different concentrations and probiotic strains, which do not trigger the same immunostimulatory effect [15, 31, 32].
Certain serious adverse effects have been reported with the use of probiotics, particularly endocarditis, liver abscess, bacteremia, and septicemia or septic shock, especially in immunocompromised patients, or in patients with chronic disease, or in those with ventilatory support or with central venous catheters [33–35]. During the study, we received no report of serious adverse events, no clinically significant changes were noted in any safety parameter measured, and no patient developed sepsis, bacteremia, or acute inflammatory response. In addition, total bacterial load in feces decreased in probiotics and synbiotic groups and, the probiotics group showed an increase in the concentration of beneficial bacteria, as Bifidobacterium species, which have less potential for adhesion and translocation . Further, we found that the synbiotic group had a tendency of reduction in beneficial and harmful bacterial loads and had a significant reduction in the concentration of bacterial translocation.
ARV treatment has increased survival in patients with HIV infection; however, survival is at least 10 years less than in general population. In addition, cardiovascular risk is twice as high in HIV-positive subjects . In our study, the use of the synbiotic demonstrated a significant decrease in the concentration of cytokine IL-6, which has been utilized as a marker of cardiovascular risk, accelerated atherosclerosis, and mortality in HIV-infected patients . However, it would therefore be important to assess, in our study, other cardiovascular risk-related parameters, such as d-dimer and high-sensitivity C-reactive protein .
ARV drugs can cause several adverse effects including dyslipidemia, insulin resistance, lactic acidosis, lipodystrophy, and diarrhea, among others [39, 40]. Our study demonstrated a significant increase in CD4+ T lymphocyte levels in the synbiotic group, which could delay time of initiation of ARV treatment and decrease costs in countries with limited resources. Moreover, in our region, the agave pines of Agave tequilana Weber var. azul are widely employed to produce the national drink, tequila, and could also be a potential source of prebiotics and part of synbiotic with accessible prices.
On the other hand, we found no decrease in HIV-1 plasma viral load; therefore, the use of a synbiotic could not provide the benefit of maintaining an undetectable viral load as part of the primary prevention of HIV transmission.