RESUMEN
BACKGROUND: HIV-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. METHODS: A 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. RESULTS: We 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). CONCLUSIONS: Our 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.
Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Traslocación Bacteriana , Enteropatía por VIH/dietoterapia , Mucosa Intestinal/microbiología , Prebióticos , Probióticos , Adulto , Antiinflamatorios no Esteroideos/efectos adversos , Bifidobacterium/clasificación , Bifidobacterium/crecimiento & desarrollo , Bifidobacterium/inmunología , Bifidobacterium/aislamiento & purificación , Recuento de Linfocito CD4 , Citocinas/sangre , Citocinas/metabolismo , ADN Bacteriano/sangre , Progresión de la Enfermedad , Método Doble Ciego , Heces/microbiología , Femenino , Enteropatía por VIH/inmunología , Enteropatía por VIH/microbiología , Enteropatía por VIH/fisiopatología , Humanos , Mucosa Intestinal/inmunología , Mucosa Intestinal/fisiopatología , Lacticaseibacillus rhamnosus/clasificación , Lacticaseibacillus rhamnosus/crecimiento & desarrollo , Lacticaseibacillus rhamnosus/inmunología , Lacticaseibacillus rhamnosus/aislamiento & purificación , Masculino , México , Proyectos Piloto , Prebióticos/efectos adversos , Probióticos/efectos adversos , Probióticos/aislamiento & purificación , Calidad de Vida , Adulto JovenRESUMEN
A diarréia crônica é a manifestaçäo gastrointestinal mais comum em pacientes infectados pelo HIV. Deve-se a um conjunto de múltiplos fatores, entre eles o próprio HIV, que causa alteraçöes estruturais da mucosa do intestino delgado. A atrofia vilosa foi a alteraçäo mais freqüentemente observada, provavelmente devido a um desarranjo da funçäo regulatória do sistema imune sobre a estrutura da mucosa. É encontrada já na fase inicial da infecçäo pelo HIV, mesmo sem alteraçöes nos níveis sangüíneos de células CD4+ e sem infecçöes por microrganismos oportunistas. Conhecida como enteropatia pelo HIV, seu diagnóstico obriga que todas as outras possíveis causas de alteraçöes estruturais da mucosa tenham sido excluídas, após cuidadosa investigaçäo diagnóstica. Os autores fazem uma revisäo bibliográfica e discutem os mecanismos propostos para a participaçäo do HIV nessas alteraçöes.