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

ABSTRACT

Introduction: Recent insights show that gut-mucosal immunity and intestinal microbiota play a key role in the pathogenesis of HIV infection. Alterations in the composition of intestinal flora (dysbiosis) could be associated with an impaired intestinal epithelium barrier activity and an impaired mucosal immunity function, significantly contributing to microbial translocation which is considered a major driver of chronic immune activation.

Areas covered: This article provides an overview on the novel trends in probiotic therapy application. A particular emphasis is addressed to the importance of probiotics as a novel strategy to attenuate or prevent gastrointestinal involvement and to improve gut-mucosal immunity in HIV-infected subjects. Therefore, opportunities, limits and methodological criticalities of supplementation with probiotic therapy are considered and analyzed.

Expert opinion: Use of probiotics is emerging as a novel strategy to manage dysbiosis and gut-mucosal impairment, to reduce immune activation and to limit a number of non-AIDS-related disorders. However, despite the growing use of probiotic therapy, mechanisms by which oral bacteria intake exhibits its effects are strain-related and disease-specific, hence clinicians need to take these two factors into consideration when suggesting probiotic supplementation to HIV-infected patients.

Trial registration: ClinicalTrials.gov identifier: NCT02164344.

Trial registration: ClinicalTrials.gov identifier: NCT02441244.

Trial registration: ClinicalTrials.gov identifier: NCT02441231.

Trial registration: ClinicalTrials.gov identifier: NCT02706717.

KEYWORDS:

• HIV
• Microbiota
• probiotics
• gut
• immune activation
• gut-brain axis
• Central Nervous System
• multi-strain
• mucosal immunity
• Th17
• IFN

Article highlights

• The impairment of the gut-mucosal barrier immunity is associated with a damage of the intestinal epithelium; dysbiosis contributes significantly to microbial translocation which is considered a major driver of chronic immune activation and is linked to the progression of inflammatory symptoms in HIV-infected population.

• Antiretroviral therapy is unable to fully revert gut impairment and the subsequent disorders.

• Probiotic supplementation has showed potential benefits in the management of gut impairment and could represent a useful therapeutic resource for HIV-infected individuals in association with antiretroviral therapy.

• The development of a research area devoted to the safety of probiotics in the setting of HIV infection is needed.

• Interplay between basic research and application-oriented research are expected in the further development of the field and large clinical trials to bridge the actual knowledge gaps are needed.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.