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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.

nutrition journal

Synbiotic therapy decreases microbial translocation and inflammation and improves immunological status in HIV-infected patients: a double-blind randomized controlled pilot trial