title: Rifaximin has a marginal impact on microbial translocation, T-cell activation and inflammation in HIV-positive immune non-responders to antiretroviral therapy - ACTG A5286.
abstract: BACKGROUND
  Rifaximin, a nonabsorbable antibiotic that decreases lipopolysaccharide (LPS) in cirrhotics, may decrease the elevated levels of microbial translocation, T-cell activation and inflammation in human immunodeficiency virus (HIV)-positive immune nonresponders to antiretroviral therapy (ART).
  
  
  METHODS
  HIV-positive adults receiving ART for ≥96 weeks with undetectable viremia for ≥48 weeks and CD4(+) T-cell counts <350 cells/mm(3) were randomized 2:1 to rifaximin versus no study treatment for 4 weeks. T-cell activation, LPS, and soluble CD14 were measured at baseline and at weeks 2, 4, and 8. Wilcoxon rank sum tests compared changes between arms.
  
  
  RESULTS
  Compared with no study treatment (n = 22), rifaximin (n = 43) use was associated with a significant difference between study arms in the change from baseline to week 4 for CD8(+)T-cell activation (median change, 0.0% with rifaximin vs +0.6% with no treatment; P = .03). This difference was driven by an increase in the no-study-treatment arm because there was no significant change within the rifaximin arm. Similarly, although there were significant differences between study arms in change from baseline to week 2 for LPS and soluble CD14, there were no significant changes within the rifaximin arm.
  
  
  CONCLUSIONS
  In immune nonresponders to ART, rifaximin minimally affected microbial translocation and CD8(+)T-cell activation. Trial registration number. NCT01466595.
authors.affiliation: Department of Medicine.
authors.forename: Allan R
authors.initials: AR
authors.lastname: Tenorio
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Chan
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Bosch
authors.affiliation: Division of Infectious Diseases, University of Pittsburgh School of Medicine.
authors.forename: Bernard J C
authors.initials: BJ
authors.lastname: Macatangay
authors.affiliation: HIV Research Branch, TRP, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda.
authors.forename: Sarah W
authors.initials: SW
authors.lastname: Read
authors.affiliation: ACTG Operations Center, Social and Scientific Systems, Silver Spring, Maryland.
authors.forename: Suria
authors.initials: S
authors.lastname: Yesmin
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Babafemi
authors.initials: B
authors.lastname: Taiwo
authors.affiliation: Department of Medicine, University of North Carolina, Chapel Hill.
authors.forename: David M
authors.initials: DM
authors.lastname: Margolis
authors.affiliation: Division of Infectious Diseases and HIV, Drexel University, Philadelphia, Pennsylvania.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Jacobson
authors.affiliation: Department of Immunology and Microbiology, Rush University Medical Center.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Landay
authors.affiliation: Department of Medicine, University of Colorado at Denver, Aurora.
authors.forename: Cara C
authors.initials: CC
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018988:Bacterial Translocation; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007249:Inflammation / Q000517:prevention & control; D018950:Lipopolysaccharide Receptors / Q000097:blood; D008070:Lipopolysaccharides / Q000097:blood; D008213:Lymphocyte Activation; D008297:Male; D008875:Middle Aged; D012294:Rifamycins / Q000627:therapeutic use*; D000078262:Rifaximin; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D018950:Lipopolysaccharide Receptors; D008070:Lipopolysaccharides; D012294:Rifamycins; D000078262:Rifaximin
keywords: HIV; immune activation; immune nonresponders to ART; inflammation; microbial translocation; rifaximin