title: Effect of probiotics (Saccharomyces boulardii) on microbial translocation and inflammation in HIV-treated patients: a double-blind, randomized, placebo-controlled trial.
abstract: BACKGROUND
  Microbial translocation has been associated with an increase in immune activation and inflammation in HIV infection despite effective highly active antiretroviral therapy. It has been shown that some probiotics have a beneficial effect by reducing intestinal permeability and, consequently, microbial translocation.
  
  
  OBJECTIVE
  To assess changes in microbial translocation and inflammation after treatment with probiotics (Saccharomyces boulardii) in HIV-1-infected patients with virologic suppression.
  
  
  METHODS
  A double-blind, randomized, placebo-controlled trial was conducted in 44 nonconsecutive HIV-1-infected patients with viral load of <20 copies per milliliter for at least 2 years. Patients were randomized to oral supplementation with probiotics or placebo during 12 weeks. Markers of microbial translocation (lipopolysaccharide-binding protein [LBP] and soluble CD14), inflammation (interleukin 6 [IL-6], tumor necrosis factor alpha, interferon gamma, high-sensitivity C-reactive protein), and immunological and clinical data were determined before and after the intervention and 3 months after treatment discontinuation. Quantitative variables were compared using the Mann-Whitney U test, and categorical variables were compared using the Fisher exact test.
  
  
  RESULTS
  After 12 weeks of treatment, differences between the probiotic arm and the placebo arm were observed in LBP values (-0.30 vs +0.70 pg/mL) and IL-6 (-0.60 vs +0.78 pg/mL). These differences were also noted at 3 months after treatment withdrawal. Qualitative analysis was performed, defining a variable as "decreased" or "increased" from baseline LBP. A significant decrease of LBP at 12 weeks of treatment was observed (57.9% patients in the probiotic group vs 6.2% in the placebo group, P = 0.002).
  
  
  CONCLUSIONS
  Treatment with S. boulardii decreases microbial translocation (LBP) and inflammation parameters (IL-6) in HIV-1-infected patients with long-term virologic suppression.
authors.affiliation: *Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain; †IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; ‡Department of Medicine, Universitat Autònoma de Barcelona, Spain; and §Reference Laboratory of Catalonia, Barcelona, Spain.
authors.forename: Judit
authors.initials: J
authors.lastname: Villar-García
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Hernández
authors.forename: Robert
authors.initials: R
authors.lastname: Güerri-Fernández
authors.forename: Alicia
authors.initials: A
authors.lastname: González
authors.forename: Elisabet
authors.initials: E
authors.lastname: Lerma
authors.forename: Ana
authors.initials: A
authors.lastname: Guelar
authors.forename: David
authors.initials: D
authors.lastname: Saenz
authors.forename: Lluisa
authors.initials: L
authors.lastname: Sorlí
authors.forename: Milagro
authors.initials: M
authors.lastname: Montero
authors.forename: Juan P
authors.initials: JP
authors.lastname: Horcajada
authors.forename: Hernando
authors.initials: H
authors.lastname: Knobel Freud
mesh_terms: D000209:Acute-Phase Proteins; D000284:Administration, Oral; D018988:Bacterial Translocation; D002097:C-Reactive Protein / Q000032:analysis; D002352:Carrier Proteins / Q000097:blood; D016207:Cytokines / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000628:therapy; D006801:Humans; D007249:Inflammation / Q000517:prevention & control*; D018950:Lipopolysaccharide Receptors / Q000097:blood; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood; D010919:Placebos / Q000008:administration & dosage; D019936:Probiotics / Q000627:therapeutic use*; D012440:Saccharomyces / Q000254:growth & development / Q000502:physiology*; D016896:Treatment Outcome; D000099231:Lipopolysaccharide-Binding Protein
chemical_list: D000209:Acute-Phase Proteins; D002097:C-Reactive Protein; D002352:Carrier Proteins; D016207:Cytokines; D018950:Lipopolysaccharide Receptors; D008562:Membrane Glycoproteins; D010919:Placebos; D000099231:Lipopolysaccharide-Binding Protein