Effect of Probiotic Supplementation on CD4 Cell Count in HIV-Infected Patients: A Systematic Review and Meta-analysis

Progressive decline in CD4 cell counts is associated with human immunodeficiency virus (HIV) disease progression. Loss of CD4 cells might contribute to gut microbiota alteration and bacterial translocation. Probiotics, by inducing epithelial healing, may promote the restoration of the intestinal CD4+ T-cell population. The aim of this meta-analysis was to systematically review all randomized controlled trials (RCTs) of probiotic/prebiotic/synbiotic supplementation on CD4 cell counts in HIV-infected patients. A systematic search of RCTs was conducted through PubMed, Scopus, and Google Scholar databases up to August 2015. Effect sizes of eligible studies were pooled using random-effects models (the DerSimonian-Laird estimator). Eleven studies with 14 treatment arms met the inclusion criteria. Pooled analysis showed no significant reduction in CD4 counts (-7.5 mg/l, p = .7) in intervention-treated individuals. Subgroup analysis on potential influencing factors highlighted sex, country of origin, study duration, and the type of intervention as having significant effects on CD4 cell counts. As a whole, the results of this meta-analysis suggested that supplementation with probiotic may not change CD4 counts. However, a significant increase in CD4 counts was seen in females and following synbiotics as opposed to treatment with pro- or prebiotics alone.