Introduction :
Antiretroviral therapy (ART) is the basis of treatment for adults with a
CD4+ count of less than 350 cells per microliter or with a CD4+ count
that has any of the following conditions: Concurrent hepatitis B or a
sexual partner with this disease, HIV-induced nephropathy, age
> 50, active tuberculosis, a viral load greater than
100000, or malignancy associated with HIV or malignancy requiring
chemotherapy/radiotherapy.[1]
Viral load and CD4+ count are two factors that determine treatment
success.
virologic failure is defined as incomplete response or no response from
HIV RNA to ART or virologic recurrence, as defined below:
Incomplete virologic response: more than 400 copies HIV RNA per
milliliter after 24 weeks of treatment with HAART or more than 50
copies/ml at week 48 of treatment in a patient receiving treatment for
the first time.
Virologic relapse: HIV RNA up to 400-1000 copies/ml, four to eight weeks
after viral suppression, in two sessions.[2]
Immunologic failure: an increase in CD4 cell count of 150 per cubic
millimeter is expected in the first year of HIV treatment. If this
increase is less than 25 to 50 in the first year, or if the CD4 count
does not increase from baseline despite decreased viral load, or if CD4
cells are consistently below 100 cells per cubic millimeter or decrease
by 50% of the maximum CD4 count during treatment, immunologic failure
is present.
Generally, immunologic failure follows virologic failure, and then
clinical exacerbations occur. However, these may occur months to years
apart and do not necessarily occur in the order mentioned. [3]
In the patients in our study, viral load was minimized and the desired
virologic response was achieved, but despite this success, we observed
immunologic failure , so according to previous studies we try to
increase the gut microflora by probiotics especially with high count of
lactobacilli to reduce intestinal inflammation and achieve immunologic
response .
Probiotics are live microorganisms that, when administered in adequate
numbers of colonies, can delay immune destruction and help maintain
immunity in HIV patients. A study by Ruben Hummeln et al.(9)
investigated the effect of probiotics on the immune system of patients
with HIV. The results indicate that at the end of week 25, the group
that received placebo in combination with ART had an increase of mean 19
CD4 cells per microliter and the group that received probiotics in
combination with ART had an increase of mean 46 CD4 cells per
microliter. [4]
In another study of the effect of probiotics on two groups of HIV
patients, 19 patients received probiotics with a colony count of 2x109 CFU/day and 25 patients received placebo. At the end
of week 25, the CD4 count of patients in the probiotics and placebo
groups increased by 19 and 46 cells, respectively. [5]
Several other studies have shown the effect of probiotics on increasing
CD4 cell counts. Based on these results, we designed this study to
investigate the effect of probiotics in patients who have immunologic
failure despite virologic success.