Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China.
Liuzhou Center for Disease Control and Prevention, 1 Tanzhongxi Road, Liuzhou, Guangxi Zhuang Autonomous Region 545000, China.
Biomed Res Int. 2020 Nov 26;2020:7947342. doi: 10.1155/2020/7947342. eCollection 2020.
Probiotics as a potential adjuvant therapy may improve the restoration of the intestinal CD4 T-cell population in HIV-infected patients, whereas findings from clinical trials are inconsistent. This systematic review and meta-analysis of randomized controlled trials (RCTs) was performed to quantify the effects of probiotic, prebiotic, and synbiotic supplementation on CD4 counts in HIV-infected patients.
We searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials for relevant articles published up to March 20, 2020. Two authors independently performed the study selection, data extraction, and risk of bias assessment. Data were pooled by using the random effects model, and weighted mean difference (WMD) was considered the summary effect size. Publication bias was evaluated by a funnel plot and Egger's test.
The search strategy identified 1712 citations. After screening, a total of 16 RCTs with 19 trials were included in the meta-analysis. Pooling of the extracted data indicated no significant difference between the probiotics/prebiotics/synbiotics and placebo groups on CD4 counts (WMD = 3.86, 95% confidence interval (CI) -24.72 to 32.45, = 0.791). In subgroup analysis, a significant increase in CD4 counts was found in the study with high risk of bias (WMD = 188, 95% CI 108.74 to 227.26, ≤ 0.001). Egger's test showed no evidence of significant publication bias ( = 0.936).
In summary, the evidence for the efficacy of probiotics, prebiotics, and synbiotics in improving HIV-infected patients' CD4 counts as presented in currently published RCTs is insufficient. Therefore, further comprehensive studies are needed to reveal the exact effect of probiotics, prebiotics, and synbiotics on CD4 cell counts.
益生菌作为一种潜在的辅助治疗方法，可能有助于恢复 HIV 感染患者的肠道 CD4 T 细胞群体，而临床试验的结果并不一致。本系统评价和荟萃分析对随机对照试验（RCT）进行了研究，以量化益生菌、益生元和合生菌补充剂对 HIV 感染患者 CD4 计数的影响。
我们检索了 PubMed、Embase、Web of Science、Scopus 和 Cochrane 对照试验中心注册库，以获取截至 2020 年 3 月 20 日发表的相关文章。两名作者独立进行了研究选择、数据提取和偏倚风险评估。使用随机效应模型汇总数据，并将加权均数差（WMD）视为汇总效应量。通过漏斗图和 Egger 检验评估发表偏倚。
搜索策略确定了 1712 条引文。经过筛选，共有 16 项 RCT 包含 19 项试验被纳入荟萃分析。对提取数据的汇总表明，益生菌/益生元/合生菌与安慰剂组之间的 CD4 计数无显著差异（WMD = 3.86，95%置信区间（CI）-24.72 至 32.45， = 0.791）。在亚组分析中，高偏倚风险的研究发现 CD4 计数显著增加（WMD = 188，95%CI 108.74 至 227.26， ≤ 0.001）。Egger 检验表明无显著发表偏倚证据（ = 0.936）。
综上所述，目前发表的 RCT 中，益生菌、益生元和合生菌在改善 HIV 感染患者 CD4 计数方面的疗效证据不足。因此，需要进一步开展全面的研究，以揭示益生菌、益生元和合生菌对 CD4 细胞计数的确切影响。
