Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Telemedicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
J Trop Pediatr. 2022 Feb 3;68(2). doi: 10.1093/tropej/fmac006.
Depletion of CD4+ T-cells in the gut-associated lymphoid tissue is the hallmark of HIV infection, with only partial restoration by potent antiretroviral therapy (ART). Gut dysbiosis, together with disruption of mucosal integrity contributes to chronic immune activation that further exacerbates the disease. Data from randomized controlled trials in pediatric HIV patients have indicated potential of probiotics in complementing routine ART in managing HIV-associated gastrointestinal complications. We have systematically extracted data from these trials and performed meta-analysis to quantify the effect of probiotics on CD4+ T-cell counts and any adverse events associated with their supplementation.
A systematic search through multiple databases yielded three studies that were pooled using fixed-effect model. Risk of bias assessment was done by the Cochrane risk of bias tool and publication bias was assessed by Egger's test.
Included studies had moderate risk of bias and Egger's statistics revealed no publication bias (p > 0.05). Pooled analysis showed significant improvement in CD4+ T-cell counts, with mean difference, 123.92 (95% CI: 104.36-143.48), p < 0.0001, no heterogeneity (I2=0) among the included trials. Subgroup analysis also depicted improvement in CD4+ T-cell counts irrespective of treatment duration, in both ART naïve and treated patients. No adverse effects with probiotic consumption were reported.
Probiotics supplementation led to an improvement in CD4+ T-cell counts among HIV-infected children with no observed adverse effects. Despite the inherent limitations of included studies, our systematic review would justify more well-designed, large-scale trials in children, which may guide pediatricians on whether to incorporate probiotics as an adjunct therapy to routine ART.
肠道相关淋巴组织中 CD4+T 细胞的耗竭是 HIV 感染的标志，尽管采用高效抗逆转录病毒疗法（ART）进行治疗，也只能部分恢复。肠道菌群失调和黏膜完整性破坏导致慢性免疫激活，进一步加重疾病。在儿科 HIV 患者的随机对照试验中获得的数据表明，益生菌有可能在常规 ART 治疗管理中补充治疗 HIV 相关胃肠道并发症。我们已经系统地从这些试验中提取数据并进行荟萃分析，以量化益生菌对 CD4+T 细胞计数的影响，以及与补充益生菌相关的任何不良事件。
通过多个数据库进行系统搜索，共纳入三项研究，采用固定效应模型进行汇总分析。采用 Cochrane 偏倚风险工具进行偏倚风险评估，采用 Egger 检验评估发表偏倚。
纳入的研究存在中度偏倚风险，Egger 统计数据显示无发表偏倚（p>0.05）。汇总分析显示 CD4+T 细胞计数有显著改善，平均差异为 123.92（95%CI：104.36-143.48），p<0.0001，纳入研究之间无异质性（I2=0）。亚组分析还显示，无论治疗持续时间长短，在 ART 初治和治疗患者中，益生菌治疗均可改善 CD4+T 细胞计数。益生菌治疗未观察到不良反应。
益生菌补充治疗可改善 HIV 感染儿童的 CD4+T 细胞计数，且无不良反应。尽管纳入研究存在固有局限性，但我们的系统评价仍将为儿童开展更多设计良好、规模更大的试验提供依据，这可能有助于儿科医生决定是否将益生菌作为常规 ART 的辅助治疗。
