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.