Rifaximin has a marginal impact on microbial translocation, T-cell activation and inflammation in HIV-positive immune non-responders to antiretroviral therapy - ACTG A5286

J Infect Dis. 2015 Mar 1;211(5):780-90. doi: 10.1093/infdis/jiu515. Epub 2014 Sep 11.

Abstract

Background: Rifaximin, a nonabsorbable antibiotic that decreases lipopolysaccharide (LPS) in cirrhotics, may decrease the elevated levels of microbial translocation, T-cell activation and inflammation in human immunodeficiency virus (HIV)-positive immune nonresponders to antiretroviral therapy (ART).

Methods: HIV-positive adults receiving ART for ≥96 weeks with undetectable viremia for ≥48 weeks and CD4(+) T-cell counts <350 cells/mm(3) were randomized 2:1 to rifaximin versus no study treatment for 4 weeks. T-cell activation, LPS, and soluble CD14 were measured at baseline and at weeks 2, 4, and 8. Wilcoxon rank sum tests compared changes between arms.

Results: Compared with no study treatment (n = 22), rifaximin (n = 43) use was associated with a significant difference between study arms in the change from baseline to week 4 for CD8(+)T-cell activation (median change, 0.0% with rifaximin vs +0.6% with no treatment; P = .03). This difference was driven by an increase in the no-study-treatment arm because there was no significant change within the rifaximin arm. Similarly, although there were significant differences between study arms in change from baseline to week 2 for LPS and soluble CD14, there were no significant changes within the rifaximin arm.

Conclusions: In immune nonresponders to ART, rifaximin minimally affected microbial translocation and CD8(+)T-cell activation. Trial registration number. NCT01466595.

Keywords: HIV; immune activation; immune nonresponders to ART; inflammation; microbial translocation; rifaximin.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active / methods*
  • Bacterial Translocation*
  • CD8-Positive T-Lymphocytes / immunology*
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • Humans
  • Inflammation / prevention & control
  • Lipopolysaccharide Receptors / blood
  • Lipopolysaccharides / blood
  • Lymphocyte Activation*
  • Male
  • Middle Aged
  • Rifamycins / therapeutic use*
  • Rifaximin
  • Treatment Outcome
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Lipopolysaccharide Receptors
  • Lipopolysaccharides
  • Rifamycins
  • Rifaximin

Associated data

  • ClinicalTrials.gov/NCT01466595

Grant support