Effect of probiotics (Saccharomyces boulardii) on microbial translocation and inflammation in HIV-treated patients: a double-blind, randomized, placebo-controlled trial

J Acquir Immune Defic Syndr. 2015 Mar 1;68(3):256-63. doi: 10.1097/QAI.0000000000000468.


Background: Microbial translocation has been associated with an increase in immune activation and inflammation in HIV infection despite effective highly active antiretroviral therapy. It has been shown that some probiotics have a beneficial effect by reducing intestinal permeability and, consequently, microbial translocation.

Objectives: To assess changes in microbial translocation and inflammation after treatment with probiotics (Saccharomyces boulardii) in HIV-1-infected patients with virologic suppression.

Methods: A double-blind, randomized, placebo-controlled trial was conducted in 44 nonconsecutive HIV-1-infected patients with viral load of <20 copies per milliliter for at least 2 years. Patients were randomized to oral supplementation with probiotics or placebo during 12 weeks. Markers of microbial translocation (lipopolysaccharide-binding protein [LBP] and soluble CD14), inflammation (interleukin 6 [IL-6], tumor necrosis factor alpha, interferon gamma, high-sensitivity C-reactive protein), and immunological and clinical data were determined before and after the intervention and 3 months after treatment discontinuation. Quantitative variables were compared using the Mann-Whitney U test, and categorical variables were compared using the Fisher exact test.

Results: After 12 weeks of treatment, differences between the probiotic arm and the placebo arm were observed in LBP values (-0.30 vs +0.70 pg/mL) and IL-6 (-0.60 vs +0.78 pg/mL). These differences were also noted at 3 months after treatment withdrawal. Qualitative analysis was performed, defining a variable as "decreased" or "increased" from baseline LBP. A significant decrease of LBP at 12 weeks of treatment was observed (57.9% patients in the probiotic group vs 6.2% in the placebo group, P = 0.002).

Conclusions: Treatment with S. boulardii decreases microbial translocation (LBP) and inflammation parameters (IL-6) in HIV-1-infected patients with long-term virologic suppression.

Trial registration: ClinicalTrials.gov NCT01908049.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute-Phase Proteins
  • Administration, Oral
  • Bacterial Translocation*
  • C-Reactive Protein / analysis
  • Carrier Proteins / blood
  • Cytokines / blood
  • Double-Blind Method
  • Female
  • HIV Infections / complications*
  • HIV Infections / therapy
  • Humans
  • Inflammation / prevention & control*
  • Lipopolysaccharide Receptors / blood
  • Male
  • Membrane Glycoproteins / blood
  • Placebos / administration & dosage
  • Probiotics / therapeutic use*
  • Saccharomyces / growth & development
  • Saccharomyces / physiology*
  • Treatment Outcome


  • Acute-Phase Proteins
  • Carrier Proteins
  • Cytokines
  • Lipopolysaccharide Receptors
  • Membrane Glycoproteins
  • Placebos
  • lipopolysaccharide-binding protein
  • C-Reactive Protein

Associated data

  • ClinicalTrials.gov/NCT01908049