Human immunodeficiency virus (HIV) is a virus infecting and killing CD4 + T cells which play an important role in the immune response against invasion of pathogenic microorganisms. In the course of HIV disease, enteropathy often occurs in patients infected with HIV.
Enteropathy is the changing condition of digestive tract normal structure, as the defense mechanism of the digestive tract is damaged due to widespread HIV infection in the body of patients. Under normal conditions, microbes and their products in the digestive tract will be eliminated by immune cells in the intestinal lining and channeled into the lymphatic circulation. However, in HIV patients with enteropathy, these defense mechanisms do not function and transfer of microbes from the digestive tract to the systemic circulation.
Lipopolysaccharide (LPS) is one of the major components of the outer membrane of Gram-negative bacteria, the main bacteria in the digestive tract and a strong inflammatory factor and the amount can be measured in blood plasma. The amount of LPS in the blood can reflect the level of bacterial movement proportional to the level of damage to the digestive tract in patients with chronic infections, especially patients with HIV infection. The pathogenic Escherichia coli ( E. coli ) uses lipopolysaccharide to damage the membrane of intestinal epithelium in the strong bond of epithelial cells ( tight junctions ) when it infects the digestive tract.
Antiretroviral therapy (ARV) in patients with HIV infection has been known to suppress viral replication and improve CD4 + T cell counts. However, antiretroviral drugs alone is proven unable to repair structural damage and defense mechanisms of the digestive tract which are the main causes of microbial movement stimulating chronic immune activation.
Several studies have proven that supplementation of probiotics in HIV patients receiving ARV therapy can improve the health of the digestive system and accelerate the long-term improvement of patients’ illnesses. Supplementation is said to contribute damage repair on to the intestinal epithelial cell bonding after LPS exposure from E. coli.
Probiotics are microorganisms and when they are consumed in optimal amounts, they can provide health benefits for the host. Probiotics play a role in reducing the permeability of the epithelial layer, reducing systemic and mucosal inflammation associated with the humoral and systemic immune system, and helping to reduce the growth and movement of pathogenic microbes.
The probiotic Lactobacilus plantarum IS-10506 has been studied and proven to reduce blood LPS levels in HIV-infected children and ARV therapy after six weeks of supplementation. Probiotic Lactobacilus plantarum IS-10506 has great potential as supplement in HIV infected children receiving ARV therapy. Other studies have also shown that probiotic supplementation for 16 weeks can reduce the rate of microbial transfer from the gastrointestinal tract to the systemic circulation in HIV-infected adult patients who do not even receive ARV therapy. Not only the rate of microbial movement, the study also found the number of pathogenic bacteria decreased in the digestive tract in HIV patients.
A study has recorded a decrease in the number of IgA-producing plasma cells ( Immunoglobulin A ) in the large intestine and small intestine in HIV-positive patients, relative to non-HIV-infected patients. On this basis, bacteria can make a move from the cavity of digestive tract into the systemic blood circulation and then activate the chronic systemic immune system and persistent inflammation. So enteropathy is not only associated with damage to the structure of the epithelial layer, but also to the level of sIgA ( Secretory Immunoglobulin A ) produced by plasma cells in the intestinal epithelial membrane, but this theory still needs further research.
The results of analysis found in this study after supplementation of probiotic Lactobacilus plantarum IS-10506 for 6 weeks, sIgA did not show a significant increase correlated to a significant decrease in blood LPS levels. Thus, it can be said that probiotics reduce LPS levels through pathways that do not involve SIgA. This study also showed that probiotics did not affect the chronic systemic immune system as reflected by absolute CD4 + T counts, CD4 percentage, absolute CD8 + T cell counts, and CD4 + / CD8 + T cell ratio in HIV-infected patients.
This study showed no serious side effects observed, worsening clinical changes, sepsis, bacteremia, or acute inflammatory response after supplementation of probiotic Lactobacilus plantarum IS-10506 in HIV-infected children for 6 weeks. Several studies have shown that patients with HIV infection do not have significant side effects from the administration of prebiotics, probiotics, and synbiotics. In some reported cases, probiotics cause only minor abdominal discomfort and flatulence.
It can be concluded that probiotics can reduce blood LPS levels in HIV-infected children who are receiving ARV therapy, but do not affect the humoral mucosal immune response and systemic immune response. Probiotics can be given as supplementation to HIV-infected patients. (*)
Author: Dr. Alpha Fardah Athiyyah, dr., Sp.A(K)
Department of Child Health Sciences, Dr. Soetomo, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.
Details of this research available at:
http://ijm.tums.ac.ir/index.php/ijm/article/view/2077
Athiyyah A, Brahmantya H, Dwiastuti S, Darma A, Puspitasari D, Husada D, Ranuh R, Endaryanto A, Surono I, Sudarmo S. Effect of Lactobacillus plantarum IS-10506 on blood lipopolysaccharide level and immune response in HIV-infected children. Iran J Microbiol. 11(2):137-144.
