Effect of probiotics supplementation on CD4⁺T cell counts and inflammation in adults living with HIV: A systematic review and meta-analysis

Introduction: This systematic review and meta-analysis aimed to evaluate the effect of prebiotics and synbiotics supplementation on cluster of differentiation 4 positive T cell (CD4⁺ T cell) counts and biomarkers of inflammation adults living with Human Immunodeficiency Virus (HIV). Methods: The present systematic review searched in PubMed, Cochrane Library, Embase, PubMed databases, and Chinese electronic databases (CNKI, VIP, Wanfang), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and the Clinical Trials.gov trials registers. The Cochrane risk of bias assessment tool 2.0 was employed to assess the risk of bias, and meta-analyses used RevMan 5.1 software. Subgroup analysis was performed according to participants who accepted Antiretroviral Therapy (ART) or were ART naive, from low- or middle-income countries or high-income countries and by duration of intervention. Results: Fifteen Randomized Controlled Trials (RCTs) including 733 HIV-infected individuals were included in this review. The methodological quality of most included trials was moderate. Probiotics supplementation showed no significant increase in CD4⁺ T cells in HIV-infected individuals (MD: 37.74, 95 % CI:13.75 to 87.04; I² = 71 %; 10 studies; P = 0.15) compared with placebo. Subgroup analyses also showed that CD4⁺ T cell counts did not increase significantly in the probiotics group. No trial assessing soluble inflammatory markers was included in this meta-analysis. Adverse events were reported in nine studies and there was no statistically significant difference between the probiotics and placebo groups (OR: 1.58, 95 %CI: 0.75 to 3.32; 9 studies, I²= 51 %, P = 0.22). Conclusion: The results of this meta-analysis suggested that probiotics supplementation may have no effect on CD4⁺ T cells counts. The adverse events reported appeared to have no correlation with the probiotics treatments.