HIV and The Gut Microbiome: Prebiotics and Probiotics

The other problem in the gut is that HIV disease causes a change in the composition of bacteria living in the gut. HIV infection alters the gut microbiome. The good bacteria that are normally in the gut are slowly replaced by bacteria that are not so good. Keeping these good bacteria in the gut is very important because they help us digest food and absorb nutrients and even are needed to produce certain vitamins that we use.

Is there any way we can target the gut microbiome and improve health outcomes for HIV infection? There are two ways that we may be able to do this. Prebiotics are foods or supplements we consume take that can nourish and increase levels of good bacteria. These foods and products contain dietary fiber that undergoes a special process in the large intestine (fermentation) that nourishes the growth of good bacteria.

Probiotics are the actual good bacteria themselves. They can be acquired from eating fermented foods, such a yogurt with live cultures or sauerkraut. They contain important good bacteria like Lactobacillus (sound familiar?) and Bifobacterium. There are also tablet supplements that contain these bacteria. So the big question is: Do they work? In a number of studies, eating yogurt enriched with probiotic bacteria has led to some mild increases in CD4+ lymphocytes in HIV patients on treatment. In other studies, probiotic supplements have produced a number of benefits which include reduced inflammation, possible reductions in bacteria leaking from the gut and normalization of the gut microbiome.

But before you run out and binge on yogurt, a precaution: There have been some isolated cases of HIV patients eating yogurt and developing infections from the probiotics. In these rare cases, all of the individuals had very advanced HIV disease and were not on treatment, and they all had other disease conditions that could have contributed as well. Modest consumption of yogurt or a supplement in a person controlled on HIV medication is probably safe.

It is important to remember that while some of the damage caused in the gut by HIV may be permanent, taking effective HIV therapy is the most effective way for maintaining long-term health. The use of probiotics and healthy diet (with prebiotics) may provide additional benefits. Discuss this with your healthcare provider and/or a nutritionist. [see the article in “10 types of Bacteria that are good for you” Nov. 2, 2016]


Dr. Crawford received a B.S degree in Biology from Cornell University and a B.S. in Pharmacy from Temple University. He completed a residency in clinical pharmacy at the National Institutes of Health. He earned a doctorate in Pharmacology from the Uniformed Services University of the Health Sciences in Bethesda, Maryland. He completed a post-doctoral fellowship at the National Institutes of Health, studying microbial biochemistry and genetics.

He is currently with the Division of AIDS at the National Institutes of Health. He has over 25 years of experience in HIV treatment and clinical research. This article reflects his personal views and opinions.

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