From the Guidelines
Lactobacillus probiotics are generally considered safe for most HIV-immunocompromised individuals, but caution is advised, especially for those with severely compromised immune systems (CD4 counts below 200). For HIV patients with moderate to good immune function, standard probiotic doses (typically 1-10 billion CFU daily) of commercially available Lactobacillus products are usually well-tolerated, as supported by a study published in 2021 1. However, individuals with advanced HIV disease, very low CD4 counts, or those experiencing opportunistic infections should consult their healthcare provider before starting any probiotic supplement. The potential benefits of Lactobacillus for HIV patients include supporting gut health, which is often compromised in HIV infection, and possibly helping to maintain immune function, as noted in a review of probiotic safety published in 2019 1. Some healthcare providers may recommend starting with lower doses and gradually increasing while monitoring for any adverse effects. The theoretical concern with probiotics in severely immunocompromised patients is the small risk of the probiotic organisms causing infection, though this is rare with commercial Lactobacillus products, as discussed in a guideline published in 2021 1. Always inform your HIV specialist about any supplements you're considering to ensure they don't interact with your antiretroviral therapy or other medications. Key considerations for the use of Lactobacillus probiotics in HIV-immunocompromised individuals include:
- Careful evaluation of the patient's immune status and overall health before starting probiotic supplementation
- Selection of a high-quality, commercially available Lactobacillus product with a proven safety record
- Monitoring for potential adverse effects, such as infection or interaction with antiretroviral therapy
- Consultation with an HIV specialist before starting any probiotic supplement, especially for individuals with advanced HIV disease or severely compromised immune systems.
From the Research
Safety of Lactobacillus for HIV-Infected Individuals
- The use of Lactobacillus as a probiotic in HIV-infected individuals has been studied in several clinical trials, with most suggesting that it is safe and may have immunological benefits 2, 3, 4, 5.
- A study published in 2015 found that Lactobacillus casei Shirota supplementation was associated with an increase in T lymphocytes and a significant decrease in inflammatory cytokines in HIV-infected individuals 2.
- Another study published in 2018 reviewed the safety and adverse event reporting from clinical trials that have tested probiotics in at-risk populations, including HIV-infected individuals, and found that the benefits of probiotic therapy outweigh their potential risks 3.
- A 2012 study found that micronutrient supplemented probiotic yogurt was well-tolerated and may support immune function among people living with HIV 4.
- However, a 2016 case report highlighted the potential risk of bacteraemia due to Lactobacillus acidophilus in an HIV-infected individual who consumed excessive amounts of probiotic-enriched yogurt 6.
- A 2011 study found that Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 may be safely consumed by moderately immune-compromised HIV patients, but did not universally preserve immune function 5.
Key Findings
- Lactobacillus supplementation may modulate immunological parameters and reduce inflammation in HIV-infected individuals 2, 3.
- Probiotic therapy may be an effective and safe adjunctive treatment for HIV-infected individuals, although special care should be taken in individuals with extreme immunosuppression and severe medical conditions 3.
- Micronutrient supplemented probiotic yogurt may support immune function and improve quality of life among people living with HIV 4.
- Excessive consumption of probiotic-enriched products may pose a risk of bacteraemia in HIV-infected individuals 6.