The Effectiveness of Probiotics for Managing Diarrhoea in People with HIV Infection: A Critically Appraised Topic

OBJECTIVES : The implications of HIV infection are vast. Management of clinical symptomatology, though, cannot be overshadowed by focus on disease management. These must be managed in concert. Diarrhoea, a common complaint of HIV-infected people, can be difficult to manage, and complicated further by polypharmacy. This review will critically appraise literature related to the management of diarrhoea with probiotics in HIV-infected people.

METHODS : PubMed, CINAHL, and The Cochrane Library were searched for randomized controlled trials investigating the use of probiotics in HIV-infected people, which included diarrhoeal symptoms as a primary or secondary endpoint.

RESULTS : Three randomized controlled trials and one randomized control cross-over study were identified as best evidence. One study identified a statistically significant improvement in diarrhoea for those treated with probiotics. An additional study identified improvement in diarrhoea; however, a similar improvement was seen in those treated with placebo. Two studies did not identify a statistical difference for those treated with probiotics.

CONCLUSIONS : There is insufficient evidence to allow a strong recommendation to be made for or against the use of probiotics for diarrhoea, but safety and lack of drug-drug interactions make it a reasonable option for some patients.