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 drugdrug interactions make it a reasonable option for some patients.