Even though the antiretroviral therapy is effective in suppressing viral replication and decreasing HIV-associated morbidity and mortality, most HIV-infected individuals show a high prevalence of problems related to cognitive impairment. A research group from Italy published a very interesting article on the Journal of NeuroVirology with the results of a 6 month supplementation of a high-concentration probiotic (the De Simone Formulation) based on the cerebrospinal fluid (CSF) analysis and a neurocognitive assessment in 13 HIV-positive patients.

All patients underwent a basic neurocognitive assessment and blood sampling at time zero and after six months of probiotic supplementation. Specifically, immune phenotyping and activation of specific markers (CD38 and HLA-DR) were evaluated on peripheral blood. Plasma levels of IL-6, sCD14, and MIP-1β were detected, by enzyme-linked immunosorbent assay (ELISA). The functional proteomic analysis of the CSF sample was carried out by two-dimensional electrophoresis.

Highly concentrated probiotics led to an improvement of several cognitive tests and neurocognitive performance in HIV-positive subjects. In addition, a significant reduction in the percentage of CD4+, CD38+ HLA-DR-T cells was also observed at the peripheral level after taking the probiotics (p = 0.008). The probiotic supplementation during cART therapy significantly modifies protein species composition as well and abundance at the CSF level, especially those related to inflammation (β2-microglobulin p = 0.03; haptoglobin p = 0.06; albumin p = 0.003; hemoglobin p = 0.003); modifications in the metabolites of the bacterial flora and intestinal permeability has reduced the production of pro-inflammatory cytokines, especially TNF-α, at systemic level. Additionally, the amelioration of the CSF proteomic profile suggests that it is locally protected by the action of pro-inflammatory molecules, bringing an improvement of the clinical status, thus an improvement in the cognitive decline.¹