Background. Probiotics as a potential adjuvant therapy may improve the restoration of the intestinal CD4⁺ T-cell population in HIV-infected patients, whereas findings from clinical trials are inconsistent. This systematic review and meta-analysis of randomized controlled trials (RCTs) was performed to quantify the effects of probiotic, prebiotic, and synbiotic supplementation on CD4 counts in HIV-infected patients. Methods. We searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials for relevant articles published up to March 20, 2020. Two authors independently performed the study selection, data extraction, and risk of bias assessment. Data were pooled by using the random effects model, and weighted mean difference (WMD) was considered the summary effect size. Publication bias was evaluated by a funnel plot and Egger’s test. Results. The search strategy identified 1712 citations. After screening, a total of 16 RCTs with 19 trials were included in the meta-analysis. Pooling of the extracted data indicated no significant difference between the probiotics/prebiotics/synbiotics and placebo groups on CD4 counts (, 95% confidence interval (CI) -24.72 to 32.45, ). In subgroup analysis, a significant increase in CD4 counts was found in the study with high risk of bias (, 95% CI 108.74 to 227.26, ). Egger’s test showed no evidence of significant publication bias (). Conclusions. In summary, the evidence for the efficacy of probiotics, prebiotics, and synbiotics in improving HIV-infected patients’ CD4 counts as presented in currently published RCTs is insufficient. Therefore, further comprehensive studies are needed to reveal the exact effect of probiotics, prebiotics, and synbiotics on CD4⁺ cell counts.

中文翻译：

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益生菌、益生元和合生元对 HIV 感染患者 CD4 计数的影响：系统评价和荟萃分析

背景。益生菌作为一种潜在的辅助疗法可能会改善 HIV 感染患者肠道 CD4 ⁺ T 细胞群的恢复，而临床试验的结果并不一致。这项对随机对照试验 (RCT) 的系统评价和荟萃分析旨在量化补充益生菌、益生元和合生元对 HIV 感染患者 CD4 计数的影响。方法. 我们在 PubMed、Embase、Web of Science、Scopus 和 Cochrane Central Register of Controlled Trials 中搜索了截至 2020 年 3 月 20 日发表的相关文章。两位作者独立进行了研究选择、数据提取和偏倚风险评估。使用随机效应模型汇总数据，加权平均差（WMD）被认为是总效应量。通过漏斗图和 Egger 检验评估发表偏倚。结果。搜索策略确定了 1712 次引用。筛选后，共有 16 项 RCT 和 19 项试验被纳入荟萃分析。汇总提取的数据表明，益生菌/益生元/合生元和安慰剂组在 CD4 计数上没有显着差异（, 95% 置信区间 (CI) -24.72 至 32.45,）。在亚组分析中，研究发现 CD4 计数显着增加，具有高偏倚风险（, 95% CI 108.74 至 227.26,）。Egger 的检验显示没有明显的发表偏倚的证据（）。 结论。总之，目前发表的 RCT 中提出的益生菌、益生元和合生元在改善 HIV 感染患者 CD4 计数方面的功效的证据不足。因此，需要进一步的综合研究来揭示益生菌、益生元和合生元对 CD4 ⁺细胞计数的确切影响。