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J Infect Dis. 2015 Mar 1;211(5):780-90. doi: 10.1093/infdis/jiu515. Epub 2014 Sep 11.

Rifaximin has a marginal impact on microbial translocation, T-cell activation and inflammation in HIV-positive immune non-responders to antiretroviral therapy - ACTG A5286.

Author information

1
Department of Medicine.
2
Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts.
3
Division of Infectious Diseases, University of Pittsburgh School of Medicine.
4
HIV Research Branch, TRP, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda.
5
ACTG Operations Center, Social and Scientific Systems, Silver Spring, Maryland.
6
Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
7
Department of Medicine, University of North Carolina, Chapel Hill.
8
Division of Infectious Diseases and HIV, Drexel University, Philadelphia, Pennsylvania.
9
Department of Immunology and Microbiology, Rush University Medical Center.
10
Department of Medicine, University of Colorado at Denver, Aurora.

Abstract

BACKGROUND:

Rifaximin, a nonabsorbable antibiotic that decreases lipopolysaccharide (LPS) in cirrhotics, may decrease the elevated levels of microbial translocation, T-cell activation and inflammation in human immunodeficiency virus (HIV)-positive immune nonresponders to antiretroviral therapy (ART).

METHODS:

HIV-positive adults receiving ART for ≥96 weeks with undetectable viremia for ≥48 weeks and CD4(+) T-cell counts <350 cells/mm(3) were randomized 2:1 to rifaximin versus no study treatment for 4 weeks. T-cell activation, LPS, and soluble CD14 were measured at baseline and at weeks 2, 4, and 8. Wilcoxon rank sum tests compared changes between arms.

RESULTS:

Compared with no study treatment (n = 22), rifaximin (n = 43) use was associated with a significant difference between study arms in the change from baseline to week 4 for CD8(+)T-cell activation (median change, 0.0% with rifaximin vs +0.6% with no treatment; P = .03). This difference was driven by an increase in the no-study-treatment arm because there was no significant change within the rifaximin arm. Similarly, although there were significant differences between study arms in change from baseline to week 2 for LPS and soluble CD14, there were no significant changes within the rifaximin arm.

CONCLUSIONS:

In immune nonresponders to ART, rifaximin minimally affected microbial translocation and CD8(+)T-cell activation. Trial registration number. NCT01466595.

KEYWORDS:

HIV; immune activation; immune nonresponders to ART; inflammation; microbial translocation; rifaximin

PMID:
25214516
PMCID:
PMC4334803
DOI:
10.1093/infdis/jiu515
[Indexed for MEDLINE]
Free PMC Article

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