Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 to prevent or cure bacterial vaginosis among women with HIV.

2010-11-02
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 111(3)
- Ruben Hummelen
- John Changalucha
- Nicodemus L Butamanya
- Adrian Cook
- J Dik F Habbema
- Gregor Reid

PubMed: 20801446
DOI: 10.1016/j.ijgo.2010.07.008

Study Design

Type: Randomized Controlled Trial (RCT)
Population: 65 HIV-infected women with an aberrant microbiota (Nugent score 4-10)
Methods: Randomized, double-blind, placebo-controlled trial; daily probiotics or placebo for 6 months; metronidazole for 10 days for those with BV
Blinding: Double-blind
Duration: 6 months
Funding: Unclear

Objective

To assess, among women with HIV, whether long-term oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 supplementation can prevent bacterial vaginosis (BV) and enhance the cure rate of metronidazole among those with BV.

Methods

A randomized, double-blind, placebo-controlled trial conducted among 65 HIV-infected women with an aberrant microbiota (Nugent score 4-10) who were randomized to receive daily probiotics or placebo for 6 months. Those with BV (Nugent score 7-10) additionally received metronidazole for 10 days (400 mg twice daily).

Results

We did not find an enhanced cure rate of BV among women with HIV treated with adjuvant probiotics to metronidazole treatment. Among women with an intermediate vaginal flora, probiotics tended to increase the probability of a normal vaginal flora (odds ratio 2.4; P=0.1) and significantly increased the probability of a beneficial vaginal pH (odds ratio 3.8; P=0.02) at follow-up.

Conclusion

Supplementation of probiotic L. rhamnosus GR-1 and L. reuteri RC-14 did not enhance the cure of BV among women living with HIV, but may prevent the condition among this population.

Trial registration

NCT00536848.

Research Insights

Lactobacillus reuteri RC-14→Improved Cure of Bacterial Vaginosis
We did not find an enhanced cure rate of BV among women with HIV treated with adjuvant probiotics to metronidazole treatment.
Effect
Neutral
Effect size
Small
Dose
daily probiotics for 6 months (exact dose not specified in abstract)
Lactobacillus reuteri RC-14→Increased Vaginal Lactobacilli Levels
Among women with an intermediate vaginal flora, probiotics tended to increase the probability of a normal vaginal flora (odds ratio 2.4; P=0.1)
Effect
Neutral
Effect size
Small
Dose
daily probiotics for 6 months (exact dose not specified in abstract)
Lactobacillus reuteri RC-14→Reduced Vaginal pH
significantly increased the probability of a beneficial vaginal pH (odds ratio 3.8; P=0.02) at follow-up
Effect
Beneficial
Effect size
Moderate
Dose
daily probiotics for 6 months (exact dose not specified in abstract)
Lactobacillus rhamnosus GR-1→Improved Cure of Bacterial Vaginosis
We did not find an enhanced cure rate of BV among women with HIV treated with adjuvant probiotics to metronidazole treatment.
Effect
Neutral
Effect size
Small
Dose
daily probiotics for 6 months (exact dose not specified in abstract)
Lactobacillus rhamnosus GR-1→Increased Vaginal Lactobacilli Levels
Among women with an intermediate vaginal flora, probiotics tended to increase the probability of a normal vaginal flora (odds ratio 2.4; P=0.1)
Effect
Neutral
Effect size
Small
Dose
daily probiotics for 6 months (exact dose not specified in abstract)
Lactobacillus rhamnosus GR-1→Reduced Vaginal pH
significantly increased the probability of a beneficial vaginal pH (odds ratio 3.8; P=0.02) at follow-up
Effect
Beneficial
Effect size
Moderate
Dose
daily probiotics for 6 months (exact dose not specified in abstract)