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Infectious disease in the developing world continues to represent one of the greatest challenges facing humanity. Every year over a million children suffer and die from the sequela of enteric infections, and in 2008 was estimated almost 2.7 million (UNAIDS 2009 update) adults and children became infected with human immunodeficiency virus (HIV). While oral rehydration therapy for diarrhea and antiretrovirals (ARV) for HIV are critical, there is a place for adjunctive therapies to improve quality of life. The importance of the human microbiota in retaining health is now recognized, as is the concept of replenishing beneficial microbes through probiotic treatments. Studies have shown that probiotics can reduce the duration of diarrhea, improve gut barrier function, help prevent bacterial vaginosis (BV) and enhance immunity even in HIV-infected subjects. However, many issues remain before the extent of probiotic benefits can be verified, and their application to the developing world realized. This consensus report outlines the potential probiotic, and to a lesser extent prebiotic, applications in resource disadvantaged settings, and recommends steps that could bring tangible relief to millions of people. The challenges to both efficacy and effectiveness studies in these settings include a lack of infrastructure and funding for scientists, students and research projects in developing countries; making available clinically proven probiotic and prebiotic products at affordable prices; and undertaking appropriately designed clinical trials. We present a roadmap on how efficacy studies may be conducted in a resource disadvantaged setting among persons with chronic diarrhea and HIV. These examples and the translation of efficacy into effectiveness are described. © 2011 Landes Bioscience. Chemicals/CAS: glutamine, 56-85-9, 6899-04-3; retinol, 68-26-8, 82445-97-4; zinc, 14378-32-6, 7440-66-6

Publisher Summary This chapter discusses how the immunostimulatory properties of probiotics are helpful in the treatment of AIDS, thus improving quality of life. The HIV-infected children have no chance, as a healthy child does, to develop a balanced microfloral, for the most important gut first colonization happens through breast-feeding, followed by exposure to the environment, maternal flora, delivery characteristics, and the use of antibiotics. After 2 years of age, the gastrointestinal micro-biota has implications on the functional ability of gut flora to optimize its activities in nutrition, food and drugs absorption and metabolism, vitamin synthesis, defense, and education of the local immune system. Probiotics, a commensal bacteria, interact with the host immune system, acting as an important antigenic stimulus for the improvement of gut-associated lymphoid tissue, starting the local immune responses. The protection role of the microflora is mediated by a number of mechanisms, such as competitive exclusion, increasing normal intestinal barrier function, and stimulating immunoglobulin production. It has been proven that the microbiota has a positive impact on immune regulation. There are some studies relating to probiotics and immune-response through an increase in CD8+ and CD4+ in healthy women. However, the proof of probiotics' direct involvement needs to be studied further.