How the Gut Microbiome Affects Outcomes in HIV

"Gut microbiome" is becoming a buzzword in the health care community. For decades, the gut microbiome was accepted as a simple fact–a collection of microbiota in the intestines that if disrupted, resulted in gastrointestinal signs and symptoms. However, it’s increasingly apparent that the gut microbiome has extensive function throughout the body.

Specifically, gut microbiome alterations have been associated with frailty in older individuals. The journal HIV and Aging has published an article that discusses how aging and HIV affect the gut microbiome, and what impacts these factors have on health.

Aging is associated with reduced bacterial diversity and dysbiosis. Researchers have noted specific reductions in bifidobacteriaFaecalibacterium prausnitzii, and Clostridium cluster IV over time. They’ve also noted that very old patients have increases in bacteria possessing pro-inflammatory properties. Factors that may influence this change are nutritional status, antibiotic use, and chronic use of prescription medications including statins.

The intestine is the primary location for HIV infection resulting in mucosal CD4+ T lymphocyte depletion, viral dissemination, microbial translocation, and immune activation.

Studies are underway to determine how exactly HIV infection changes gut microbiome in comparison with individuals who do not have HIV infection. It is clear that in HIV, microbiota alterations may increase inflammatory responses.

Researchers have conducted numerous studies to determine if prebiotic and probiotic interventions might improve health in individuals with HIV, many of which reported positive effects. Small studies have also linked changes in the microbiotic to specific health alterations (eg myocardial infarction and increased cardiac plaque).

The authors indicated that clinicians should counsel individuals with HIV to avoid health-related behaviors that may alter microbiota and decrease inflammation and immune activation. In general, recommendations to avoid alcohol and substance use are prudent. Improving diet, exercise, and sleep have also been associated with better gut microbiotic distribution.

Desai SN, Landay AL. HIV and aging: role of the microbiome. Curr Opin HIV AIDS. 2017 Oct 14. doi: 10.1097/COH.0000000000000433. [Epub ahead of print]

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