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Altered gut microbiome composition in HIV infection: causes, effects and potential intervention

Bandera, Alessandra; De Benedetto, Ilaria; Bozzi, Giorgio; Gori, Andrea

Current Opinion in HIV and AIDS: January 2018 - Volume 13 - Issue 1 - p 73–80
doi: 10.1097/COH.0000000000000429
THE MICROBIOME IN HIV: Edited by Alan L. Landay, James G. Kublin and Seema N. Desai

Purpose of review Aim of this review is to summarize the alterations occurring in gut microbiome composition after HIV infection, and to underline how intestinal dysbiosis can affect immune homeostasis, immune recovery, and persisting immune activation under antiretroviral therapy (ART). Many interventions have been suggested, mostly with inconclusive results.

Recent findings Recent evidence showed that gut microbiota from HIV-infected patients harbor reproducible differences compared to uninfected individuals. In this line, there is growing evidence that alterations in gut ecology during HIV infection correlate with persistence of immune defects and chronic inflammation. A reduced microbial diversity in feces of HIV-infected patients is highly associated with microbial translocation and monocyte activation markers; moreover, changes in mucosa-associated bacteria correlate with inflammation and T-cell activation.

Summary Studying the human host–microbiota interaction suggests that the consequences of HIV infection on microbial composition can influence immune status in HIV patients. ART induces microbiome changes that are independent of HIV infection, and some imply that ART may enhance dysbiosis. Studies and trials evaluated the effects of administering probiotics and prebiotics, finding a potential benefit on inflammation markers and immune cell activation. Emerging data on fecal microbial transplantation need to be assessed with further studies.

Infectious Diseases Unit, S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy

Correspondence to Alessandra Bandera, MD, PhD, Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital, University of Milan-Bicocca, Via Pergolesi 33, 20052 Monza, Italy. Tel: +39 039 2339317; fax: +39 039 2339327; e-mail:

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