As HIV-infected people live longer, the medical community is learning more about how both the disease and the antiretroviral therapy (ART) used to manage it affect different areas of health.
Research has shown an enrichment in the bacterial populations, genes and functional capabilities of the gut microbiota of people with HIV.
These changes may contribute to both inflammation and immune recovery. One of the effects observed in HIV+ patients undergoing ART is a change in the microbiome of the gut.
In people with immune response to highly active ART, gut bacteria are distinct from HIV+ people not receiving treatment. This leads to question of how the ecosystem of the gut might contribute not only to chronic inflammation and disease progression, but also to ART-mediated immune recovery.
A study published in the journal EBioMedicine in 2016 sought to clarify how the metabolism of gut bacteria affects immune recovery in people with HIV.
In the study, which included eight healthy controls and 29 people with HIV infection, researchers examined the active fraction of the gut microbiome.
By studying protein synthesis and the accumulation of metabolites in the bloodstream and the gut bacteria, the researchers determined HIV infection appears to trigger changes in the microbiome activity, but does not alter microbial diversity.
Furthermore, ART causes additional microbial reactivity of various subsets of the microbiome.
The nature of this reactivity differs depending on the degree of immune recovery of the individuals such that the effects are heightened in immunological ART responders.
Overall, these findings lead to the idea that ART-induced reduction in inflammation and associated disease progression is the result of the activity of fractions of the gut microbiota and host immunological response.
