How can the gut microbiota affect immune recovery in HIV-infected individuals?

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The explosion of the microbiome field has shaken our understanding of the pathogenesis of a number of conditions, including HIV disease, in which participation of intestinal bacteria in the course of the disease was far from being suspected. The increasingly appreciated implications in human physiology, including nutrition, metabolism and immunity have open new avenues also in HIV research. Persistence of immune defects, such as sustained activation of the innate and adaptive immunity, during otherwise effective antiretroviral therapy (ART) remains an important clinical challenge, since it contributes to an increased risk of mortality and no therapeutic strategy to date has proved ability to fully reverse these defects. Given the ability of the microbiota to instruct the immune system and control the inflammatory response, expectations about the potential usefulness of targeting the microbiota with interventions to improve the immune recovery and dampen inflammation during HIV infection are high.

Recent works have underlined that HIV-infected individuals harbor a distinct microbiota – the so-called HIV-associated dysbiosis. The ongoing hypothesis that some bacteria might evolve in response to HIV infection to help controlling disease progression begins to take shape. In this line, there is emerging consensus that disturbances in the gut microbial ecology during HIV infection correlate with chronic immune defects and inflammation [1]. For example, microbial diversity in feces of HIV-infected patients seems to inversely correlate with biomarkers of microbial translocation and monocyte activation [2], and changes in mucosa-associated bacteria correlate with inflammation and T-cell activation [3,4].

Click here to read the full article in Future Microbiology.

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