Therapeutic avenues for restoring the gut microbiome in HIV infection

• Published in: Current opinion in pharmacology Vol. 54; pp. 188 - 201
• Main Authors: Rosel-Pech, Cecilia, Chávez-Torres, Monserrat, Bekker-Méndez, Vilma Carolina, Pinto-Cardoso, Sandra
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2020
• ISSN: 1471-4892; 1471-4973
• DOI: 10.1016/j.coph.2020.09.010

•The gut microbiota is profoundly altered in human immunodeficiency virus (HIV) infection.•HIV dysbiosis is defined by an increase in deleterious taxa, a decrease in beneficial taxa and their metabolic end-products.•Microbiome-based therapeutics for restoring the gut microbiota in HIV infection are discussed here.•Fecal microbial transplantation proved safe, with mild engraftment of donor microbiota but no effect on systemic activation. The interplay between the gut microbiota, the intestinal barrier and the mucosal immune system is profoundly altered in Human Immunodeficiency Virus (HIV) infection. An HIV-associated microbial dysbiotic signature has been difficult to define due to the strong impact of confounders that are intimately linked with HIV infection, namely HIV risk behaviors. When controlling for sexual preference and gender, HIV-associated microbial dysbiotic signatures are characterized by an increase in deleterious taxa and a decrease in beneficial bacteria and their respective metabolic end-products. First attempts to restore the gut microbiota of HIV subjects on Antiretroviral Therapy using Fecal Microbiota Transplantation proved to be safe and reported mild transient engraftment of donor microbiota and no effect on markers of HIV disease progression. This review focuses on the current evidence supporting a role for microbial dysbiosis in HIV pathogenesis, and reviews current microbiome-based therapeutics for restoring the gut microbiota in HIV infection.