Lights and Shadows of Microbiota Modulation and Cardiovascular Risk in HIV Patients

Abstract

Human immunodeficiency virus (HIV) infection is associated with premature aging and the development of aging-related comorbidities, such as cardiovascular disease (CVD). Gut microbiota (GM) disturbance is involved in these comorbidities and there is currently interest in strategies focused on modulating GM composition and/or functionality. Scientific evidence based on well-designed clinical trials is needed to support the use of prebiotics, probiotics, symbiotics, and fecal transplantation (FT) to modify the GM and reduce the incidence of CVD in HIV-infected patients. We reviewed the data obtained from three clinical trials focused on prebiotics, 25 trials using probiotics, six using symbiotics, and four using FT. None of the trials investigated whether these compounds could reduce CVD in HIV patients. The huge variability observed in the type of compound as well as the dose and duration of administration makes it difficult to adopt general recommendations and raise serious questions about their application in clinical practice.

Keywords: HIV infection; cardiovascular risk; fecal transplantation; gut microbiota; prebiotics; probiotics; symbiotics.

Figure 1

Under normal physiological conditions, microorganisms in the intestinal lumen interact with intestinal cells in a state of symbiosis; however, when HIV infection occurs, depletion of CD4⁺ T lymphocytes occurs in the gut-associated lymphoid tissue. This is accompanied by rupturing of the epithelial barrier, which triggers alterations in the intestinal lumen as well as the composition of the microbiota (at least at the bacterial level) [18]. This dysbiosis favors the passage of microorganisms and their components to the lamina propria and, therefore, to the circulation, which is known as bacterial translocation (BT), leading to subsequent intestinal and systemic inflammation [19]. (A) Gut homeostasis. (B) Gut dysbiosis after HIV infection. Modified from Pérez-Matute P et al. [22].

Figure 2

Flow chart of the study selection concerning the effects of prebiotics, probiotics, and symbiotics in HIV-infected people.