Untangling the role of the microbiome across the stages of HIV disease

Abstract

Purpose of review: The primate microbiome consists of bacteria, eukaryotes, and viruses that dynamically shape and respond to host health and disease. Understanding how the symbiotic relationship between the host and microbiome responds to HIV has implications for therapeutic design.

Recent findings: Advances in microbiome identification technologies have expanded our ability to identify constituents of the microbiome and to infer their functional capacity. The dual use of these technologies and animal models has allowed interrogation into the role of the microbiome in lentiviral acquisition, vaccine efficacy, and the response to antiretrovirals. Lessons learned from such studies are now being harnessed to design microbiome-based interventions.

Summary: Previous studies considering the role of the microbiome in people living with HIV largely described viral acquisition as an intrusion on the host:microbiome interface. Re-framing this view to consider HIV as a novel, albeit unwelcome, component of the microbiome may better inform the research and development of pre and postexposure prophylaxes.

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FIGURE 1

The primate microbiome is a diverse community of bacterial, eukaryotic, and viral constituents residing in the gastrointestinal lumen (as shown) and other external interfaces. Antigenic and metabolic stimulation by the microbiome may prime vaccine outcomes, alter susceptibility to lentiviral acquisition, modulate lentiviral disease progression, and fluctuate during postexposure prophylaxes. These interventions and disease states may also alter homeostasis of the healthy microbiome. A detailed understanding of the mechanisms underpinning these dynamic relationships will inform novel, improved therapeutic interventions. 1. Corley MJ, Sacdalan C, Pang APS, et al. Abrupt and altered cell-type specific DNA methylation profiles in blood during acute HIV infection persists despite prompt initiation of ART. PLoS Pathog 2021;17:e1009785.