January 11, 2020
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HIV-related microbiota alterations contribute to metabolic comorbidities

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HIV-related microbiota alterations raise the risk for metabolic syndrome and visceral adipose tissue accumulation, especially among patients with a history of severe immunodeficiency, according to findings published in Clinical Infectious Diseases.

“People living with HIV have increased risk of developing abdominal obesity and metabolic syndrome, even in individuals well-treated with combination antiretroviral therapy, and [regardless] of demographic and lifestyle factors,” Marco Gelpi, MD, of the Viro-Immunology Research Unit at the University of Copenhagen, and colleagues wrote. “While the gut microbiota has been suggested to contribute to cardiometabolic disorders in the uninfected population, the determinants of this association are unclear . . . The potential association between HIV infection and gut microbiota alterations has been investigated in several studies, with conflicting results.”

Gelpi and colleagues conducted the present study aiming to establish an HIV-related microbiota profile, regardless of sexual behavior and other related cofounders, and examine potential connections between the HIV-related microbiota and metabolic comorbidities. The researchers conducted bacterial 16S rRNA analyses on stool samples from 405 patients with HIV and 111 uninfected participants in the Copenhagen Comorbidity in HIV Infection (COCOMO) study. Researchers stratified participants by sexual behaviors, such as men who have sex with men and non-MSM.

After omitting MSM-related microbiota traits and adjusting for confounders, researchers identified an HIV-related microbiota signature that consisted of lower biodiversity, increased relative abundance of the bacterial clades Gammaproteobacteria and Desulfovibrionaceae and a drop in several Clostridia. This microbiota profile correlated with a twofold excess risk for metabolic syndrome, that was driven by an uptick in Desulfovibrionaceae and a decrease in Clostridia. This association was heightened (by a five-fold excess risk) among individuals with previous severe immunodeficiency, which also affected the relationship between HIV-associated microbiota signature and visceral adipose tissue area (p-interaction, .012). As a result, HIV-related microbiota correlated with 30 cm2 larger visceral adipose tissue in participants with a history of severe immunodeficiency but not in those without this history.

“Our findings suggest a potential interplay between microbiota alterations, immune dysfunction and metabolic comorbidities,” Gelpi and colleagues wrote. “Interventions targeting the gut microbiome may be warranted to reduce cardiovascular risk, particularly in individuals with previous immunodeficiency.” – by Caitlyn Stulpin

Disclosures: Gelpi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.