Gut Microbiome Signatures Linked to Atherosclerosis Progression in HIV Patients

Overview

A longitudinal study by Masiá et al identified distinct gut microbiome changes associated with subclinical atherosclerosis progression in people with HIV (PWH) on stable antiretroviral therapy. Notably, increases in Agathobacter and Ruminococcus 2 and decreases in Prevotella 7 correlated with carotid intima-media thickness progression independent of traditional cardiovascular risk factors.

Background

The gut microbiome plays a critical role in modulating immunity and metabolism, influencing atherogenesis. In PWH, cardiovascular disease risk is elevated, but the contribution of gut microbiota to atherosclerosis progression remains unclear. Prior studies were limited by cross-sectional designs and small cohorts. This study provides the first longitudinal analysis linking gut microbial dynamics with subclinical atherosclerosis in virologically suppressed PWH.

Data Highlights

Key Findings

• Longitudinal increases in Agathobacter and Ruminococcus 2 genera correlated with progression of subclinical atherosclerosis measured by carotid intima-media thickness (cIMT).
• Prevotella 7 was enriched in participants without cIMT progression, despite its known association with cardiovascular risk in the general population.
• Associations persisted after adjusting for confounders including age, sex, BMI, hypertension, dyslipidemia, smoking, sexual behavior, and nadir CD4 count.
• Agathobacter and Ruminococcus 2 are SCFA-producing bacteria, typically considered beneficial for gut and immune health, making their increase in cIMT progression unexpected.
• The observed microbiome changes may represent compensatory ecological adaptations to counteract inflammation rather than direct drivers of atherosclerosis.
• Further research integrating metabolomics and immunological profiling is needed to clarify causal mechanisms and therapeutic potential.

Clinical Implications

These findings suggest that gut microbiome composition may serve as a biomarker for cardiovascular risk stratification in PWH. Clinicians should consider the complex interplay between microbiota and inflammation when evaluating cardiovascular risk. Targeting the microbiome therapeutically could emerge as a novel strategy to mitigate atherosclerosis progression in this population.

Conclusion

The study highlights distinct gut microbiome signatures associated with subclinical atherosclerosis progression in PWH, underscoring the microbiome’s potential prognostic and therapeutic roles. Validation and mechanistic studies are essential to translate these insights into clinical practice.

References

1. Masiá et al 2024 -- Longitudinal Study of Gut Microbiome and Atherosclerosis in PWH
2. General Microbiome and Atherosclerosis Reviews