Nourishing the Gut-Immune Connection: Dietary, Prebiotic, and Probiotic Approaches to Address Chronic Inflammation in HIV Patients Under Antiretroviral Therapy: A Narrative Review

By
Aaron A. Fletcher
Ziad Koberssy
Joviane Daher
Nicolas Moussallem
Grace A. McComsey
July 17, 2026

Frontiers In Immunology

Overview

This narrative review explores the impact of dietary, prebiotic, and probiotic interventions on chronic inflammation in people living with HIV (PWH) undergoing antiretroviral therapy (ART). It highlights the role of gut dysbiosis and microbial translocation in ongoing systemic inflammation despite ART, referencing findings from various studies.

Background

Chronic inflammation in PWH is linked to gut dysbiosis and immune activation, contributing to non-AIDS comorbidities such as cardiovascular disease and metabolic syndrome. Understanding the gut-immune connection is crucial for addressing these health disparities, especially as the population on ART continues to grow. Interventions targeting gut health are discussed in the context of existing literature.

Data Highlights

This review synthesizes findings from randomized controlled trials, mechanistic studies, and systematic reviews regarding nutritional interventions in PWH.

Key Findings

Reduced production of short-chain fatty acids (SCFAs) is associated with morbidity and mortality in PWH, as noted in several studies.
Probiotics, prebiotics, and synbiotics have shown reductions in inflammatory biomarkers such as sCD14 and hsCRP in various trials.
The Mediterranean diet and omega-3 fatty acids may modulate gut microbiota and SCFA production, according to recent research.
Current literature lacks trials with clinically meaningful endpoints and optimal probiotic strains, as highlighted in systematic reviews.
Research is needed on dietary patterns that effectively reduce inflammation in PWH, as indicated by gaps in the current literature.

Clinical Implications

Clinicians managing PWH should consider the role of gut health in chronic inflammation, as supported by the literature. Further research is needed to establish effective dietary interventions.

Conclusion

Addressing gut dysbiosis and systemic inflammation through dietary and microbiome-targeted interventions is discussed in the context of improving health outcomes for PWH on ART, based on current findings.