Clinical Scorecard: Unique Gut Microbiota Profiles Linked to Atherosclerosis Progression in Individuals with HIV

At a Glance

Key Highlights

• Atherosclerosis progression in PWH is linked to specific gut microbiota profiles, notably increased Agathobacter and Ruminococcus 2 and decreased Prevotella 7.
• Gut microbiota composition differs significantly between PWH with and without carotid intima-media thickness (cIMT) progression over 96 weeks.
• Longitudinal microbiome analysis is essential due to intraindividual variability and dynamic changes in gut microbial communities.

Guideline-Based Recommendations

Diagnosis

• Use carotid intima-media thickness (cIMT) measurement via B-mode ultrasonography to monitor subclinical atherosclerosis progression in PWH.
• Collect stool samples for gut microbiota profiling using 16S rRNA sequencing to identify microbial signatures associated with disease progression.

Management

• Maintain virologic suppression with non-protease inhibitor-based ART regimens to minimize cardiovascular risk confounding.
• Consider monitoring and potentially modulating gut microbiota as part of cardiovascular risk management in PWH, pending further evidence.

Monitoring & Follow-up

• Perform serial cIMT measurements at baseline, 48 weeks, and 96 weeks to assess atherosclerosis progression.
• Repeat gut microbiota profiling longitudinally to capture dynamic changes and their association with cardiovascular outcomes.

Risks

• Protease inhibitor-based ART regimens may increase cardiovascular risk and confound atherosclerosis progression assessments.
• Antibiotic use within 90 days before stool sampling can alter gut microbiota composition and should be avoided prior to sample collection.

Patient & Prescribing Data

Virologically suppressed adults with HIV on non-protease inhibitor ART

Exclusion of protease inhibitors from ART regimens reduces confounding cardiovascular risk; stable viral suppression is critical for study validity.

Clinical Best Practices

• Exclude patients with known cardiovascular disease and recent antibiotic use when assessing gut microbiota and atherosclerosis progression.
• Use standardized ultrasonography protocols and a single trained ultrasonographer to ensure consistency in cIMT measurements.
• Adjust microbiome analyses for traditional cardiovascular risk factors, sexual behavior (MSM status), and nadir CD4 count to control confounders.

References

• Editorial Commentary by Serrano-Villar and Martínez
• HIV-associated cardiovascular disease burden and risk