Clinical Scorecard: The Role of the Gut Microbiome in HIV-Related Atherosclerosis: Unraveling a Complex Relationship
At a Glance
Category
Detail
Condition
HIV-associated subclinical atherosclerosis
Key Mechanisms
Gut microbiome composition influences inflammation and immune modulation affecting atherogenesis
Target Population
People with HIV (PWH) on stable antiretroviral therapy with virological suppression
Care Setting
HIV specialty and cardiovascular risk management clinics
Key Highlights
Longitudinal study links changes in gut microbiome genera (Agathobacter, Ruminococcus 2, Prevotella 7) with progression of subclinical atherosclerosis measured by carotid intima-media thickness (cIMT) in PWH.
Increases in SCFA-producing bacteria (Agathobacter and Ruminococcus 2) and decreases in Prevotella 7 were associated with cIMT progression, suggesting complex ecological adaptations rather than direct pathogenic roles.
Findings support the potential of microbiome signatures as biomarkers and therapeutic targets for cardiovascular disease risk stratification in PWH, pending further validation.
Guideline-Based Recommendations
Diagnosis
Consider longitudinal assessment of subclinical atherosclerosis using carotid intima-media thickness (cIMT) in PWH.
Evaluate gut microbiome composition changes as potential biomarkers for cardiovascular risk stratification in research settings.
Management
Maintain stable antiretroviral therapy with virological suppression to reduce HIV-related inflammation.
Explore therapeutic modulation of the gut microbiome as a future strategy to mitigate cardiovascular risk in PWH.
Monitoring & Follow-up
Monitor traditional cardiovascular risk factors alongside emerging microbiome signatures in PWH.
Incorporate multiomics and immunological profiling in research to better understand microbiome-cardiovascular disease interplay.
Risks
Recognize that microbiome changes may reflect compensatory responses rather than direct causative factors in atherosclerosis progression.
Account for potential confounders such as diet and environment when interpreting microbiome data.
Patient & Prescribing Data
Virologically suppressed people with HIV on stable antiretroviral therapy
Current evidence does not support direct microbiome-targeted therapies; however, microbiome modulation holds potential as adjunctive treatment pending further research.
Clinical Best Practices
Use longitudinal and multiomics approaches to evaluate the gut microbiome’s role in cardiovascular risk among PWH.
Integrate cardiovascular risk assessment with HIV management, considering inflammation and immune dysfunction.
Interpret microbiome data cautiously, recognizing ecological adaptations and the need for mechanistic validation.
Support research into microbiome-based biomarkers and therapeutic targets for HIV-associated cardiovascular disease.
