Clinical Scorecard: Links Among Gut Microbiota, Inflammatory Responses, and Cardiovascular Health in Individuals Living with HIV
At a Glance
Category
Detail
Condition
Chronic HIV infection with associated inflammation and cardiovascular disease risk
Key Mechanisms
Gut microbiota alterations leading to systemic inflammation, immune activation, and subclinical coronary artery disease
Target Population
People living with HIV aged >40 years without known cardiovascular disease
Care Setting
Infectious diseases clinics and cardiovascular risk assessment settings
Key Highlights
People with HIV exhibit altered gut microbiome diversity and composition linked to inflammation and subclinical coronary artery disease.
Depletion of butyrate-producing bacteria correlates with immune activation, microbial translocation, and increased cardiovascular risk in HIV.
Specific gut bacterial species (e.g., Bifidobacterium pseudocatenulatum) correlate with lower plaque burden, while others (e.g., Ruminococcus bromii) correlate with higher plaque burden.
Guideline-Based Recommendations
Diagnosis
Assess subclinical cardiovascular disease in people with HIV using coronary computed tomography angiography (CCTA).
Measure inflammatory and microbial translocation biomarkers such as hsCRP, interleukin 6, D-dimer, CD40 ligand, and intestinal fatty acid–binding protein (I-FABP).
Evaluate gut microbiome composition via stool 16S rRNA sequencing to identify dysbiosis patterns.
Management
Consider interventions targeting gut microbiota to reduce systemic inflammation and cardiovascular risk in HIV.
Address traditional cardiovascular risk factors alongside monitoring of inflammatory markers in people with HIV.
Promote dietary modifications to support beneficial gut bacteria, including increasing fiber intake to enhance short chain fatty acid production.
Monitoring & Follow-up
Regularly monitor cardiovascular risk markers and inflammatory biomarkers in people with HIV on antiretroviral therapy.
Track changes in gut microbiota composition in relation to inflammation and cardiovascular outcomes.
Risks
Persistent gut dysbiosis and microbial translocation contribute to chronic inflammation and increased cardiovascular disease risk despite effective ART.
Traditional cardiovascular risk factors do not fully explain elevated CVD risk in HIV; gut microbiome alterations are an additional risk factor.
Patient & Prescribing Data
People living with HIV aged over 40 years without known cardiovascular disease
Antiretroviral therapy alone has limited impact on cardiovascular risk; addressing gut microbiota and inflammation may provide additional therapeutic benefit.
Clinical Best Practices
Incorporate cardiovascular risk assessment including imaging and biomarker evaluation in routine care of people with HIV.
Integrate gut microbiome analysis to identify patients at higher risk of inflammation-driven cardiovascular disease.
Encourage dietary and lifestyle interventions that promote gut microbial health and reduce systemic inflammation.
Use a multidisciplinary approach combining infectious disease, cardiology, and nutrition expertise to manage cardiovascular risk in HIV.
by Rachel MacCann, Junhui Li, Alejandro Abner Garcia Leon, Riya Negi, Dana Alalwan, Willard Tinago, Padraig McGettrick, Aoife G Cotter, Alan Landay, Caroline Sabin, Paul W O’Toole, Patrick W G Mallon, for the Understanding the Pathology of Comorbid Disease in HIV-Infected Individuals (HIV UPBEAT) Study Group, Padraig McGettrick, Elena Alvarez Barco, Willard Tinago, Alejandro Garcia Leon, Aoife McDermott, Tara McGinty, Aoife G Cotter, Alan Macken, Patrick W G Mallon, Eoin Kavanagh, Geraldine McCarthy, Gerard Sheehan, John Lambert, William Powderly, Juliet Compston, Caroline Sabin
