Systematic review finds intestinal microenvironment abnormalities are more severe in HIV immunological non-responders compared to responders.

A systematic review investigated intestinal microenvironment characteristics in people living with HIV (PLWH), distinguishing between immunological non-responders (INRs) and immunological responders. The analysis focused on immunological status as the primary stratification variable, noting that specific study design details, sample sizes, and settings were not reported in the source data. The review aimed to characterize the biological differences associated with varying immunological responses to antiretroviral therapy.

Results indicate that intestinal microenvironment abnormalities are more severe in INRs compared to immunological responders. Specifically, INRs demonstrated persistently low levels of intestinal CD4+ T cells with limited reconstitution. Additionally, a significant reduction in the proportion of Th17 cells was observed in this group. Mucosal anti-infective capacity and immune regulatory function were severely impaired in INRs, alongside elevated levels of pro-inflammatory mediators. The composition of the gut microbiome also differed, showing a marked decrease in beneficial symbiotic bacteria and an expansion of opportunistic pathogens in non-responders.

These physiological changes contributed to intestinal mucosal injury, barrier failure, and microbial community problems that were present in all PLWH but were more severe in INRs. Consequently, the risk of disease progression and complications was higher in this subgroup. The review did not report data on adverse events, serious adverse events, discontinuations, or overall tolerability of the regimens. Furthermore, no specific p-values, confidence intervals, or absolute numbers were provided for the reported outcomes.

The practice relevance of these findings is important for improving the long-term prognosis of patients and advancing individualized treatment strategies. However, the absence of reported sample sizes and specific statistical measures limits the precision of these conclusions. Clinicians should interpret these results as descriptive associations rather than definitive causal evidence, given the lack of reported causality notes and the observational nature of the underlying data.