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HIV status and ART exposure associated with altered skin microbiome diversity and composition in IndonesiaDoes HIV change the bacteria living on your skin, and does treatment help?

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Key Takeaway
Note that HIV status and ART exposure are independently associated with skin microbiome composition, though clinical implications remain unclear.

This prospective observational study evaluated skin microbiome composition among 244 participants in Indonesia. The population included people living with HIV, HIV-ART-naïve individuals, and HIV-negative controls. The primary outcome assessed alpha diversity, community structure, and differential abundance of skin microbiota. Secondary outcomes included clinical, demographic, behavioral, anatomical factors, body mass index, and skincare habits.

Results indicated that alpha diversity was significantly reduced in both HIV groups compared with HIV-negative controls. Community composition differed by HIV status. The microbiome was dominated by Corynebacterium, Cutibacterium, Staphylococcus, and Streptococcus. Differential abundance analysis showed increased Staphylococcus and reduced Streptococcus in ART-naïve individuals versus controls. ART exposure resulted in partial attenuation of these deviations. HIV-associated differences were observed within both sebaceous and dry sites. HIV status remained independently associated with microbiome composition after adjustment for multiple factors. Notably, sampling site explained a larger proportion of variation than HIV status.

Safety and tolerability data were not reported, as adverse events, serious adverse events, discontinuations, and tolerability were not reported. The study design is a prospective observational study; associations were reported, and causality was not established. Limitations include that the impact on skin microbiome and modifying effect of ART remain incompletely defined. Longitudinal studies integrating functional profiling and host markers of cutaneous barrier integrity and inflammation are needed to clarify clinical implications. Functional profiling and host markers were not yet integrated in this analysis.

Your skin is covered in tiny bacteria that protect you from germs. But what happens when your immune system is fighting HIV? A new look at skin samples from 244 people in Indonesia shows that those with HIV have fewer types of skin bacteria compared to healthy controls. This difference was seen whether the person was taking HIV medication or not, though the medicine did help bring the bacterial levels closer to normal.

The study looked at people living with HIV, those not yet on treatment, and HIV-negative controls. It found that where the sample was taken on the body mattered more than the HIV status itself. However, even after accounting for location and other factors, having HIV still changed the mix of bacteria found on the skin. The most common bacteria were the usual suspects like Staphylococcus and Streptococcus, but their numbers shifted depending on HIV status and medication use.

This is important because it suggests HIV itself alters the skin's microbial environment. Yet, we must be careful not to jump to conclusions. This was an observational study, meaning it shows connections but does not prove that HIV directly causes these changes. Scientists say we need longer studies that track changes over time to truly understand how these bacteria affect skin health and how best to treat them.

What this means for you:
HIV changes skin bacteria, but treatment helps restore balance; more study is needed.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
IntroductionThe skin microbiome plays a key role in cutaneous immunity and is shaped by host immune status. HIV infection is associated with immune dysfunction and dermatological disease, yet its impact on the skin microbiome and the modifying effect of antiretroviral therapy (ART) remain incompletely defined. This prospective observational study conducted in Indonesia aimed to characterize differences in skin microbiome composition across HIV status and ART exposure and relate these profiles to clinical parameters.MethodsSkin swabs were obtained from sebaceous (posterior neck) and dry (dorsal forearm) sites in HIV-ART-naïve individuals, people living with HIV on ART, and HIV-negative controls, and analyzed using 16S rRNA gene sequencing. Microbial diversity and community structure were assessed using Bray–Curtis dissimilarity, PERMANOVA, and differential abundance testing with ANCOM-BC2, with multivariable models adjusting for demographic, clinical, behavioral, and anatomical factors and subgroup analyses by body mass index, skincare habits, and sampling site.ResultsIn total, 488 samples from 244 participants were analyzed. Both HIV groups showed significantly reduced alpha diversity compared with controls, and overall community composition differed by HIV status, although sampling site explained a larger proportion of variation. Across groups, the microbiome was dominated by Corynebacterium, Cutibacterium, Staphylococcus, and Streptococcus. Differential abundance analyses indicated targeted genus-level shifts rather than global dysbiosis, with ART-naïve individuals showing the most consistent deviations, including increased Staphylococcus and reduced Streptococcus relative to controls, and partial attenuation among participants receiving ART. HIV-associated differences were observed within both sebaceous and dry sites, and HIV status remained independently associated with microbiome composition after adjustment.ConclusionsThese findings suggest that HIV infection is associated with subtle but consistent alterations in the skin microbiome within the context of strong site-specific skin microenvironments. Longitudinal studies integrating functional profiling and host markers of cutaneous barrier integrity and inflammation are needed to clarify their clinical implications.
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