# Intestinal microecology: a crucial factor influencing incomplete immune reconstitution after antiretroviral therapy in people living with HIV-1

## TL;DR

The intestinal microbiome may play a key role in why some HIV patients don't fully recover their immune systems after treatment.

## Contribution

This review highlights novel mechanisms linking gut microecology to immune reconstitution failure in HIV patients and proposes new therapeutic strategies.

## Key findings

- Intestinal microecology influences immune reconstitution through microbiota changes and mucosal barrier damage.
- Fecal microbiota transplantation and probiotics are proposed as potential interventions for incomplete immune reconstitution.
- Personalized therapeutic strategies based on gut microecology could improve outcomes for people living with HIV-1.

## Abstract

Some people living with HIV-1 (PLWH) experience insufficient increases in CD4 + T cell counts after antiretroviral therapy (ART), a clinical manifestation referred to as incomplete immune reconstitution (INR). INR significantly increases in the incidence of AIDS and non-AIDS events and profoundly affects the life expectancy and quality of life of PLWH. Recent studies have indicated that intestinal microecology plays a crucial role in immune reconstitution through multiple pathways. This review summarizes several mechanisms through which intestinal microecology contributes to impaired immune reconstitution in PLWH, including changes in microbiota composition, variations in intestinal metabolic products, and damage to the intestinal mucosal barrier. Additionally, intervention strategies such as fecal microbiota transplantation, probiotics, and traditional Chinese medicine are proposed. These innovative therapeutic approaches hold promise for overcoming the limitations of conventional treatments, providing clinicians with a scientific basis for personalized therapeutic strategies and researchers with theoretical guidance for exploring novel mechanisms and research methods. Ultimately, these efforts aim to improve the prognosis and quality of life for PLWH and reduce the global public health burden posed by HIV-1 infection.