Metabolic disease.

BackgroundEffective antiretroviral therapy (ART) has improved the life expectancy of people with HIV (PWH). However, this population is now experiencing accelerated age‐related comorbidities, contributed to by chronic immune activation and inflammation, with dysbiosis of the gut microbiome also implicated.MethodWe conducted a systematic literature search of PubMed, Embase, Scopus, Cochrane reviews and international conference abstracts for articles that examined for the following non-communicable diseases (NCDs); cardiovascular disease, cancer, frailty, metabolic, bone, renal and neurocognitive disease, in PWH aged >18 years. Studies were included that measured gut microbiome diversity and composition, microbial translocation markers or microbial metabolite markers.ResultsIn all, 567 articles were identified and screened of which 87 full‐text articles were assessed for eligibility and 56 were included in the final review. The data suggest a high burden NCD, in particular cardiovascular and metabolic disease in PWH. Alterations in bacterial diversity and structure varied by NCD type, but a general trend in reduced diversity was seen together with alterations in bacterial abundances between different NCD. Lipopolysaccharide was the most commonly investigated marker of microbial translocation across NCD followed by soluble CD14. Short-chain fatty acids, tryptophan and choline metabolites were associated with cardiovascular outcomes and also associated with chronic liver disease (CLD).ConclusionsThis systematic review is the first to summarise the evidence for the association between gut microbiome dysbiosis and NCDs in PWH. Understanding this interaction will provide insights into the pathogenesis of many NCD and help develop novel diagnostic and therapeutic strategies for PWH.背景：有效抗反转录病毒治疗（antiretroviral therapy, ART）已显著提升了人类免疫缺陷病毒感染者（people with HIV, PWH）的预期寿命。然而，该人群正面临加速进展的年龄相关性共病，此类共病由慢性免疫激活与炎症介导，肠道菌群失调亦被证实参与其中。 方法：本研究针对PubMed、Embase、Scopus、Cochrane综述及国际会议摘要开展系统性文献检索，筛选针对18岁以上HIV感染者所患以下非传染性疾病（non-communicable diseases, NCDs）的相关研究：心血管疾病、癌症、衰弱症、代谢性疾病、骨骼疾病、肾脏疾病及神经认知疾病。纳入的研究需检测肠道菌群多样性与组成、微生物易位标志物或微生物代谢物标志物。 结果：本研究共检索并筛选出567篇文献，其中87篇全文本文章接受资格评估，最终56篇被纳入本综述。数据显示，HIV感染者的非传染性疾病负担较重，尤以心血管疾病与代谢性疾病为甚。细菌多样性与结构的改变因非传染性疾病类型而异，但普遍呈现多样性降低的趋势，且不同非传染性疾病间细菌丰度存在差异。脂多糖（lipopolysaccharide）是各类非传染性疾病中研究最广泛的微生物易位标志物，其次为可溶性CD14。短链脂肪酸、色氨酸及胆碱代谢物与心血管结局相关，同时也与慢性肝病（chronic liver disease, CLD）存在关联。 结论：本系统性综述为首篇总结HIV感染者肠道菌群失调与非传染性疾病间关联证据的研究。阐明二者间的相互作用，可为诸多非传染性疾病的发病机制提供新视角，并有助于为HIV感染者开发新型诊断与治疗策略。