Examining HIV-associated symptom burden and microbial translocation in the Veterans Aging Cohort Study: A secondary data analysis

The pathophysiological effects of HIV infection, including inflammation, contribute to symptom burden and poor clinical outcomes. Within the gut associated lymph tissue, immune activation leads to dysfunction of the gastrointestinal epithelial barrier and subsequent movement of microbial products from the gut into the blood. The translocation of microbial products from the gut into the blood circulation has been identified as a key contributor to HIV disease progression and chronic inflammation. Chronic inflammation has been associated with various symptoms including symptoms commonly reported in HIV disease. However, it is unknown if these symptoms are associated with inflammation related to microbial translocation. The inflammatory effects of HIV infection on the gastrointestinal epithelial barrier and circulating microbial products may be associated with symptoms of the gastrointestinal tract and systemic symptoms in general.

The summation of symptoms or symptom burden has been associated with poor adherence to HIV medications. However, it is unknown whether symptom presence can support the identification of epithelial barrier dysfunction or chronic microbial translocation. Furthermore, it is unknown if interventions targeted toward reducing microbial translocation could possibly reduce or prevent symptom burden and thus improve outcomes. The results of this study are intended to contribute to identifying possible strategies aimed at decreasing health disparities among people living with HIV.

Data from the Veterans Aging Cohort Study provides a unique opportunity to retrospectively examine the relationship among microbial translocation, inflammation, and symptoms among people on HIV antiretroviral therapy. As a first step of developing strategies to heal gastrointestinal epithelial barrier dysfunction and reduce microbial translocation, the aim of this study is to evaluate whether there is an association between gastrointestinal barrier dysfunction and symptoms, as well as, whether the microbial translocation is associated with symptoms. A secondary aim is to identify if there is an association between specific symptoms or symptom clusters within the context of microbial translocation.

Keywords: microbial translocation, symptoms, inflammation, HIV, adherence, retrospective analysis, gastrointestinal, epithelial barrier dysfunction