Altered intestinal permeability and fungal translocation in Ugandan children with HIV

BACKGROUND: Children with perinatally acquired HIV (PHIVs) face a lifelong cumulative exposure to HIV and ART. The relationship between gut integrity, microbial translocation and inflammation in PHIV is poorly understood. METHODS: This is a cross-sectional study in 57 PHIVs, 59 HIV exposed uninfected (HEUs) and 56 HIV unexposed uninfected (HIV-) children aged 2-10 years old in Uganda. PHIVs were on stable ART with HIV-1 RNA 0.05). Among PHIVs who were breastfed, levels of sCD163 and IL6 were higher than levels in PHIV who were not breastfed (p<0.05). Additionally, in PHIVs with a history of breastfeeding, sCD14, BDG, LBP, zonulin and I-FABP correlated with several markers of systemic inflammation including hsCRP, IL6, d-dimer, sTNFRI and II (p≤0.05). CONCLUSION: Despite viral suppression, PHIVs have evidence of altered gut permeability and fungal translocation. Intestinal damage and the resultant bacterial and fungal translocation in PHIVs may play a role in the persistent inflammation that leads to many end organ diseases in adults.