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

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.