HIV/SARS-CoV-2 co-infection is characterized by heightened microbial translocation and species-specific microbiota alterations rather than global dysbiosis, with Blautia depletion potentially correlating with COVID-19 severity.
Key Findings
Results
Co-infected patients exhibited significantly elevated plasma LPS compared to SARS-CoV-2-negative HIV controls.
Plasma LPS was 78.09 pg/mL in the PC group versus 48.72 pg/mL in the NC group (p=0.032).
LPS elevation indicates increased microbial translocation in co-infected patients.
Blood samples from 38 HIV/AIDS patients were analyzed: 20 SARS-CoV-2 co-infected (PC group) and 18 SARS-CoV-2-negative (NC group).
sCD14 was 2667 ng/mL in the PC group versus 1927 ng/mL in the NC group (p=0.0015).
Elevated sCD14 is a marker of microbial translocation and immune activation.
This difference was more statistically significant than the LPS difference (p=0.0015 vs p=0.032).
Results
No significant differences in alpha-diversity or overall taxonomic abundance were observed between co-infected and HIV-only patients.
Fecal metagenomic profiling was performed via whole-genome shotgun sequencing using Illumina NovaSeq/HiSeq platforms.
The absence of global dysbiosis suggests species-specific rather than broad microbiota alterations characterize co-infection.
Despite similar overall diversity, 329 PC-unique and 216 NC-unique microbial species were identified, indicating compositional differences at the species level.
Results
Nine microbial genera demonstrated diagnostic potential for HIV/SARS-CoV-2 co-infection, with Akkermansia showing the highest predictive value.
Nine genera had an Area Under the Curve (AUC) greater than 0.7 for distinguishing co-infected from non-co-infected patients.
Akkermansia had the highest AUC of 0.811 among the nine genera.
These findings were derived from fecal metagenomic profiling of 38 HIV/AIDS patients.
Results
Blautia abundance was significantly reduced in severe-to-critical COVID-19 cases compared to mild-to-moderate cases and HIV-only controls.
Blautia was significantly lower in severe-to-critical co-infected patients (PC2, n=3) versus mild-to-moderate co-infected patients (PC1, n=13) with p=0.043.
Blautia was also significantly lower in PC2 versus HIV-only controls (NC, p=0.006).
The PC group was stratified by COVID-19 severity: mild-to-moderate (PC1, n=13), severe-to-critical (PC2, n=3), and mixed infections (PC3, n=4).
Results
Functional prediction analysis suggested that SARS-CoV-2 may exacerbate lipid metabolic dysregulation in HIV-infected individuals.
Gut microbiota functional prediction was performed using metagenomic data.
The finding indicates a potential interaction between SARS-CoV-2 co-infection and lipid metabolism pathways mediated through the gut microbiota.
This functional dysregulation was identified as a distinct feature of co-infection beyond taxonomic changes.
Methods
Serum zonulin levels were measured as a marker of gut barrier integrity in co-infected and control patients.
Zonulin was measured alongside LPS and sCD14 to assess gut barrier integrity and microbial translocation.
The cohort included blood and fecal samples from 38 HIV/AIDS patients (20 co-infected, 18 SARS-CoV-2-negative).
Zonulin is a marker of intestinal permeability; specific quantitative results for zonulin are not reported in the abstract.
Yan X, Zhang X, Wang L, Song W, Qi T, Wang Z, et al.. (2026). Gut microbiota alterations and microbial translocation in HIV/SARS-CoV-2 co-infected patients.. Frontiers in cellular and infection microbiology. https://doi.org/10.3389/fcimb.2026.1688580