Gut microbiota of sub-Saharan Africa infants exposed to antiretroviral therapy: Scoping review

Abstract

Background Antiretroviral (ARV) exposure influences the early-life gut microbiota in regions with high human immunodeficiency virus (HIV) burdens. Understanding how ARV drugs affect the infant gut microbiota is important for optimising short-term and long-term health outcomes.

Aim This scoping review synthesises current evidence on the gut microbiota of infants born to mothers with HIV (MWH) in sub-Saharan Africa, focusing on the effects of in utero and postnatal ARV exposure. By examining emerging data in this context, we highlight potential implications for infant health and identify key areas for future research.

Method Online databases were systematically searched using comprehensive search strategies. In addition, grey literature was explored. Three authors independently screened titles and abstracts for relevance, evaluated full-text articles for eligibility and performed data extraction.

Results The scoping review highlights differences in gut microbiota because of HIV exposure and ARV drugs in infants born to sub-Saharan African MWH. Of interest is a disturbance in the gut bacterial balance in infants with HIV, who harboured enriched with more diverse and potentially harmful bacteria relative to HIV-exposed uninfected infants. There was agreement from some countries, that is Nigeria and Zimbabwe, that their gut microbiota genomes comprise Bifidobacterium longum subspecies infantis and Enterococcus.

Conclusion Both antiretroviral therapy and HIV influence the gut microbiota in infants born to MWH. Pathogenic overgrowth within the infant gut microbiota for individuals with HIV may impair immune maturation during early-life, with lasting consequences for host health.

Contribution This highlights the need for further research into probiotic interventions for infants in high HIV-burden settings.