Our gut does much more than digest food. It supports our immune system, helps regulate metabolism and may influence inflammation throughout the body. As more of us live longer with HIV, researchers are asking whether looking after our gut could also support healthier ageing.
The gut microbiome is the community of trillions of bacteria, fungi and viruses living in our digestive system. A healthy and diverse microbiome helps break down food, absorb nutrients and protect against disease. It is shaped by many things, including diet, age, medications, exercise, stress and sleep.
HIV can affect the gut in particular ways. Early in infection, HIV can damage immune tissue in the gut and weaken the intestinal barrier. This may allow bacterial products to pass into the bloodstream—a process called microbial translocation—which can contribute to ongoing inflammation. While effective HIV treatment greatly improves health, some gut disruption and inflammation may persist even when HIV is well controlled.
This matters because long-term inflammation is associated with health conditions that become more common as we age, including cardiovascular disease, diabetes, frailty and changes in cognition. Researchers are now exploring how diet, the microbiome and gut inflammation may be connected to biological ageing and these age-related conditions in people living with HIV.
At Positive Life NSW’s In the Know Research and Treatments Evening 23 May 2025, Dr Nila Dharan discussed research into HIV, inflammation and clonal haematopoiesis, an age-related change in blood-forming cells. Research has found clonal haematopoiesis to be more common among people living with HIV and associated with inflammation, frailty and reduced quality of life. Emerging findings suggest gut health may be one part of this complex picture, but more research is needed.
What can we do now? Supporting general gut health does not require expensive products. Eating a varied, balanced diet, staying hydrated, exercising regularly, getting enough sleep and managing stress can all help. If you are considering probiotics, prebiotics or other supplements, speak with your HIV doctor, pharmacist or dietitian, as the evidence varies and products may not be suitable for everyone.
