Decreased intestinal abundance of <i>Akkermansia muciniphila</i> is associated with metabolic disorders among people living with HIV

Previous studies have shown changes in gut microbiota after human immunodeficiency virus (HIV) infection, but there is limited research linking the gut microbiota of people living with HIV (PLWHIV) to metabolic diseases. A total of 103 PLWHIV were followed for 48 weeks of anti-retroviral therapy (ART), with demographic and clinical data collected. Gut microbiome analysis was conducted using metagenomic sequencing of fecal samples from 12 individuals. Nonalcoholic fatty liver disease (NAFLD) was diagnosed based on controlled attenuation parameter (CAP) values of 238 dB/m from liver fibro-scans. Participants were divided based on the presence of metabolic disorders, including NAFLD, overweight, and hyperlipidemia. <i>Akkermansia</i> abundance in stool samples was measured using RT-qPCR, and Pearson correlation and logistic regression were applied for analysis. Metagenomic sequencing revealed a significant decline in gut <i>Akkermansia</i> abundance in PLWHIV with NAFLD. STAMP analysis of public datasets confirmed this decline after HIV infection, while KEGG pathway analysis identified enrichment of metabolism-related genes. A prospective cohort study with 103 PLWHIV followed for 48 weeks validated these findings. <i>Akkermansia</i> abundance was significantly lower in participants with NAFLD, overweight, and hyperlipidemia at baseline, and it emerged as an independent predictor of NAFLD and overweight. Negative correlations were observed between <i>Akkermansia</i> abundance and both CAP values and body mass index (BMI) at baseline and at week 48. At the 48-week follow-up, <i>Akkermansia</i> remained a predictive marker for NAFLD. <i>Akkermansia</i> abundance was reduced in PLWHIV with metabolic disorders and served as a predictive biomarker for NAFLD progression over 48 weeks of ART.