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Gut Microbes. 2017 Sep 3;8(5):440-450. doi: 10.1080/19490976.2017.1334034. Epub 2017 May 25.

Limited engraftment of donor microbiome via one-time fecal microbial transplantation in treated HIV-infected individuals.

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a Division of Experimental Medicine , University of California , San Francisco, San Francisco , CA , United States.
b Division of HIV, AIDS, and Global Medicine , University of California , San Francisco, San Francisco , CA , United States.
c Division of Gastroenterology , University of California , San Francisco, San Francisco , CA , United States.


Many HIV-infected individuals on antiretroviral therapy (ART) exhibit persistent systemic inflammation, which predicts morbidity and mortality. ART-treated subjects concurrently exhibit marked compositional alterations in the gut bacterial microbiota and the degree of dysbiosis correlates with systemic inflammation. Whether interventions to modulate the microbiome can affect systemic inflammation is unknown. An open-label fecal microbial transplantation (FMT) was delivered by colonoscopy to asymptomatic HIV-infected ART-suppressed individuals without antibiotic pre-treatment. Stool was assessed before and after FMT for engraftment of donor microbes, and peripheral blood was assayed for immune activation biomarkers. Six participants received FMT and 2 participants served as controls. No serious adverse effects occurred during 24 weeks of follow-up. At baseline, HIV-infected individuals exhibited microbiota profiles distinct from uninfected donors. During the 8 weeks post-FMT, recipients demonstrated partial engraftment of the donor microbiome (P < 0.05). Recipient microbiota remained significantly distant from donors, unlike that observed following FMT for treatment of C. difficile infection. Systemic inflammatory markers showed no significant change post-FMT. FMT was well-tolerated in ART-treated, HIV-infected individuals. Engraftment was detectable but modest, and appeared to be limited to specific bacterial taxa. Whether antibiotic conditioning can enhance engraftment and the capacity of microbiota to modulate inflammation remains to be investigated.


HIV; Microbiota; engraftment; fecal microbiome transplant; fecal transplant; inflammation; microbiome engraftment

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