Complementary strategies to target residual immune activation and mucosal dysfunction in treated HIV: role of probiotics and pidotimod
- 1Clinic of Infectious Diseases, Department of Medicine and Science of Aging, G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
Abstract
Alterations in the microbiota, loss of mucosal barrier integrity, and persistent immune activation are important determinants of susceptibility to infections and, in people with HIV receiving effective antiretroviral therapy, of non-AIDS comorbidities. This narrative mini-review examines two mechanistically distinct interventions within a shared translational hypothesis: strain-specific probiotics may act upstream by modifying the intestinal ecosystem and barrier function, whereas pidotimod may modulate downstream innate and mucosal immune responses. Evidence for probiotics in HIV remains heterogeneous across strains, formulations, doses, treatment duration, ART status, and endpoints. Pidotimod has shown immunological and clinical signals in small adult studies of community-acquired pneumonia and COVID-19, while HIV-specific evidence is currently limited to pilot study. These findings support further hypothesis-driven investigation but do not establish either a generalized probiotic class effect or pidotimod as a therapy for residual immune activation in treated HIV. Future randomized studies should separate validated clinical endpoints from exploratory biomarkers and evaluate safety, interactions, and patient subgroups prospectively.
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BibTeX
@article{falasca2026complementary,
title = {{Complementary strategies to target residual immune activation and mucosal dysfunction in treated HIV: role of probiotics and pidotimod}},
author = {Katia Falasca and Raffaele Ferri and Jacopo Vecchiet},
journal = {Frontiers in Cellular and Infection Microbiology},
year = {2026},
month = oct,
doi = {10.3389/fcimb.2026.1985254},
url = {https://doi.org/10.3389/fcimb.2026.1985254},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Complementary strategies to target residual immune activation and mucosal dysfunction in treated HIV: role of probiotics and pidotimod
AU - Katia Falasca
AU - Raffaele Ferri
AU - Jacopo Vecchiet
PY - 2026
DA - 2026/10/21
JO - Frontiers in Cellular and Infection Microbiology
DO - 10.3389/fcimb.2026.1985254
UR - https://doi.org/10.3389/fcimb.2026.1985254
AB - Alterations in the microbiota, loss of mucosal barrier integrity, and persistent immune activation are important determinants of susceptibility to infections and, in people with HIV receiving effective antiretroviral therapy, of non-AIDS comorbidities. This narrative mini-review examines two mechanistically distinct interventions within a shared translational hypothesis: strain-specific probiotics may act upstream by modifying the intestinal ecosystem and barrier function, whereas pidotimod may modulate downstream innate and mucosal immune responses. Evidence for probiotics in HIV remains heterogeneous across strains, formulations, doses, treatment duration, ART status, and endpoints. Pidotimod has shown immunological and clinical signals in small adult studies of community-acquired pneumonia and COVID-19, while HIV-specific evidence is currently limited to pilot study. These findings support further hypothesis-driven investigation but do not establish either a generalized probiotic class effect or pidotimod as a therapy for residual immune activation in treated HIV. Future randomized studies should separate validated clinical endpoints from exploratory biomarkers and evaluate safety, interactions, and patient subgroups prospectively.
SN - 2235-2988
ER -