Complementary strategies to target residual immune activation and mucosal dysfunction in treated HIV: role of probiotics and pidotimod
Year: 2026
Type: review
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.
Authors: Katia Falasca, Raffaele Ferri, Jacopo Vecchiet
Institution: University of Chieti-Pescara
Language: English
Topic: HIV Research and Treatment
Subfield: Virology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223121830