Longitudinal effects of antiretroviral therapy on the oral microbiota in people living with HIV: A systematic review.
Handayani Ali, Irene Edith Rieuwpassa, Nurlindah Hamrun et al.
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In 30 seconds
This systematic review assessed longitudinal changes in oral microbiota before and after antiretroviral therapy (ART) initiation in people living with HIV. Six eligible human studies used 16S rRNA sequencing or metagenomic methods; substantial heterogeneity meant results were synthesized narratively. ART was associated with partial, non-uniform microbiota changes: beta diversity and selected taxa commonly shifted, while alpha-diversity findings were inconsistent. Several dominant oral genera remained stable, and evidence connecting microbiota changes to immune recovery was limited. Overall, the findings did not show consistent normalization toward a non-HIV microbial profile.
Key findings
- Six longitudinal studies met the review’s inclusion criteria.
- Changes in beta diversity and selective taxonomic shifts were commonly reported after ART initiation.
- Alpha-diversity changes were inconsistent, and several dominant oral genera remained stable.
- Evidence linking oral microbiota changes with immune recovery was limited.
Why it matters
The review suggests that viral suppression and immune recovery do not necessarily correspond to uniform restoration of the oral microbial community. Persistent or variable microbial changes may be relevant to understanding oral disease burden in people living with HIV. The findings support attention to oral health as part of long-term HIV care, while highlighting that the microbiota evidence remains heterogeneous.
What to keep in mind
Only six longitudinal studies were included, and substantial heterogeneity required narrative synthesis. Evidence linking microbiota changes with immune recovery was limited.