Evaluation of Six Weekly Oral Fecal Microbiota Transplants in People with HIV

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Netanya Sandler Utay
Ana N. Monczor
Anoma Somasunderam
Sofia Lupo
Zhi-Dong Jiang
Ashley S. Alexander
Malcolm Finkelman
Karen J. Vigil
Jordan E. Lake
Blake Hanson
Herbert L. DuPont
Roberto C. Arduino


Background: Reduced microbiota diversity (dysbiosis) in people with HIV (PWH) likely contributes to inflammation, a driver of morbidity and mortality. We aimed to evaluate the safety and tolerability of 6 weekly oral fecal microbiota transplants (FMT) administered to reverse this dysbiosis.

Methods: Six PWH on suppressive antiretroviral therapy (ART) received 6 weekly doses of lyophilized fecal microbiota product from healthy donors. Shotgun sequencing on stool before, after last FMT, and 20 weeks thereafter was performed. Inflammation and gut permeability biomarkers were measured.

Results: Median age at week 0 was 39 years, CD4+ T cell count 496 cells/mm3, HIV RNA levels <20 copies/mL. FMT was safe and well-tolerated. Alpha diversity increased in 4 participants from weeks 0 to 6, including the 3 with the lowest alpha diversity at week 0. At week 26, alpha diversity more closely resembled week 0 than week 6 in these 4 participants. Metagenomic analysis showed no consistent changes across all participants. One participant had high gut permeability and inflammation biomarker levels and low alpha diversity that improved between weeks 0 and 6 with a shift in distribution.

Conclusions: Weekly FMT was safe and well-tolerated. Alpha diversity increased in participants with the lowest baseline alpha diversity during the treatment period. Future randomized, controlled trials of FMT should consider evaluating PWH with greater inflammation, gut damage, or dysbiosis as this population may be most likely to show a significant response.

ClinicalTrials.gov Identifier: NCT03329560


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Author Biography

Netanya Sandler Utay, Division of General Medicine, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas Kelsey Research Foundation, Houston, Texas

Internal Medicine

Assistant Professor


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