Key result
People with well-controlled HIV had shorter gastric emptying and longer small bowel and colonic transit times than controls, and those with small bowel transit >6 hours were more likely to have SIBO.
Why the study?
It was unknown whether autonomic neuropathy contributes to chronic systemic inflammation in people with HIV by altering gastrointestinal motility.
Are gastrointestinal motility and autonomic function altered in people with well-controlled HIV compared to controls?
Cross-Sectional (n=189)
Are gastrointestinal motility and autonomic function altered in people with well-controlled HIV compared to controls?
People with well-controlled HIV exhibit altered gastrointestinal motility, which may be influenced by autonomic function changes and contribute to small intestinal bacterial overgrowth.
BACKGROUND: Gastrointestinal dysfunction, including microbiome changes and increased bacterial translocation across a compromised gastrointestinal barrier, plays a role in the chronic systemic inflammation experienced by people with HIV (PWH). It is unknown whether autonomic neuropathy (AN) may contribute to these mechanisms by altering gastrointestinal motility. METHODS: This is a cross-sectional study of 100 PWH and 89 controls. All participants underwent assessment of gastrointestinal transit times using a wireless motility capsule. All PWH and a subset of controls also underwent a standardized battery of autonomic function tests summarized as the Modified Composite Autonomic Severity Score (MCASS) and its adrenergic, cardiovagal, and sudomotor subscores, breath testing for small intestinal bacterial overgrowth (SIBO), and the Patient Assessment of Upper Gastrointestinal Disorders Symptoms (PAGI-SYM) and Composite Autonomic Symptom Score 31 (COMPASS-31) questionnaires. RESULTS: Compared to controls, PWH displayed shorter gastric emptying times (GET) and longer small bowel and colonic transit times (SBTT, CTT). Among PWH, GET was associated with PAGI-SYM score. The MCASS and its sudomotor subscore (reflecting peripheral sympathetic function) were associated with SBTT but not GET or CTT. PWH with prolonged SBTT (>6 hours) were more likely to have SIBO. CONCLUSIONS: Gastrointestinal motility is altered in PWH. This study provides preliminary evidence that changes in autonomic function may influence SBTT in PWH and that prolonged SBTT may contribute to the development of SIBO. Future studies are needed to more fully elucidate the pathophysiologic links between HIV-associated AN, altered gastrointestinal motility, the gastrointestinal microbiome, chronic inflammation, and resulting morbidity and mortality among PWH.
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Robinson‐Papp et al. (2025) conducted a cross-sectional in Well-controlled HIV (n=189). Well-controlled HIV vs. Controls was evaluated on Gastrointestinal transit times (gastric emptying, small bowel, and colonic). People with well-controlled HIV had shorter gastric emptying and longer small bowel and colonic transit times than controls, and those with small bowel transit >6 hours were more likely to have SIBO.
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