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In a recent publication in Gut, Fu et al1 report links between microbiome ageing trajectories, which correlate with other biological ageing processes, and chronic comorbidities. It is well demonstrated that people living with HIV (PLHIV) have accelerated biological ageing,2 including twice the risk of having clonal haematopoiesis (CH), the expansion of clonal populations of stem cells driven by specific somatic mutations that increase with age and are associated with inflammation.3 Research in the general population has demonstrated an association between diet quality and CH4 and between CH and liver disease.5 HIV infection leads to a reduction in gut-associated lymphoid tissue (GALT),6 resulting in microbial translocation and associated systemic inflammation and liver fibrosis,7 making the associations between the gastrointestinal tract and CH seen in the general population of particular relevance for PLHIV.