sequences of bacteria
Introduction: Among people living with human immunodeficiency virus (PLWH), those who exhibit immunological non-responsiveness (INR) are highly susceptible to developing pruritus. The aim of this study was to examine the relationships among pruritus, alteration of the gut and skin microbiomes, and systemic inflammation in PLWH with INR. Methods: Thirty-three PLWH with INR were enrolled and divided into Pruritus (n=18) and Control (n=15) groups. All participants met the defining criterion of a low CD4+ T cell count (350 cells/L). We performed 16S rRNA gene sequencing of fecal and skin samples, and measured plasma IL-1 and IL-10 levels. Results: Microbiome analysis revealed specific, bidirectional patterns of microbial dysbiosis. Specifically, the skin microbiome of the Pruritus group exhibited significantly greater microbial richness (Chao1 and Faiths Phylogenetic Diversity indices, P<0.01), coupled with significantly lower representation of the potentially protective genus Bacillus (P<0.05), compared with that of the Control group. Conversely, the gut microbiome of the Pruritus group exhibited significantly lower alpha diversity (P<0.05). Furthermore, we identified a significant positive correlation between levels of plasma pro-inflammatory cytokine IL-1 and the relative abundance of the opportunistic gut genus Veillonella (P<0.07). Conclusions: PLWH with INR who develop pruritus exhibit specific, multifaceted microbial dysbiosis: hyper-richness of the skin microbiome with Bacillus depletion and attenuated gut microbial diversity. These findings support a systemic inflammatory basis for pruritus, characterized by microbial dysbiosis in both the gut and skin. This suggests that microbiome-targeted therapeutic interventions may offer novel management strategies for pruritus.