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IntroductionThe role of microbial translocation (MT) in HIV patients living with HIV from low‐ and middle‐income countries (LMICs) is not fully known. The aim of this study is to investigate and compare the patterns of MT in patients from Vietnam, Ethiopia and Sweden.MethodsCross‐sectional samples were obtained from treatment‐naïve patients living with HIV‐1 and healthy controls from Vietnam (n=83; n=46), Ethiopia (n=9492; n=50) and Sweden (n=51; n=19). Longitudinal samples were obtained from a subset of the Vietnamese (n=24) in whom antiretroviral therapy (ART) and tuberculostatics were given. Plasma lipopolysaccharide (LPS), sCD14 and anti‐flagellin IgG were determined by the endpoint chromogenic Limulus Amebocyte Assay and enzyme‐linked immunosorbent assay.ResultsAll three biomarkers were significantly increased in patients living with HIV‐1 from all countries as compared to controls. No differences were found between males and females. Vietnamese and Ethiopian patients had significantly higher levels of anti‐flagellin IgG and LPS, as compared to Swedes. ART reduced these levels for the Vietnamese. Vietnamese patients given tuberculostatics at initiation of ART had significantly lower levels of anti‐flagellin IgG and higher sCD14. The biomarkers were lower in Vietnamese who did not develop opportunistic infection.ConclusionsHigher MT is common in patients living with HIV compared to healthy individuals, and in patients from LMICs compared to patients from a high‐income country. Treatment with tuberculostatics decreased MT while higher levels of MT are associated with a poorer clinical outcome.