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Main Forums => Living With HIV => Topic started by: angels4kelly on August 03, 2006, 10:16:58 am
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HIV Hides from Treatment in the Gut
By Tim Horn, Senior Writer & Editor, AIDSmeds.com
A University of California research team has discovered that HIV is able to survive the antiviral effects of treatment by hiding out in the mucosal tissues of the intestine. Even when blood tests show that viral load is undetectable and T-cell counts are responding well to HIV treatment, there is likely ongoing viral replication and immune system damage occurring in the gut. While its not entirely clear what these findings mean for HIV-positive people, the researchers hint at the possible need for early HIV treatment, intestinal biopsies, and the use of anti-inflammatory medications to effectively manage HIV infection in the gut.
The study, reviewed in the August issue of the Journal of Virology, was conducted by Satya Dandekar, PhD, and her colleagues with the UC Davis Health System in Davis, California. According to Dr. Dandekar, who is professor and chair of the Department of Medical Microbiology and Immunology, "The real battle between the virus and exposed individuals is happening in the gut immediately after viral infection. We need to be focusing our efforts on improving treatment of gut mucosa where massive destruction of immune cells is occurring."
Dr. Dendekar explained that gut-associated lymphoid tissue (GALT) accounts for 70% of the body's immune system. "Restoring its function is crucial to ridding the body of the virus," she said.
Last year, Dr. Dandekar published a study of HIV-infected patients who, despite the lack of treatment, had survived over 10 years with healthy levels of T-cells and suppressed viral loads. "We looked at their gut lymphoid tissue and did not see loss of T-cells there. This correlated with better clinical outcome," she explained.
Those results prompted Dr. Dandekar and her team to undertake the current study evaluating the effect of combination HIV treatment on viral suppression and immune restoration in GALT. They followed 10 patients receiving HIV treatment, taking blood samples and small biopsies of intestinal tissue both before and after three years of treatment. Three of the patients were treated within four to six weeks of first being infected with the virus (patients with primary HIV infection). The other participants were known to be HIV positive for more than one year (patients who chronic HIV infection).
"We found a substantial delay in the time that it takes to restore the gut mucosal immune system in those with chronic infections," Dr. Dandekar said. "In these patients the gut is acting as a viral reservoir that keeps us from ridding patients of the virus."
Hoping to figure out why HIV treatment does not work as well in the gut, Dr. Dandekar's group further examined the GALT samples collected after at least three years of therapy. They found evidence of inflammation, which disrupts tissue function, promotes cell death, and upsets the normal balance of gut flora. They also found that the activity of genes that control and promote mucosal repair and regeneration was suppressed, while the genes responsible for the inflammatory response were more active than in normal tissue.
GALT samples collected from the three patients with primary HIV infection – compared to those with chronic HIV infection – suggested that they had fewer signs of inflammation at the beginning of the study and experienced greater recovery of GALT after three years of treatment.
Based on these findings, Dr. Dandekar and the other authors suggest that anti-inflammatory drugs may improve HIV treatment outcomes, although no specific anti-inflammatory recommendations are made.
The researchers also suggest that early treatment may be necessary to maintain the health of GALT, before it is heavily damaged by HIV. According to Thomas Prindiville, MD, a gastroenterologist and co-author of the study, "What we continue to see is that restoration of immune function is more likely when treatment is started early. Starting treatment before T-cell counts fall below 350, would preserve immune function and hasten its full recovery."
To measure the effects of early treatment and anti-inflammatory therapy on the gut, Dr. Dandekar's group indicates that intestinal biopsies may be necessary. Blood measurements of viral load and T-cell counts, she says, do not provide an accurate picture of what is going on in GALT.
Of course, there is a lot more to learn about HIV replication in GALT before treatment guidelines are revised or intestinal biopsies are recommended to people living with HIV and their healthcare providers. Is HIV replication in the gut, while someone is on HIV treatment, a cause of drug resistance? Would improved HIV treatment activity in the gut really provide the immune system with greater protection against AIDS-related opportunistic infections? Which HIV medications are most effective against HIV in GALT? Will early treatment, the use of anti-inflammatories, and intestinal biopsies actually help HIV-positive people live longer, healthier lives? These are just some of the questions that need to be addressed in clinical trials before the suggestions of Dr. Dandekar's group are put into practice.
Dr. Dandekar's group says that it plans to keep testing ways of improving the efficacy of HIV therapy in GALT. This includes studies evaluating the treatment of gut inflammation, starting treatment earlier, and using gut biopsies to monitor treatment success.
"If we are able to restore the gut's immune response, the patient will be more likely to clear the virus," Dr. Prindiville said. He added: "You can't treat any infectious disease without the help of the immune system."
Source:
Guadalupe M, Sankaran S, George MD, et al. Viral suppression and immune restoration in the gastrointestinal mucosa of human immunodeficiency virus type 1-infected patients initiating therapy during primary or chronic infection. J Virol 80:8236-47, 2006.
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I have been having a lot of pain in my stomach after I eat something, this has been going on for 2 years now and nothing has really been done for me. My stomach bloats up real big and makes me look as if I'm the first man that's nine months pg. They say I have gerd and I'm taking medication for that but it doesn't help with the stomach pain I get from the bloating. I understand that I have lipodystrophy in my gut and lipoatrophy in my face but all of the people that I know that have the same thing never talk about having any pain associated with there's. And when I talk to my Dr. at the AIDS clinic she says there is nothing they can do and I should be happy to be alive. When I saw this article I thought maybe I have some type of infection or something in my stomach going on. Nothing surprises me anymore because I've been HIV+ for 17 years now. Can anyone tell me if they have pain associated with there Lipodystrophy?
Thank You,
MrRevere@insightbb.com ;D
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Have you had a gastroscopy? have you been checked for heliobacter Pylori?
Coen
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MrRevere,
Do you notice the stomach pain after you eat fatty foods? I was diagnosed in Dec. 2005. I started meds in Jan.2006. All of this year I have been struggling with figuring out what to eat. It's much better now that I've eliminated some foods. I was getting severe stomach pain and bloating and found a link with eating fatty foods. Fatty meaning avocado(which I love to death but I can't eat it anymore), lamb, and some fried foods. Ever since eliminated those things, I feel much better and have way less incidences of gastric distress.
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No question about it, this discovery is very significant. Let's hope it leads to bigger and better things....J.
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I totally agree with you, J.! ;D
Peace,
Kelly 8)
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Hello Kelly, it is Eldon. This is good news that they know more about the HIV virus and this can lead to bigger and better things.
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May be we should start drinking friendly bacteria yogurts for gut? :D
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I knew about the high levels of HIV in anal secretions, i.e, the mucous lining the large intestine and often found "elsewhere" after anal sex.
Mr. Revere, I suffered for years with the problems you describe. In my case, they were dietary/autoimmune-related.
May I suggest you have the test (a blood test is now available) for gluten intolerance? After discovering I was gluten intolerant and making the necessary changes in my diet, my symptoms subsided.
I should note that, depending on your age, it will take the gut a year or more to recover from gluten exposure (which explains why we gluten-intolerant folks are so picky).
The type of bloating and pain you discuss also can be experienced by those who are lactose intolerant.
It has been noted here before that many HIV-positive people are lactose intolerant. I wonder whether this most recent finding may have anything to do with that?
I have found I can eat organic yoghurt, but not the commercial ones (they contain wheat products).
These are just suggestions, buy maybe altering your diet may help alleviate the pain you now experience.
HUGS,
Mark
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May be we should start drinking friendly bacteria yogurts for gut? :D
I often wondered what probiotics would do. It's something that should only be done after consultation with a professional.
On the topic of gut problems, I started the exact same things that you (catwoman) have a few years back. I don't have HIV. It could be IBS but you should get a full check-out with your doctor. Intolerance for fat could be a sign of gall bladder problems.
R
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Hi Angel,
Thank you for posting this article by Tim Horn on the GALT Study at UC Davis. I am one of the research subjects involved in this particular study, having donated tissue samples from my intestines in May of 2005.
Information about research findings are hard to get ahold of through my own contacts, and I'm glad I had the time to read your thread today.
Very interesting, and proof that once again, AM continues to be a fore-runner on all things related to the issue of HIV/AIDS, including ground-breaking research in these important matters.
Appreciatively,
Zephyr
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Thank you so much, Zephyr for being willing to participate in this study ;D
Your generosity helps us all!
Again THANK YOU :-*
Peace,
Kelly
(http://i55.photobucket.com/albums/g142/angels4kelly/angel1.gif)