Restoring gut health may slow HIV progression to AIDS - study

A groundbreaking study conducted by infectious diseases scientists at the University of Pittsburg has uncovered a potential breakthrough in HIV/AIDS research.

The study, published in the journal JCI Insight, suggests that restoring and improving gut health could be the key to slowing HIV progression to AIDS.

The research, performed with simian immunodeficiency virus (SIV), challenged the conventional approach of solely targeting systemic immune activation and inflammation to control disease progression and associated health issues.

Instead, the study proposes that treatments should focus on healing the gut, which is an immediate target of HIV infection.

Lead author Cristian Apetrei, MD, PhD, a professor of infectious diseases at Pitt's School of Medicine, explains: "Every study so far targeting systemic inflammation by addressing immune activation has very short-lived results. Upon reflection, we realized those results told us something very important: Inflammation generated by the virus damaging the intestinal lining is driven by a separate mechanism from immune activation. We just had to prove it."

HIV hijacks immune cells

HIV infection is characterized by the hijacking of immune cells called "helper T cells" to replicate the virus. While efforts have centered around treamtents to stop this replication process, virus suppression alone only calmed immune activation and inflammation but failed to restore them to pre-infection levels.

The gut's role in HIV progression has been known for a quarter of a century. Within weeks of infection, the virus depletes the majority of immune cells in the intestines, resulting in damage to the intestinal lining and the release of gut flora into the bloodstream. 

Individuals with the fastest progressing HIV exhibit less healthy gut microbiomes and more intestinal lesions.

It was previously believed that controlling disease progression involved calming immune activation and halting HIV replication, with gut health being of lesser importance. 

However, the recent study with African green monkeys infected with SIV revealed that intestinal dysfunction is the primary factor driving systemic inflammation and disease progression. 

Ivona Pandrea, professor of pathology at Pitt Medicine and senior author of the study, emphasized the need for therapies aimed at preserving gut integrity to prevent accelerated aging, comorbidities, and premature death in people living with HIV. 

"The issue is that we don't yet all the mechanisms responsible for gut famage in HIV infection," Pandrea said. "We plan to test the role of these pathways in vivo."