Great, do you have an idea why we have a leaky gut? Is it HIV itself that causes damages to the gut, if so this should be in the few weeks post infection and should be at least alleviated during suppressive therapy? Does it get better with HAART? Or is it because our gut flora is disturbed? Has anyone checked if our gut bacteria is the same as a healthy control? Does it change during therapy? Do different ART have better response in the gut? Maraviroc interests me as far as the gut is concerned as I have reviewed some studies that want to see if it has any effect on fibrosis or scar tissue in the gut. As you can see all the questions are about the gut and GALT, do you have any suggestions besides pro and pre-biotics that will help with the damage we have? Thanks in advance, you are one of the best assets in our community. We appreciate it, thanks again. >

First of all, you may want to read this recent answer provided in this column: Effect of HAART on beneficial gut microbes

Question 1: Is it HIV itself that causes damages to the gut, if so this should be in the few weeks post infection and should be at least alleviated during suppressive therapy?

Answer: Yes, dysfunction in gut associated lymphatic tissue (GALT) and gut permeability happens early in HIV infection. It can improve with suppressive HIV therapy but no one knows to what extend.

Question 2: Or is it because our gut flora is disturbed? Has anyone checked if our gut bacteria is the same as a healthy control? Does it change during therapy?

Answer (read link provided above): It seems that preliminary data show differences in our gut flora compared to HIV negatives even when we are taking suppressive HIV treatment. No one has studied what happens to the flora once HIV medications are initiated. HIV medications tend to decrease lipopolysaccharides (LPS), a toxin that originates from gut bacteria and that leaches into the blood stream due to leaky gut. However, some LPS remains in most patients that may contribute to inflammation and activation. LPS is known to activate the immune system and increase inflammatory cytokines (chemical messengers of immune cells. Several studies are looking at ways to lower LPS in HIV and also its effect on senescence (immune system aging)and metabolic disorders.

Question 3: Do different ART have better response in the gut? Maraviroc interests me as far as the gut is concerned as I have reviewed some studies that want to see if it has any effect on fibrosis or scar tissue in the gut.

Answer: No comparison studies have been done among HIV regimens.

This study observed no statistically significant effect of intensification of ART with maraviroc on a variety of immunologic and virologic parameters in the GALT. Antiviral and Immunological Effects of Intensification of Suppressive ART with Maraviroc, a CCR5 Antagonist

However, another study saw a decrease in gut associated plasma lipopolysaccharide (LPS) declined through week 24 in the maraviroc intensified arm

Immunomodulatory Effects of MVC Intensification in HIV-infected Individuals with Incomplete CD4+ T Cell Recovery during Suppressive AR

My suggestions:

1- Take pre and probiotics

2- Consume at least 30 grams of soluble plus insoluble fiber

3- Do not overuse antibiotics

4- Try glutamine for improving gut integrity

5- Drink lots of water during the day to keep gut moving

6- Take HIV medications and aim for undetectable viral load

Stay tuned since this is a hot topic with more data coming soon!

Nelson Vergel