2163. Long-term use of proton pump inhibitors and increased immune activation in patients with chronic HIV-1 infection
Session: Poster Abstract Session: HIV Inflammation and Immune Activation
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • PPI poster Final.pdf (828.2 kB)
  • Background: Translocation of microbial products from the damaged gut causes increased systemic immune activation in HIV and is associated with increased mortality. Proton pump inhibitors (PPIs) predispose to microbial overgrowth in the gut. We hypothesized that long-term use of PPIs is associated with greater microbial translocation, resulting in increased systemic inflammation in chronic HIV

    Methods: HIV-1-infected persons on suppressive antiretroviral therapy (ART) were studied. Long-term use of PPIs was defined as filling six or more 30-day supplies of PPIs in the prior 12 months. We determined the CD38+HLA-DR+ (activated) CD8+ T-cell frequency and plasma levels of lipopolysaccharide (LPS, a component of Gram- bacteria), LPS binding protein (LBP, induced by LPS), soluble CD14 (sCD14, reflecting LPS-induced monocyte activation), and intestinal fatty acid binding protein (I-FABP, reflecting enterocyte turnover). We performed comparisons by t-test and chi2 test. Significant variables were included in a multivariate logistic regression model

    Results: We recruited 37 HIV-infected subjects on long-term PPIs (cases), 40 HIV-infected subjects not taking any gastric acid reducers (controls), and 20 HIV-uninfected volunteers. Cases were older (60 vs. 55 years; P=0.028) and more likely to have hypertension (75% vs. 50%; P=0.020) and receive statins (54% vs. 25%; P=0.009) than controls. Nadir and CD4+ T-cell counts at enrollment and time receiving ART did not differ between groups. Cases had higher concentrations of sCD14 (2.15 vs. 1.50 mcg/ml; P < 0.001) and LBP (21.78 vs. 18.28 mcg/ml; P = 0.013) than controls. Higher sCD14 levels remained significantly associated with PPI use in the multivariate model. Levels of activated CD8+ T-cells, LPS and I-FABP were similar between cases and controls. HIV-infected cases and controls had higher levels of studied markers than HIV-uninfected subjects

    Conclusion: Long-term PPI use was associated with increased microbial translocation but not with increased enterocyte turnover or T-cell activation in HIV-1-infected persons. Larger studies are needed to determine the clinical implications of our findings. In the meantime, cautious use of long-term PPIs is advised in this patient population

    Jose Serpa, MD, MS1, Adriana M. Rueda, MD1,2, Anoma Somasunderam, PhD3, Netanya S. Utay, MD3, Dorothy Lewis, PhD4, Jacob Couturier, MS4, Katharine Breaux, PA-C, MPAS1,2 and Maria C. Rodriguez-Barradas, MD, FIDSA1,2, (1)Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, (2)Section of Infectious Diseases, Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, (3)Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX, (4)Division of Infectious Diseases, The University of Texas Medical School at Houston, Houston, TX

    Disclosures:

    J. Serpa, None

    A. M. Rueda, None

    A. Somasunderam, None

    N. S. Utay, None

    D. Lewis, None

    J. Couturier, None

    K. Breaux, None

    M. C. Rodriguez-Barradas, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.