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Impact of Heroin and HIV on Gut Integrity and Immune Activation
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Hileman, Corrilynn O. MD, MS1; Bowman, Emily R. BA2; Gabriel, Janelle MS2; Kettelhut, Aaren MS2; Labbato, Danielle RN3; Smith, Cheryl BA4; Avery, Ann MD4; Parran, Theodore MD5; Funderburg, Nicholas PhD2; McComsey, Grace A. MD6
JAIDS 2022
Conclusions
Heroin use is associated with heightened microbial translocation, systemic inflammation,
monocyte and T cell activation and this is independent of HIV status. Participants with HIV who
did not use heroin demonstrated heightened measures of nearly all markers tested when
compared to those without HIV demonstrating that HIV infection results in disruption of gut
integrity, microbial translocation, systemic inflammation and immune activation. This likely
explains why differences in markers assessed among heroin users and non-users with HIV were
smaller than differences between heroin users and non-users without HIV. Indeed, HIV infection
did not appear to substantially worsen the multiple effects that heroin has on microbial
translocation, systemic inflammation and immune activation. Future studies should assess the
effects of heroin in the context of HIV infection over time and potential reversal of these effects
with cessation of heroin with and without medication assisted treatment for opioid use disorder.
Abstract
Background:
Altered gut integrity is central to HIV-related immune activation. Opioids may promote similar changes in gut permeability and/or increase systemic inflammation potentially augmenting processes already occurring in people with HIV (PWH).
Setting:
Urban hospital systems in Cleveland, Ohio and surrounding communities.
Methods:
This is prospectively-enrolled, cross-sectional study including people with and without HIV using heroin, and people with and without HIV who have never used heroin matched by age, sex and CD4+ count (PWH only) to compare markers of gut integrity, microbial translocation, systemic inflammation, and immune activation.
Results:
100 participants enrolled. Active heroin use was associated with higher lipopolysaccharide binding protein (LBP), beta-D-glucan (BDG), high sensitivity C-reactive protein (hsCRP), soluble tumor necrosis factor-α receptors-I and –II, soluble CD163, inflammatory monocytes, and activated CD4+ lymphocytes in adjusted models. HIV status tended to modify the effect between heroin use and LBP, BDG, hsCRP, patrolling monocytes, and activated CD4+ lymphocytes (p<0.15 for interactions); however, not as expected. The effect of heroin on these markers (except patrolling monocytes) was greatest among those without HIV rather than those with HIV.
Conclusions:
Heroin use is associated with heightened microbial translocation, systemic inflammation, and immune activation. Concurrent HIV infection in virologically-suppressed individuals does not appear to substantially worsen effects heroin has on these markers.
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