Long-term Use of Proton Pump Inhibitors Is Associated with Increased Microbial Product Translocation, Innate Immune Activation, and Reduced Immunologic Recovery in Patients with Chronic Human Immunodeficiency Virus-1 Infection

Abstract

Background. Translocation of microbial products from the damaged gut causes increased immune activation in human immunodeficiency virus (HIV). Proton pump inhibitors (PPIs) predispose to bacterial overgrowth in the gut. We hypothesized that longterm use of PPIs is associated with greater microbial translocation and immune activation in HIV. Methods. HIV-infected persons on suppressive antiretroviral therapy (ART), including those receiving long-term PPIs (PPI+ group) or not (PPI? group), were enrolled. We determined CD38+HLA-DR+CD8+ (activated) T-cell frequency, and plasma levels of lipopolysaccharide (LPS), LPS binding protein (LBP), soluble CD14 (sCD14), and intestinal fatty acid binding protein (I-FABP). Results. We recruited 77 HIV-infected participants (37 PPI+ and 40 PPI?) and 20 HIV-uninfected volunteers. PPI+ subjects were older and more likely to have hypertension and receive statins than PPI?. Nadir and enrollment CD4 counts, activated T-cells, and time on ART were similar in both groups. PPI+ group had higher sCD14 (2.15 vs. 1.50 mcg/mL, P