Liquor Tied to Gut Integrity and Inflammation in Adults With HIV

A 96-week study of adults with well-controlled HIV infection linked drinking liquor to markers of decreased gut integrity and increased immune activation and inflammation. Although this study group generally had poor diets, no other dietary factors predicted worse gut integrity, immune activation or inflammation.

Hallmarks of HIV infection include ongoing inflammation, monocyte activation and microbial translocation -- movement of bacteria and bacterial products across the intestinal wall. Altered gut integrity may help drive inflammation and activation. Promoting vascular health could decrease inflammation and lower cardiovascular disease risk. Case Western Reserve University researchers who conducted this study noted that the role of diet in gut integrity and inflammation remains poorly understood in people with HIV.

To address these issues, the Case Western team analyzed 147 HIV-positive adults enrolled in a rosuvastatin trial for 96 weeks. All participants had a viral load below 1000 copies/mL and normal lipids. But all had evidence of either heightened T-cell activation or inflammation.

When entering the study and at weeks 24, 48 and 96, participants completed a standardized 55-question diet interview. Four survey questions assessed alcohol use. The researchers used fasting samples collected at the four noted times to measure markers of immune activation, inflammation and gut integrity. To examine associations between dietary variables and gut integrity, immune activation and inflammation, the researchers used multiple linear regression for baseline biomarkers and linear mixed effects models for longitudinally measured biomarkers.

The 147 study participants averaged 45.4 years in age, 78% were men, 68% African American and 63% current smokers. Everyone took antiretroviral therapy, 84% had a viral load below 75 copies/mL and CD4 count averaged 640 cells/mm3. The study group consumed an average 2395 kcal/day, including 108 g of total fat, 36 g of saturated fat, 19 g of fiber, 266 g of total carbohydrates (almost twice the recommended intake), 246 g of bad carbohydrates (total – fiber) and 15.6 g of protein (one-third the recommended intake). Almost half of the group, 47%, drank alcohol in the past week, averaging 2.87 beers, 2.22 servings of liquor and about one glass of wine.

The only baseline dietary factor associated with a marker of gut integrity (I-FABP) was polyunsaturated fat:saturated fat ratio, and that association went in the unexpected direction (a lower ratio was associated with better gut integrity). The study disclosed no evidence to support the hypothesis that eating more fat leads to worse gut integrity and increased inflammation.

The only baseline alcohol factor associated with gut integrity was liquor consumed in the past week, with more liquor predicting worse gut integrity reflected in the marker lipopolysaccharide binding protein (LBP) (r = 0.192, P = .037). Regression analysis controlling for age, sex, race, body mass index, statin treatment group, current CD4 count and time confirmed that drinking more liquor predicted worse gut integrity by LBP (β = 0.326, P = .018). Drinking more liquor also predicted greater immune activation as reflected in sCD14 (β = 0.031, P < .001) and greater inflammation as reflected in IL-6 (β = 0.203, P = .004).

The Case Western researchers believe their findings support "the hypothesis that alcohol, in particular liquor, use increases translocation of [lipopolysaccharide], which interacts with [lipopolysaccharide binding protein], resulting in increased immune activation and inflammation, perhaps resulting in HIV disease progression." They underlined the evidence of poor diets in HIV-positive people and called for evidence-based interventions to lower carbohydrate intake and boost protein consumption. The authors proposed that "an annual dietary assessment may be beneficial in developing targeted, personalized dietary interventions for individual HIV-infected adults."