The Dangerous Relationship Between Obesity and HIV
According to recent data from the SUN (Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy), which includes 494 patients, approximately 61% were either overweight or obese. Obesity was associated with insulin resistance, elevated cholesterol, increased inflammation and atherosclerosis.
A reduction of dietary intake of 500 calories per day for 8 weeks resulted in a 6% decrease in body weight. What was remarkable in this study was the dramatic decline in systemic inflammation observed in the study participants. Indeed, two reputable markers of inflammation, tumour necrosis factor (TNF) and C-reactive protein, were reduced by almost 50% in only 8 weeks of calorie reduction.
Inflammatory diseases such as diabetes, cardiovascular disease (CVD), kidney problems, osteoporosis, cogitative impairment and fragility, are becoming increasingly common in people living with HIV. As the prevalence of obesity and HIV-associated co-morbidities continues to rise, and concerns for the spiralling economic and social costs escalate, innovative management strategies beyond primary care are urgently needed. Many traditional lifestyle interventions can be implemented with the assistance of professionals, including:
• Maintain a maximal viral suppression with antiretroviral therapy
• Reduce or stop smoking
• Lose at least 5-10% of body weight (if overweight)
• Consume more fruits and vegetables
• Reduce alcohol intake
One reason why people who are infected with HIV have high levels of inflammation is that HIV destroys the structure of the intestine (gut), causing bad bacteria to strive, and changes the dynamics of the gut microbiota.
Toxins produced by bad bacteria cross the wall of the intestine and into the blood stream to instigate and fuel inflammation, and cause age-associated diseases. Similarly, alterations of the gut microbiota and mucosal barrier have been identified as a novel CVD risk factor and are associated with metabolic diseases such as obesity and type 2 diabetes.
Incredibly, probiotic treatment using Bifidobacterium animalis ssp. lactis 420 has shown great promise in reducing body weight and liver inflammation in animal models.
The increasing prevalence of obesity and type 2 diabetes demonstrates the difficulties of conventional treatments and interventions to curb these diseases. Efforts to identify new therapeutic strategies to modulate gut microbiota are now a high priority for public health and, to date, probiotics and/or prebiotics seem to be the most effective tools.
Diet, especially high intake of fermentable fibres and plant polyphenols, appears to regulate microbial activities within the gut, supporting regulatory guidelines that encourage increased consumption of whole-plant foods (fruit, vegetables and whole-grain cereals) and providing the scientific rationale for the design of efficacious prebiotics.
Polyphenol-rich cranberry extract has been proven to protect mice from diet-induced obesity and insulin resistance, although the effect might have been mediated by the regulation of intestinal inflammation. Recent human studies with carefully selected probiotic strains have shown that ingestion of viable micro-organisms with the ability to hydrolyse bile salts could lower blood cholesterol, a recognised risk factor in obesity-related CVD.
1. Overton ET. Metabolic complications of HIV infection and its therapies. Top Antivir Med 2014,22:651-654.
2. Palmer CS. Inflammation speeds up the aging process in people infected with HIV, 2014, http://www.naturalimmunity.com.au/hiv.html#B.
3. Palmer CS, Crowe SM. How does monocyte metabolism impact inflammation and aging during chronic HIV infection? AIDS Res Hum Retroviruses 2014,30:335-336.
4. Stenman LK, Waget A, Garret C, Klopp P, Burcelin R, Lahtinen S. Potential probiotic Bifidobacterium animalis ssp. lactis 420 prevents weight gain and glucose intolerance in diet-induced obese mice. Benef Microbes 2014,5:437-445.
Dr Clovis Palmer is a graduate of the University of Sydney, Australia, and holds a PhD in plant biochemistry and molecular genetics. He conducted postdoctoral studies in immunology, liver disease and obesity at the University of New South Wales, Australia.
Dr Palmer is a reviewer for several top ranked international journals including Hepatology, AIDS and Antioxidants and Redox Signalling. He is the chief scientific editor for Natural Immunity-Health, Australia (www.naturalimmunity.com.au).
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