PrEP and Leaky Gut

The problems continue to mount

Short post today; I will discuss the recent article:

HIV prevention: does 1+1 = 2?

Essentially, the researchers were examining what the effect would be of combining PrEP with the so-called “monoclonal HIV antibody” VRC01 (I guess the naturally produced “HIV” antibodies continue to represent the opposite of what almost all antibodies do). The hope was that the combination would be doubly effective—hence the 1+1=2? in the title—however, that turned out not to be the case, as the participants experienced “increased intestinal permeability” (code for “leaky gut” syndrome, which, interestingly, is associated with the release of nonspecific antibodies from the gut into the bloodstream ).

Drugs originally designed to treat patients living with HIV, known as antiretroviral therapy (ART), are now being prescribed to populations with high incidence rates to prevent HIV acquistion. Used in this way, these drugs are known as pre-exposure prophylaxis (PrEP).

[…]

VRC01 is an example of a rare antibody that can recognize many different HIV strains, a broadly-neutralizing antibody or bNAb, and in principle could be used to protect against infections from many different HIV strains. A combined regimen of PrEP and bNAb could be even more effective at preventing HIV infection if the two treatment modalities worked together.  If 1+1=2. “We decided to look for differences between PrEP and non-PrEP users because many HVTN trials are testing prophylactic antibodies and recruit people who take or do not take these medications. Others have previously characterized the side effects of PrEP for prevention of HIV, and intestinal issues early after uptake had been described,” says Dr. Lemos. Previous studies assessing VRC01’s efficacy have not considered the effect of using PrEP, which could affect the way VRC01 is processed and cleared from the body. Furthermore, there have been multiple reports of interactions between antibodies and small molecule drugs in clinical trials for rheumatoid arthritis, cancer, and heart disease. “Our work demonstrates VRC01 is cleared ~15% faster from the blood serum in men who take PrEP, and that this is associated with increased intestinal permeability,” says Dr. Lemos. In other words, 1+1=1.85 in serum, sort of. “Additional studies will be needed to find out whether 1+1 <, = or > 2 in tissues, where the first battle against HIV often takes place” says Dr. Huang, also a member of the HVTN and the corresponding author of the paper. While uncommon, PrEP usage can affect the liver and kidneys; however, the team observed no association between VRC01 clearance and liver and kidney function, nor markers of inflammation.

There’s not a whole lot interesting here, but I remain committed to reporting on issues relevant to PrEP, and I’d say that these medications, taken by HIV-positive individuals for life, cause leaky gut syndrome is quite alarming and significant. It is rather interesting that PrEP actually increases clearance of a specific “antibody;” I don’t yet have a theory as to what this means, but I’ll be investigating further. Finally, I’ll conclude by pointing out that they have to refer to adverse effects from PrEP as “uncommon,” which we all know is a lie.

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