Microbes & HIV

Working Toward Balance
Research into treating the effects of microbes gains steam
by Jeannie Wraight

[dropcap]T[/dropcap]here’s been lots of talk recently about the importance of microbes on multiple aspects of health. HIV is no exception and more and more research is showing just how big of a role these little invisible bugs actually play.

Microbes are bacteria, fungi, and viruses of which trillions live on our skin and within our bodies. These microbes reside in colonies called the microbiome (or microbiota) which can be found throughout the body, including in our gut, mouths, sexual organs, and lungs. The microbiome naturally maintain a healthy balance of microbes, but many factors such as disease, stress, medication, and even the food we eat, can tip this balance, allowing for harmful bacteria to take hold. A disruption of the microbiome balance can have serious effects on the entire body.

Trans microbial location and dysbiosis are two important issues when discussing the microbiome and HIV. Trans microbial location occurs when damage from HIV breaches the intestinal lining, allowing bacteria that is usually contained within the small intestines to enter the blood stream. The immune system responds by attacking this bacteria, creating damaging inflammation. Research indicates that this inflammation may lead to conditions such as cardiovascular disease and neurocognitive disorders. Dysbiosis is an unhealthy disruption of the microbial balance, which can lead to illness and further trans microbial location.

Numerous studies are being conducted to bolster our knowledge and understanding of the human microbiome and to determine potential interventions. Two currently enrolling studies may help us gain insight to potential treatment options that may help restore a microbial balance and begin to answer questions of what effect that might have on conditions that affect HIV-positive people.

Probiotics: Visbiome

Probiotic formulations contain various strains of bacteria known to be beneficial.  Probiotics have been found to be helpful in disorders such as irritable bowel syndrome and Crohens disease, and may reduce microbial translocation and dysbiosis in HIV- positive people. Each probiotic supplement contains different strains of bacteria. So which probiotic is the right probiotic for a person living with HIV?

The AIDS Clinical Trials Group is looking at a specific probiotic that may hold potential. According to ACTG PI Adriana Andrade, MD, MPH, FACP, Associate Professor of Medicine at Johns Hopkins, “The formulation in Visbiome has been demonstrated to replete the CD4 cell population in the gut of SIV-infected macaques which were administered the probiotic blend. Furthermore, inflammation in the gut was markedly decreased with the formulation administration. Given these results and human studies demonstrating the benefit of the formulation found in Visbiome to improve bowel symptoms in inflammatory bowel diseases, this probiotic has the potential to positively impact HIV disease outcomes.”

A ninety-person study is currently enrolling to determine if Visbiome (made by Exegi) can:

• reduce systemic inflammatory markers

• increase microbe diversity in the gut microbiome

• improve immune function in the gut

For information on this study go to: http://bit.ly/29QaB9G.

Ecobiotic drugs: SER-109

SER-109 is an ecobiotic drug which works to restore healthy microbiome ecology and function. SER-109 is being studied to combat reoccurring Clostridium Difficile (also known as C. Diff or C. difficile) a pathogenic infection that causes, among other symptoms, extensive watery diarrhea. C. Diff is greater than two-fold more common in HIV-positive individuals than in the general population and can be deadly in people who are immune-compromised or elderly. C. Diff can occur from the use of antibiotics and is more common before or after hospital stays, but it is believed that HIV may cause alterations in fecal microbiota, gut mucosal integrity, and humoral and cell-mediated immunity that may contribute to its higher occurrence.

Dysbiosis is believed to be the underlying cause of C. Diff. C. Diff is commonly treated with antibiotics which in turn can worsen dysbiosis, leading to further occurrences of C. Diff.

SER-109 is a being studied as a treatment for C. Diff and works to restore a healthy balance in the intestinal microbiome, reversing dysbiosis. In a Phase Ib/II study of SER-109 in thirty individuals with recurrent C Diff. (three or more occurrences in a nine-month period of time), ninety-seven percent of participants achieved a clinical cure of C. Diff, defined as an “absence of CDI [C. Diff] requiring antibiotic treatment during the eight-week period after SER-109 dosing.” A Phase II placebo-controlled study called ECOSPOR, which does not exclude HIV patients, is ongoing.

SER-109 is a first-in-class microbiome therapeutic that utilizes bacterial spores from healthy donor purified stool which facilitates re-colonization of the microbiome.

Although an effective treatment for C. Diff is important, the utilization of SER-109 may surpass C. Diff alone if it is found to control dysbiosis, potentially offering a wider benefit to people living with HIV.

For more information, please see: http://bit.ly/2a6lR7P.

Jeannie Wraight is the former editor-in-chief and co-founder of HIV and HCV Haven (www.hivhaven.com) and a blogger and writer for TheBody.com. She is a member of the Board of Directors of Health People, a community-based organization in the South Bronx and an advisor to TRW (Teach me to Read and Write), a community-based organization in Kampala, Uganda. She lives with her husband in New York City.