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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 HIV-1 infection


ppi 2Long-term use of proton pump inhibitors is associated with increased microbial product translocation, innate immune activation, and reduced immunologic recovery in patients with chronic HIV-1 infection



Translocation of microbial products from the damaged gut causes increased immune activation in HIV. Proton pump inhibitors (PPIs) predispose to bacterial overgrowth in the gut. We hypothesized that long-term use of PPIs is associated with greater microbial translocation and immune activation in HIV.



HIV-infected persons on suppressive antiretroviral therapy (ART), including those receiving long-term PPIs (PPI+ group) or not (PPIgroup), 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).



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 <0.01), and LBP (21.78 vs. 18.28 mcg/mL, P=0.02), but lower I-FABP levels (608.5 vs. 2281.7 pg/mL, P=0.05) than PPI. In multivariate analysis, sCD14 levels remained associated with PPIs. In the year prior to enrollment, PPI+ group lost more CD4 cells than PPI (-18 vs. 54 cells/mm3, P = 0.03). HIV-infected subjects had higher immune activation and microbial translocation biomarkers than uninfected volunteers.



In HIV, long-term use of PPIs was associated with increased microbial translocation, innate immune activation, and reduced immune reconstitution. Further studies are needed to evaluate the clinical implications of our findings. In the meantime, cautious use of PPIs is advised.

Prevacid (lansoprazole) is a proton pump inhibitor (PPI) used to treat GERD, heartburn, gastric ulcer, and duodenal ulcer. It works by reducing acid in the stomach. … Esomeprazole is more popular than other proton pump inhibitors. It is available in brand and generic versions.

More Reasons Why Reducing Your Stomach Acid is a Risky Bet

When you take PPIs, which significantly reduce the amount of acid in your stomach, it impairs your ability to properly digest food.

Reduction of acid in your stomach also diminishes your primary defense mechanism for food-borne infections, thereby increasing your risk of food poisoning.

Additionally, if you fail to digest and absorb your food properly, you will not only increase your risk of stomach atrophy but also nearly every other chronic degenerative disease.

These drugs have also been linked to an increased risk of pneumonia, and result in an elevated risk of bone loss. The risk of a bone fracture has been estimated to be over 40 percent higher in patients who use these drugs long-term.

If You’re Already Taking These Drugs, Avoid Stopping Cold Turkey

You should NEVER stop taking proton pump inhibitors cold turkey. You have to wean yourself off them gradually or else you’ll experience a severe rebound of your symptoms, and the problem may end up being worse than before you started taking the medication.

Ideally, you’ll want to get a lower dose than you’re on now, and then gradually decrease your dose. Once you get down to the lowest dose of the proton pump inhibitor, you can start substituting with an over-the-counter H2 blocker like Tagamet, Cimetidine, Zantac, or Raniditine. Then gradually wean off the H2 blocker over the next several weeks.

Natural Treatment Options for Heartburn, GERD and Acid Reflux

As I explained in my recent Acid Reflux video,while you wean yourself off these drugs (if you’re already on one), you’ll want to start implementing a lifestyle modification program that can eliminate this condition once and for all.

These strategies include:

  • Eliminating food triggers — Food allergies can be a problem, so you’ll want to completely eliminate items such as caffeine, alcohol, and all nicotine products.
  • Increasing your body’s natural production of stomach acid — Like I said earlier, acid reflux is not caused by too much acid in your stomach — it’s usually a problem with too little acid. One of the simplest strategies to encourage your body to make sufficient amounts of hydrochloric acid (stomach acid) is to consume enough of the raw material.

One of the simplest, most basic food items that many people neglect is a high quality sea salt (unprocessed salt).

I recommend eliminating processed, regular table salt for a lot of different reasons, all of which I’ve reviewed before. But an unprocessed salt like Himalayan salt — one of the best salts on the planet – will not only provide you with the chloride your body needs to make hydrochloric acid, it also contains over 80 trace minerals your body needs to perform optimally, biochemically.

  • Taking a hydrochloric acid supplement — Another option is to take a betaine hydrochloric supplement, which is available in health food stores without prescription. You’ll want to take as many as you need to get the slightest burning sensation and then decrease by one capsule. This will help your body to better digest your food, and will also help kill the helicobacter and normalize your symptoms.
  • Modifying your diet – Eating large amounts of processed foods and sugars is a surefire way to exacerbate acid reflux as it will upset the bacterial balance in your stomach and intestine.

Instead, you’ll want to eat a lot of vegetables, and high quality, organic, biodynamic, and locally grown foods. You can also supplement with a high quality probiotic or make sure you include fermented foods in your diet. This will help balance your bowel flora, which can help eliminate helicobacter naturally.

  • Optimizing your vitamin D levels — As I’ve mentioned many times in the past, vitamin D is essential, and it’s essential for this condition as well because there’s likely an infectious component causing the problem. Once your vitamin D levels are optimized, you’re also going to optimize your production of 200 antimicrobial peptides that will help your body eradicate any infections that shouldn’t be there.

You’ll want to make sure your vitamin D level is about 60 ng/ml, and I strongly recommend you use LabCorp, which is a high quality testing facility.

As I’ve discussed in many previous articles, you can increase your vitamin D levels through appropriate amounts of sun exposure, or through the use of a safe tanning bed.

If neither of those are available, you can take an oral vitamin D3 supplement. However, whenever you use oral vitamin D, it’s imperative you get tested regularly to make sure you’re not reaching toxic levels.

  • Implementing an exercise routine — Exercise is yet another way to improve your body’s immune system, which is imperative to fight off all kinds of infections.

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