Virtual Reality: How HIV Changes the GI Tract
How HIV Disrupts Immune Function
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Virtual Reality: How HIV Changes the GI TractThe gastrointestinal tract plays a key role in both the pathogenesis of HIV infection and its clinical manifestations, such as HIV-associated wasting.GI disorders of both the upper and lower tract are prevalent in the HIV-infected population and can include oral lesions, difficulty swallowing, abdominal pain, cramping, and diarrhea, to name a few. Let’s look at some of the changes that occur in people living with HIV.Normally, the gut maintains tight junctions between cells, forming a nearly impermeable barrier. This prevents the permeation of proinflammatory pathogens, toxins, and antigens from leaking into the circulatory system.These tight junctions help maintain mucosal integrity with the help of growth factors, hormones, and immune cells such as dendrites, which produce soluble cytokines that act as messengers between innate and adaptive immune systems.The largest component of the mucosal immune system is gut-associated lymphoid tissue, or GALT, one of the primary target tissues during acute HIV infection. As time goes on, even with antiretroviral therapy, viral replication continues in the GALT— despite undetectable viral loads in the blood—and serves as a reservoir of the virus, stimulating inflammation and immune activation.In addition, the presence of HIV alters the gut flora and can result in long-term effects on epithelial barrier and T-cell function in the gut, even after years on antiretroviral treatment. Over time, these changes continue to diminish the integrity of the protective mucosal barrier. These disruptions of the GI tract are associated with inflammation and malabsorption of vital nutrients, which can contribute to HIV-associated wasting.A recent study found that changes to the gut in HIV-infected individuals reduced the gut’s capacity to absorb two of the amino acids that are essential for protein synthesis. These amino acids, phenylalanine and lysine, cannot be synthesized by the body and need to be obtained from food. Thus, proteins that include these essential amino acids cannot be produced, despite eating those essential amino acids.Even while on HAART and/or combination antiretroviral therapy, or cART, patients may have persistent HIV-related pathogenesis within the GI tract. These GI tract changes are considered to be among the most important contributing factors leading to HIV-associated wasting.
How HIV Disrupts Immune FunctionVideo of virtual reality experience developed for EMD Serono:Pathogenesis of HIV-associated Wasting: Chapter 1 Despite making great strides in controlling HIV with highly active antiretroviral therapy, combination antiretroviral therapy, or cART, is still unable to eradicate latently infected cells, and their presence continues to affect immune reactivity.The inflammation that results is then left to compromise the body’s other physiological systems.The innate immune system consists of cells and proteins that are always present and ready to mobilize and fight invading organisms. The adaptive immune system, on the other hand, is called into action against pathogens that are able to evade or overcome innate immune defenses. Both can become dysfunctional in response to HIV infection.Researchers suspect that immune dysfunction--along with other factors such as nutritional, hormonal, or metabolic dysfunctions--can still contribute to HIV-associated wasting in the current era of cART. The innate immune system releases proinflammatory cytokines upon first exposure to HIV.The inflammatory process is driven by various cytokines, including interleukin 1, or IL-1, interleukin 6, or IL-6, and tumor necrosis factor alpha, or TNF-alpha. In the presence of these cytokines, a breakdown of protein known as muscle proteolysis occurs. As this response becomes chronic, the continuing breakdown of muscle can lead to loss of lean body mass.Research shows that higher levels of catabolic cytokines TNF, IL-1, and IL-6 have been associated with a loss of lean body mass and changes in resting energy expenditure in HIV-positive study participants treated with antiretroviral therapy. Adaptive immune activation can also contribute to HIV-associated wasting in patients treated with antiretroviral therapy. A profound loss of adaptive immune system protection can occur with CD4+ and CD8+ T cell depletion and dysfunction. This loss happens alongside an increased basal metabolic rate and increased protein catabolism, accelerating the loss of lean body mass during HIV infection.The dysregulation of the adaptive immune system that occurs with HIV infection may also be associated with bone loss. In HIV-positive patients with osteopenia or osteoporosis, a greater frequency of activated CD4+ and CD8+ T cells are found. When virologically suppressed on cART, those with lower bone mineral density had a greater frequency of activated CD4+ and CD8+ T cells. This finding suggests that some immune activation leading to decreased bone density occurs, despite virologic suppression. The clinical significance of these findings remain to be determined.
What will be when we're free from Hep C?
Trofile 2
Rituxan focused issue cards
Rituxan DLBCL
Lupus Initiative Awareness Campaign
Brevagen Breast Cancer Genetic Risk Assessment
Essential Elements: Multiple Sclerosis
Healthcare Professional content: Trintellix
Product Launch: YUPELRI for COPDLeader for creative team tackling the first branded product ever launched by Mylan. Managed a nervous marketing team, and a skittish MLR panel through concepting, market research, messaging, and finally full campaign development.
YUPELRI Patient Website Leader for creative team tackling the first branded product ever launched by Mylan. Managed nervous marketing team, a skittish MLR panel through concepting, market research, messaging, and finally full campaign development. This was the original concept for the patient promotional campaign. Ended up with this model driving a convertible. We tried.
RSV Disease State Education for Healthcare Professionals
Biomarin Discover Dysplasias Rare Disease Website
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