The headline was hard to stomach: hiv hides in the gut. A University of California at Davis study confirmed that while meds may render the HIV in your bloodstream undetectable, your gastrointestinal (GI) tract lining may still teem with HIV. Because the lining, rich in CD4 cells, houses 70% of your immune system, study leader Satya Dandekar, PhD, suggests starting HIV meds immediately after infection to slow gut-tissue CD4-cell losses. Others wonder whether that’s effective—or necessary.
Dandekar compared the small intestines of ten people who’d gone medless for one to three years after contracting HIV with those of three who’d started meds within four to six weeks of infection. Early treaters, Dandekar says, “had less gut virus and inflammation and more surviving CD4 cells.” She also suggests testing gut-tissue viral load with biopsies (done by inserting a tube through the mouth or rectum) in addition to regular HIV labs.
But Marty Markowitz, MD, who does similar research (but on the large intestine) at New York City’s Aaron Diamond AIDS Research Center, says, “Hitting gut HIV early isn’t applicable,” because even people in his study who’d started meds 14 days after infection had already lost the CD4s. But this caused no symptoms, he says: “no link [with] opportunistic infections, poor treatment outcomes or overall health, nor, most significantly, with increased GI disease.” Dandekar says future HIV meds may hit this HIV reservoir; Markowitz says we won’t know until clinical trials start doing biopsies. Until then, we’ll have to go with our gut.