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 Human Immunodeficiency Virus-1 Infection

Clin Infect Dis. 2017 Oct 30;65(10):1638-1643. doi: 10.1093/cid/cix609.


Background: Translocation of microbial products from the damaged gut causes increased immune activation in human immunodeficiency virus (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.

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

Results: 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 < .01), and LBP (21.78 vs. 18.28 mcg/mL, P = .02) but lower I-FABP levels (608.5 vs. 2281.7 pg/mL, P = .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 = .03). HIV-infected subjects had higher immune activation and microbial translocation biomarkers than uninfected volunteers.

Conclusion: 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.

Keywords: HIV; immune activation; proton pump inhibitors.

MeSH terms

  • Acute-Phase Proteins
  • Adult
  • Aged
  • Bacterial Translocation / drug effects*
  • Carrier Proteins / blood
  • Case-Control Studies
  • Female
  • HIV Infections* / epidemiology
  • HIV Infections* / immunology
  • HIV Infections* / microbiology
  • HIV Infections* / physiopathology
  • Humans
  • Lipopolysaccharide Receptors / blood
  • Lipopolysaccharides / blood
  • Lymphocyte Activation / drug effects*
  • Male
  • Membrane Glycoproteins / blood
  • Middle Aged
  • Proton Pump Inhibitors / adverse effects*
  • T-Lymphocytes


  • Acute-Phase Proteins
  • Carrier Proteins
  • Lipopolysaccharide Receptors
  • Lipopolysaccharides
  • Membrane Glycoproteins
  • Proton Pump Inhibitors
  • lipopolysaccharide-binding protein