Archives

  • 2018-07
  • 2018-10
  • 2018-11
  • 2019-04
  • 2019-05
  • 2019-06
  • 2019-07
  • 2019-08
  • 2019-09
  • 2019-10
  • 2019-11
  • 2019-12
  • 2020-01
  • 2020-02
  • 2020-03
  • 2020-04
  • 2020-05
  • 2020-06
  • 2020-07
  • 2020-08
  • 2020-09
  • 2020-10
  • 2020-11
  • 2020-12
  • 2021-01
  • 2021-02
  • 2021-03
  • 2021-04
  • 2021-05
  • 2021-06
  • 2021-07
  • 2021-08
  • 2021-09
  • 2021-10
  • 2021-11
  • 2021-12
  • 2022-01
  • 2022-02
  • 2022-03
  • 2022-04
  • 2022-05
  • 2022-06
  • 2022-07
  • 2022-08
  • 2022-09
  • 2022-10
  • 2022-11
  • 2022-12
  • 2023-01
  • 2023-02
  • 2023-03
  • 2023-04
  • 2023-05
  • 2023-06
  • 2023-08
  • 2023-09
  • 2023-10
  • 2023-11
  • 2023-12
  • 2024-01
  • 2024-02
  • 2024-03
  • 2024-04
  • 2024-05

    • Considering the work of we need to focus our

    2018-10-30

    Considering the work of , we need to focus our attention on gastrointestinal hypomotility and consider specific interventions. While the authors recommend prophylactic laxative treatment based on evidence from the use of long-term opioids, schizophrenia treatment guidelines pronounce the efficacy of lifestyle modulations and nutrition advice (). However, if the underlying problem is mainly gut dysmotility as indicated by the discussed paper (), the aforementioned intervention could be inadequate to treat this significant treatment side-effect. Further research is needed to evaluate evidence-based treatment recommendation and prevention strategies for antipsychotic-induced constipation. Although the paper by demonstrates a discrepancy between objective measures of gastrointestinal hypomotility and subjective symptom presentation, we should not forget, independent of such high-quality findings, that barriers to somatic monitoring and treatment are one of the major causes of excess mortality in schizophrenia patients ().
    Human immunodeficiency virus (HIV) infection progressively destroys CD4+ mononuclear 17-aag leading to profound cellular immune deficiency that manifests as life threatening opportunistic infections and malignancies, i.e., the acquired immune deficiency syndrome (AIDS). The gut mucosa-associated lymphoid tissue (MALT, e.g., Peyer\'s patches) is a major locus of CD4+ cells. HIV\'s asymptomatic and insidious destruction of these cells compromises the integrity of the gut mucosa, allowing translocation (leakage) of microbes and other luminal contents into the circulation (). Microbial translocation induces subtle but sustained and widespread immune activation, which is a major contributor to HIV\'s pathogenesis (). Given these effects of HIV on the gut mucosa, it is not surprising that several groups have reported alterations of the gut microbial population (the microbiota) in people with HIV, including those in whom HIV is well controlled with antiretroviral therapy (ART) (). These studies comprised heterogeneous or poorly defined populations, used various methods, and have been very small — collectively fewer than 100 HIV-infected subjects including those with early HIV, HIV on ART, chronic HIV viremia without ART, and “elite controllers” (non-viremic without ART). In one recent report (), species-level diversity (termed richness or “alpha diversity”) in feces in 28 HIV viremic patients was significantly lower than in 9 controls; alpha diversity correlated positively with CD4+ cell counts and inversely with plasma markers of microbial translocation and monocyte activation. After ART initiation in these subjects, fecal alpha diversity continued to decrease (), which corroborates findings from others (). In contrast, a more recent and comprehensive study () reported that fecal alpha diversity did not differ between 21 HIV-infected subjects and 22 demographically similar, HIV-uninfected controls, although their HIV subjects did have significantly lower alpha diversity in multiple distal-gut biopsy specimens. These latter findings conflict with the conclusion by that mucosal alpha diversity does not differ consistently with untreated HIV. Considering the composition of the microbial community (termed “beta diversity” or, colloquially, “who\'s there”), the review by noted a shift in a major phylum of the gut microbiota, Bacteroidetes. Compared to various uninfected controls, colon mucosal biopsies and also feces from HIV-infected subjects, irrespective of ART, had lower abundance of Bacteroides and higher abundance of Prevotella. Independently, three studies reported that the HIV-infected subjects had increased abundance of Proteobacteria, including several potential pathogens, in biopsies but not in feces [reviewed in ()]. Higher abundance of mucosal-adherent Proteobacteria supports the hypothesis that an altered microbiota (“dysbiosis”) contributes to a vicious cycle of inflammation, gut permeability, microbial translocation, and progressive immune deficiency through depletion of CD4+ mononuclear cells ().