International Journal of Nutrition, Pharmacology, Neurological Diseases

: 2019  |  Volume : 9  |  Issue : 1  |  Page : 1--3

Binge alcohol and HIV: leaky gut and neurodegeneration through the gut–brain axis

Musthafa Mohamed Essa1, Byoung-Joon Song2, Sulie L Chang3,  
1 Department of Food Science and Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat; Institute of Neuroimmune Pharmacology, Seton Hall University, South Orange, NJ, Oman
2 Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism (NIAAA), NIH, Rockville, MD, USA
3 Institute of Neuroimmune Pharmacology, Seton Hall University, South Orange, NJ; Department of Biological Sciences, Seton Hall University, South Orange, NJ, USA

Correspondence Address:
Musthafa Mohamed Essa
Department of Food Science and Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat

How to cite this article:
Essa MM, Song BJ, Chang SL. Binge alcohol and HIV: leaky gut and neurodegeneration through the gut–brain axis.Int J Nutr Pharmacol Neurol Dis 2019;9:1-3

How to cite this URL:
Essa MM, Song BJ, Chang SL. Binge alcohol and HIV: leaky gut and neurodegeneration through the gut–brain axis. Int J Nutr Pharmacol Neurol Dis [serial online] 2019 [cited 2020 Oct 21 ];9:1-3
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Full Text

Currently, approximately 1.2 million people in the United States and 36.7 million individuals globally[1],[2] are living with human immunodeficiency virus (HIV) infection. Unfortunately, around 20% of HIV-infected people do not know whether they are infected with HIV[1] and continue unhealthy lifestyles of tobacco smoking, binge alcohol drinking, and intake of n-6 fatty acid-rich junk foods. In addition, binge drinking is now considered as a major public health problem and accounts for more than 75% of alcohol consumed in the United States.[3] Furthermore, alcohol abuse is a major cause of various disease states frequently observed in HIV-infected people[4] as approximately 50% of these HIV-infected people often indulge in binge drinking.[5]

Binge alcohol consumption is also considered one of the risk factors for HIV infection[1] and excessive alcohol intake could accelerate the progression of acquired immunodeficiency syndrome (AIDS).[6] Binge drinking could increase the risk of tissue injury in many organs. In the liver, it can cause severe hepatitis, fibrosis, cirrhosis, and carcinogenesis with liver failure, which is considered one of the main causes of death in HIV-infected people.[3],[4],[5] In the brain, excessive alcohol intake can cause Wernicke-Korsakoff syndrome, fetal alcohol syndrome, cerebellar degeneration, and dementia. Elevated bacterial endotoxin, including lipopolysaccharide from gut leakage, has been reported to play a critical role in the development and progression of both alcoholic[7] and nonalcoholic[8] inflammatory tissue injuries. Recent reports suggest that HIV-infected people with suppressed replication of HIV-1 due to treatment with the highly active antiretroviral therapy[9],[10] are more sensitive to alcohol-induced gut leakiness, resulting in inflammatory tissue injury. It is important to emphasize that HIV infection is also thought to change intestinal microbial composition and increase gut leakiness, prior to manifestations of AIDS-associated chronic inflammation and more severe symptoms, such as HIV-associated cognitive disorders (HAND) and HIV-associated dementia (HAD).[11],[12] However, the molecular mechanisms for intestinal microbiome change, elevated gut leakage, and advanced inflammatory disease observed in HIV-infected people are not well understood.

Elevated neuronal death and impaired cognition are common outcomes of alcohol abuse and HIV-1 infection.[13] Studies suggest that the onset and progression of HIV-associated neurological disorders could be highly impacted by binge drinking.[14] In addition, abused drugs (like morphine) are highly common during excessive drinking, which further leads to the accelerated progression of opioid use disorders and tissue injury.[15] Combined effect of HIV and binge drinking result in excessive production of free radicals, including reactive oxygen and nitrogen species, which can enhance mitochondrial dysfunction, energy imbalance, and necroapoptosis of parenchymal cells, eventually contributing to leaky gut, endotoxemia, neuroinflammation, tauopathy, and neurotoxicity. Increased neuroinflammation and neuroimmune signaling are highly linked with neuronal dysfunction.[16],[17] The level of interleukin (IL)-18, a proinflammatory cytokine produced in microglia of brain, was elevated in HIV-1-infected people.[18],[19] In addition, increased IL-18 and other proinflammatory cytokines/chemokines are highly associated with neuroinflammation followed by motor and cognitive dysfunction.[14] All these alterations likely lead to activation of glial cells and astrocytes followed by increased neuronal cell death with impaired cognition and behavior, ultimately contributing to neurodegeneration such as HAND and HAD [Figure 1]. The mechanisms by which alcohol, abused drugs, and HIV-1 infection promote gut leakage and further neurodegeneration are not well defined. We believe that this area needs to be extensively studied to elucidate the gut–brain interactions and generate the lead compounds for novel therapeutic strategies against pathologies associated with HIV and binge alcohol drinking alone or in combination.{Figure 1}

Numerous reports conducted in both animals and humans demonstrated that alcohol consumption, one of the widely abused substances, elevates the AIDS-related disease progression. For instance, preclinical and clinical studies showed a direct correlation between alcohol abuse and escalation of the HIV-associated neurodegeneration. Binge alcohol intake is likely to directly promote neuroinflammation and neurodegeneration in HIV-infected individuals as well as indirectly through the leaky gut and endotoxemia. Oxidative/nitrosative stress and the possible involvement of tryptophan metabolites associated with neuroinflammation might be major contributors to HAND and HAD in HIV-infected people especially with binge alcohol consumption. Based on these mechanistic studies on the HIV-associated disease states, numerous investigators have recently started studying the benefits of natural molecules, including n-3 fatty acids, against these ailments. Supplementation with docosahexaenoic acid and eicosapentaenoic acid could be able to reduce the amounts of IL-6, IL-18, and nuclear factor-KB in the striatum and pave a novel way to alleviate the additive or synergistic effects of HIV infection and binge drinking.[14] Dietary supplementation with n-3 fatty acids and/or some polyphenols, including ellagic acid, urolithin, curcumin, or quercetin, may have beneficial effects on the development and progression of HAND/HAD. To find out the exact mechanism(s) of action, extensive preclinical and clinical studies are warranted.

Financial support and sponsorship

Partially funded from NIAAA and NIDA, NIH, USA to SLC and BJS.

Conflicts of interest

There are no conflicts of interest.


1Center for Disease Control (CDC), Division of HIV/AIDS Prevention. HIV in the United States. 2011.
2 WHO Global Health Observatory data. 2015. Available at: [Accessed on 2015 Oct 6]
3Center for Disease Control (CDC). Fact Sheets: Binge Drinking, Vol. 2011. Atlanta, GA: Center for Disease Control and Prevention; 2010.
4Petry NM. Alcohol use in HIV patients: what we don’t know may hurt us. Int J Std AIDS 1999;10:561-70.
5Conigliaro J, Gordon AJ, McGinnis KA, Rabeneck L, Justice AC, Veterans Aging Cohort 3-Site Study. How harmful is hazadous alcohol use and abuse in HIV infection: do health care provides know who is at risk?. J Acquir Immune Defic Syndr 2003;33:521-5.
6Samet JH, Horton NJ, Traphagen ET, Lyon SM, Freedberg KA. Alcohol consumption and HIV disease progression: are they related? Alcoholism Clin Exp Res 2003;27:862-7.
7Keshavarzian A, Farhadi A, Forsyth CB, Rangan J, Jakate S, Shaikh M et al. Evidence that chronic alcohol exposure promotes intestinal oxidative stress, intestinal hyperpermeability and endotoxemia prior to development of alcoholic steatohepatitis in rats. J Hepatol 2009;50:538-47.
8Farhadi A, Gundlapalli S, Shaikh M, Frantzides C, Harrell L, Kwasny MM et al. Susceptibility to gut leakiness: a possible mechanism for endotoxemia in non-alcoholic steatohepatitis. Liver Int 2008;28:1026-33.
9Reid W, Sadowska M, Denaro F, Rao S, Foulke J Jr., Hayes N et al. An HIV-1 transgenic rat that develops HIV-related pathology and immunologic dysfunction. Proc Natl Acad Sci U S A 2001;98:9271–6.
10Peng J, Vigorito M, Liu X, Zhou D, Wu X, Chang SL. The HIV-1 transgenic rats as a model for HIV-1 infected individuals on HAART. J Neuroimmunol 2010;218(1-2):94-101.
11Banerjee A, Abdelmegeed MA, Jang S, Song BJ. Increased sensitivity to binge alcohol induced gut leakiness and inflammatory liver disease in HIV transgenic rats. PLoS One 2015;10:e0140498.
12Sandler NG, Douek DC. Microbial translocation in HIV infection: causes, consequences and treatment opportunities. Nat Rev Microbiol 2012;10:655-66.
13Persidsky Y, Ho W, Ramirez SH, Potula R, Abood ME, Unterwald E et al. HIV-1 infection and alcohol abuse: neurocognitive impairment, mechanisms of neurodegeneration and therapeutic interventions. Brain Behav Immun 2011;25(Suppl 1):S61-70.
14He J, Huang W, Zheng S, Vigorito M, Chang SL. Effects of docosahexaenoic acid on locomotor activity in ethanol-treated HIV-1 transgenic rats. J Neurovirol 2018;24:88-97.
15Chang SL, Huang W, Han H, Sariyer IK. Binge-like exposure to ethanol enhances morphine’s anti-nociception in B6 mice. Front Psychiatry 2019;9:756.
16Hong H, Kim BS, Im HI. Pathophysiological role of neuroinflammation in neurodegenerative diseases and psychiatric disorders. Int Neurourol J 2016;20(Suppl 1):S2-7.
17Park G, Lee SH, Oh DS, Kim YU. Melatonininhibits neuronal dysfunction-associated with neuroinflammation by atopic psychological stress in NC/Nga atopic-like mouse models. J Pineal Res 2017;e12420.1-21.
18Ahmad R, Sindhu ST, Toma E, Morisset R, Ahmad A. Elevated levels of circulating interleukin-18 in human immunodeficiency virus-infected individuals: role of peripheral blood mononuclear cells and implications for AIDS pathogenesis. J Virol 2002;76:12448-56.
19Prinz M, Hanisch UK. Murine microglial cells produce and respond to interleukin-18. J Neurochem 1999;72:2215-8.