HAART Cocktail Additions

I have speculated that AIDS related dementia, fairly often associated with some kind of aggression, is part of the reproductive evolutionary strategy of HIV.

Unpublished gene chip data. Y scale is number of genes downreg’d. Genes filtered by pathway to remove false responders. Yes, these are gut samples. Even in humans, only 10% of our nervous system is in our head, though we do prize that part very much. There is at least that much in our guts. And note the taste receptors in the gut. What is on our tongues are just a specialized version of what goes all the way down the small intestine. When you eat good food, your gut-brain probably thanks you for it. Probably a good thing our conscious sense of taste doesn’t extend all the way down…

Just saw Dallas Buyers Club last night. It reminded me of when I was working with dying AIDS patients who gave me names of men who had AIDS that were out deliberately trying to infect as many others as possible. One of those patients went through a phase of praying for my early death and little tricks to try to infect me.  There are other diseases that affect behavior such as toxoplasmosis.

HIV hits a lot of gene expressions for neurotransmitters – very early – long before AIDS.  Cannabinoids are downregulated early through glutamate/GAD downregulation, which is why I think HIV+ people should be on Marinol (Dronabinol, tetrahydrocannabinol) or cannabidiol or something like Sativex (GW Pharma).  HIV also has downregulation effect on serotonin. I suspect HIV/AIDS patients would benefit from SSRI/SNRI treatment early.  Some of the behavioral issues physicians see in early stage HIV patients on HAART are probably serotonin downregulation related.

My additions to the HAART cocktail would be:

  • Marinol, Sativex, or medical marijuana preparation.  I do not recommend smoking marijuana for HIV/AIDS. The irritation of the lungs only worsens immune compromise.
  • An SSRI/SNRI drug. (e.g. Prozac, etc.) The usual game of hopscotch trying to find one that the patient likes/tolerates well is required. I suspect early stage may be able to benefit from what would normally be considered subclinical doses for a while.
  • Nortriptyline or Desipramine because these two drugs have been shown to block exit of cytochrome C from cells, which prevents cell death on Huntingtins. Huntingtins genes showed up downregulated, and these drugs may help with prevention/slowing of dementia. They are also pretty benign, unlikely to cause harm. Note that there are interactions between SNRI and tricyclic antidepressants. And I have no data on whether any of the SNRI’s blocks cytochrome C exit or not. So that would lean toward SSRI drugs over SNRI.
  • Xyrem (Gamma hydroxybutyrate (GHB) GHB is available for prescription off-label.  GHB’s a glutamate agonist and improves sleep. Glutamate receptors are downregulated. HIV/AIDS patients often have sleep problems.
  • Baclofen (Gabapentin) might be a reasonable alternative to Xyrem.

New strain of HIV in Africa

Note that the strains in most of Africa are different than in Europe, North and South America. This is consistent with Paul Ewald’s theory that virulent HIV-1 evolved in the bathhouse culture of North America. Also, while subtype C is dominant today in sheer numbers, that has little meaning. What is meaningful here is what it shows about patterns of human sexual interactions.

At 2/3rds of the common strain, 5 year time to progression to AIDS (untreated) from Swedish researchers is significantly less than the average 7-8 years, but I wouldn’t call it extraordinary. Time to AIDS of 2 years is extraordinary. But yeah, it’s worth knowing about.

SIV – Simian immunodeficiency virus. HIV-1 is the most common strain. HIV-2 is a slow progressing strain.

What’s the use of this identification? It should help doctors and patients to make treatment decisions, perhaps help patients keep on HAART. (HIV-1/2 overview)

Of course, in my experience, too many physicians are reluctant to put HIV patients on HAART early, at least in the USA. I’m not sure why that is, perhaps it’s a carryover from the change in attitudes toward prescription of antibiotics. In the case of antibiotics, not prescribing them for every little sniffle is correct. For HIV/AIDS, it’s not.  So patients – shop around. If you have HIV, find a doctor who will be aggressive. But patients, HAART isn’t a picnic in the park, though better than progressing to AIDS – way, way better.

Recombination is fundamental to HIV replication. HIV crosses over while reproducing 2-3 times for every copy made. Combined with the very high mutation rate that means virtually every virus is some sort of mutant, this forms the basis for HIV’s evolutionary survival strategy. HIV will evolve to fill any niche it can find. So if there is a population that vectors it from person to person, it will evolve to the maximum virulence that it can and still keep transmitting successfully. 


I split off the HAART cocktail stuff into a separate post.