Olalla, J et al.  Effect of daily consumption of extra virgin olive oil on the lipid profile and microbiota of HIV-infected patients over 50 years of age. Medicine 2019 Oct; 98(42):e17528. doi: 10.1097/MD.0000000000017528.

Extra virgin olive oil (EVOO), extracted from the “highest quality olives” has been shown to have beneficial effects on cholesterol and inflammatory parameters in the general population. The goal of this study was to assess the benefits of EVOO on lipid levels as well as the intestinal microbiota in adults with HIV disease. This was a single-arm open study of patients ages 50 to 75 years who consumed 50 grams daily of olive oil for 12 weeks. All subjects had to be on ART with an undetectable viral load and CD4 count > 200 for at least six months. Multiple exclusion criteria were applied including alcohol use, history of cancer, HBV/HCV, CVD, and current probiotic use. Twenty patients were initially recruited and 18 completed the study. The authors measured lipid levels, C-reactive protein (CRP) and intestinal microbiota composition at baseline and at the end of this intervention. Stool DNA testing was used to assess the subjects microbiomes. After 12 weeks of EVOO, there was a median decrease in total cholesterol of 5 mg/dL, and a non-significant decrease in LDL cholesterol of 12 mg/dL, triglycerides of 21 mg/dL. CRP declined from 3 mg/dL to 1.75 mg/dL. There was also a significant increase in alpha diversity of bacteria in male subjects and a decrease in pro-inflammatory genera such as Dethiosulfovibrionaceae. Additional differences were also found in the microbiota of men and women and with some variation with the type of ART. The authors believe these data warrant verification of the benefits of EVOO in persons with HIV in a larger study with longer follow up that could also include clinical outcomes.

Author’s Commentary:

Although this is “soft” science, it is worth at least having some dietary information for our patients, as part of the lifestyle maintenance of changes we should be promoting at the office setting. I think these dietary interventions may increase in relevance as we continue to see more data linking new ART regimens with weight gain and hyperlipidemia. The amount of EVOO consumed in this study was only about 1 ½ ounces per day. The clinically beneficial effects of  altering gut flora remain to be determined but many patients already take probiotics. Moreover, there  are observational studies suggesting a benefit in maintaining or restoring intestinal microbiota which we know are adversely impacted by HIV during the acute phase of infection.