Inflammatory pathways amongst people living with HIV in Malawi differ according to socioeconomic status



Kelly, Christine, Tinago, Willard, Alber, Dagmar, Hunter, Patricia, Luckhurst, Natasha, Connolly, Jake, Arrigoni, Francesca, Garcia Abner, Alejandro, Kamn’gona, Raphael, Sheha, Irene
et al (show 8 more authors) (2021) Inflammatory pathways amongst people living with HIV in Malawi differ according to socioeconomic status. PLOS ONE, 16 (8). e0256576-e0256576.

Access the full-text of this item by clicking on the Open Access link.

Abstract

<jats:sec id="sec001"> <jats:title>Background</jats:title> <jats:p>Non-communicable diseases (NCDs) are increased amongst people living with HIV (PLWH) and are driven by persistent immune activation. The role of socioeconomic status (SES) in immune activation amongst PLWH is unknown, especially in low-income sub-Saharan Africa (SSA), where such impacts may be particularly severe.</jats:p> </jats:sec> <jats:sec id="sec002"> <jats:title>Methods</jats:title> <jats:p>We recruited Malawian adults with CD4&lt;100 cells/ul two weeks after starting ART in the REALITY trial (NCT01825031), as well as volunteers without HIV infection. Clinical assessment, socioeconomic evaluation, blood draw for immune activation markers and carotid femoral pulse wave velocity (cfPWV) were carried out at 2- and 42-weeks post-ART initiation. Socioeconomic risk factors for immune activation and arterial stiffness were assessed using linear regression models.</jats:p> </jats:sec> <jats:sec id="sec003"> <jats:title>Results</jats:title> <jats:p>Of 279 PLWH, the median (IQR) age was 36 (31–43) years and 122 (44%) were female. Activated CD8 T-cells increased from 70% amongst those with no education to 88% amongst those with a tertiary education (p = 0.002); and from 71% amongst those earning less than 10 USD/month to 87% amongst those earning between 100–150 USD/month (p = 0.0001). Arterial stiffness was also associated with higher SES (car ownership p = 0.003, television ownership p = 0.012 and electricity access p = 0.029). Conversely, intermediate monocytes were higher amongst those with no education compared to a tertiary education (12.6% versus 7.3%; p = 0.01) and trended towards being higher amongst those earning less than 10 USD/month compared to 100–150 USD/month (10.5% versus 8.0%; p = 0.08). Water kiosk use showed a protective association against T cell activation (p = 0.007), as well as endothelial damage (MIP1β, sICAM1 and sVCAM1 p = 0.047, 0.026 and 0.031 respectively).</jats:p> </jats:sec> <jats:sec id="sec004"> <jats:title>Conclusions</jats:title> <jats:p>Socioeconomic risk factors for persistent inflammation amongst PLWH in SSA differ depending on the type of inflammatory pathway. Understanding these pathways and their socioeconomic drivers will help identify those at risk and target interventions for NCDs. Future studies assessing drivers of inflammation in HIV should include an SES assessment.</jats:p> </jats:sec>

Item Type: Article
Uncontrolled Keywords: Humans, HIV Infections, Inflammation, Water, Family Characteristics, Social Class, Adult, Educational Status, Income, Malawi, Female, Male, Biomarkers, Carotid-Femoral Pulse Wave Velocity
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 30 Sep 2021 15:25
Last Modified: 18 Jan 2023 21:27
DOI: 10.1371/journal.pone.0256576
Open Access URL: https://doi.org/10.1371/journal.pone.0256576
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3138844