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Food insecurity is associated with increased
immune activation in people living with HIV
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IAS 2021 July 18-21
Presenter
Javier A. Tamargo
Authors
J.A. Tamargo * (1), J. Hernandez-Boyer (1), H.R. Martin (1), A. Campa (1), S. Sales Martinez (1), T. Li (1), S.D. Rouster (2), H.L. Meeds (2), K.E. Sherman (2), M.K. Baum (1)
Institutions
(1) Florida International University, Dietetics & Nutrition, Miami, United States, (2) University of Cincinnati, College of Medicine, Cincinnati, United States
BACKGROUND: Persistent immune activation is a hallmark of HIV infection and thought to play a role on chronic diseases in people living with HIV (PLWH). Food insecurity, defined as poor access to sufficient and adequate food and nutrition to sustain healthy living, is disproportionately prevalent in PLWH and is associated with adverse health outcomes. We determined whether food insecurity was associated with markers of immune activation in PLWH.
METHODS: The study consisted of a cross-sectional analysis of data from 325 PLWH on stable ART from the Miami Adult Studies on HIV (MASH) cohort, comprised mostly of low-income, middle-aged Blacks and Hispanics. All participants were seronegative for hepatitis B and C. The U.S. Household Food Security Survey was used to assess food insecurity. Biomarkers of monocyte/macrophage (sCD14, sCD163) and lymphocyte (sCD27) activation were measured from plasma; values were log-transformed.
RESULTS: A total of 138 (42.7%) participants were food insecure, with 53 (16.4%), 43 (13.3%), and 42 (13.0%) participants reporting marginal, low, and very low food security, respectively. Most (85.5%) had suppressed HIV viral loads (<200 copies/mL). Food insecurity was independently associated with higher levels of sCD14 (B=0.132, SE=0.05, p=0.008) and sCD27 (B=0.120, SE=0.05, p=0.018). The severity of food insecurity directly correlated with sCD14 (rho=0.151; p=0.006) and sCD27 (rho=0.154; p=0.006). Very low food security was associated with non-suppressed HIV viral load (p=0.02), as well as increased sCD163 levels among those with lower CD4+ cell counts (B=0.534, SE=0.22, t=2.40, p=0.02). Having a non-suppressed viral load was associated with higher levels of sCD14, sCD27, and sCD163. The relationships between food insecurity and markers of immune activation remained consistent after controlling for sociodemographic, clinical, and dietary factors.
CONCLUSIONS: Food insecurity may promote immune activation in PLWH, suggesting a biological link between food insecurity and chronic disease among PLWH. Improving financial security and access to high-quality foods could reduce the high burden of disease in this highly vulnerable population. Future research should consider diet quality, gut-permeability, and microbial translocation as potential mediators of food insecurity and immune activation.
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