Immune Activation: A Link Between Food Insecurity and Chronic Disease in People Living With Human Immunodeficiency Virus

Abstract

Persistent immune activation is a hallmark of HIV infection and thought to play a role on chronic diseases in people with HIV (PWH). Food insecurity is disproportionately prevalent in PWH and is associated with adverse health outcomes. We determined whether food insecurity was associated with increased plasma levels of sCD14, sCD27, and sCD163 in 323 antiretroviral -treated PWH from the Miami Adult Studies on HIV (MASH) Cohort. Nearly half (42.7%) of participants were food insecure and 85.5% were virally suppressed (<200 copies/mL). Food insecurity was independently associated with higher levels of sCD14 and sCD27. Very low food security was associated with increased sCD163 levels among those with lower CD4+ cell counts. Food insecurity may promote immune activation in PWH, suggesting a biological link between food insecurity and chronic disease among PWH. Improving financial security and access to high-quality diets could reduce the burden of disease in this highly vulnerable population.

Food Insecurity and Undernutrition Are Associated With Distinct Immunologic Profiles in People With Tuberculosis and Advanced HIV Starting Antiretroviral Therapy

“…21 In another cohort of people with HIV receiving ART in the United States, food insecurity was associated with greater immune activation, as evidenced by higher levels of soluble CD14 and soluble CD27. 20 In addition, angiogenesis, driven by pathways related to biomarkers such as IL-8 (increased in profiles associated with both undernutrition and food insecurity in our study) or VEGF (increased in the profile associated with food insecurity in our study), has been implicated as a potential mechanism of TB dissemination. 43,44 There are several plausible mechanisms by which food insecurity may drive inflammatory changes independent of undernutrition.…”

“…[45][46][47][48] High-fat diets, in particular, have been associated with food insecurity among people living with HIV and may lead to changes in the gut microbiome, disturbance of the intestinal mucosal barrier, and increased risk of microbial translocation. 19,20,49 Importantly, however, these studies have been conducted in highincome settings where the relationship between food insecurity and dietary patterns may differ from Botswana and similar contexts. Food insecurity's well-documented role as a psychological stressor and contributor to allostatic load are also potential mechanisms driving inflammatory changes.…”

“…Analyses have focused on the general population, [11][12][13][14] animal models, 6 latent TB infection, [15][16][17][18] or HIV on long-term antiretroviral therapy (ART) in high-income countries. [19][20][21] These studies generally suggest that impairments in immune responses are associated with undernutrition and increased immune activation and inflammation are associated with food insecurity among people with HIV on ART.…”

Menopause and estrogen associations with gut barrier, microbial translocation, and immune activation biomarkers in women with and without HIV

“…Consistently, a lack of association between age and sCD14 in people with HIV on ART has been previously observed. 39,40 Estrogens may protect against viral replication and HIV-related immune activation in women with HIV, providing an alternative mechanism by which estrogen depletion may result in immune activation independent of microbial translocation. For example, estrogens have been observed in vitro to inhibit HIV transcription in T cells 7 and to downregulate the inflammatory response of monocytederived macrophages in response to HIV infection.…”

“…Consistently, a lack of association between age and sCD14 in people with HIV on ART has been previously observed. 39,40…”