PLoS ONE (Jan 2021)

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

  • Christine Kelly,
  • Willard Tinago,
  • Dagmar Alber,
  • Patricia Hunter,
  • Natasha Luckhurst,
  • Jake Connolly,
  • Francesca Arrigoni,
  • Alejandro Garcia Abner,
  • Raphael Kamn'gona,
  • Irene Sheha,
  • Mishek Chammudzi,
  • Kondwani Jambo,
  • Jane Mallewa,
  • Alicja Rapala,
  • Patrick W G Mallon,
  • Henry Mwandumba,
  • Nigel Klein,
  • Saye Khoo

DOI
https://doi.org/10.1371/journal.pone.0256576
Journal volume & issue
Vol. 16, no. 8
p. e0256576

Abstract

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BackgroundNon-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.MethodsWe recruited Malawian adults with CD4ResultsOf 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).ConclusionsSocioeconomic 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.