Relationship between economic insecurity, inflammation, monocyte activation and intestinal integrity in children living with HIV in Uganda

ABSTRACT

We aimed to evaluate differences in socio-economic variables in a Ugandan cohort of children with perinatally acquired HIV (PHIVs), HIV exposed uninfected (HEU) and HIV unexposed uninfected (HIV-) children and their associations with markers of inflammation and intestinal integrity. This is a cross-sectional study in 57 PHIV, 59 HEU and 56 HIV – children aged 2–10 years old enrolled in Uganda. Mean age of all participants was 7 years and 55% were girls. Compared to HEU and HIV – children, PHIVs were more likely to have parents that only completed a primary education, live in a household without electricity and live in poverty (p≤0.034). PHIVs living in poverty had higher IL-6 (p=0.006), those with lack of electricity had higher hsCRP, IL6, sTNFRII and d-dimer (p≤0.048) and PHIVs with an unprotected water source had higher IL6 and d-dimer (p≤0.016). After adjusting for demographic and HIV variables, IL-6 and d-dimer remained associated with lack of electricity and having an unprotected water source only in PHIVs (p<0.019). Our findings suggest that addressing economic insecurity may mitigate the persistent low-level inflammation in HIV that lead to many end organ disease. Longitudinal studies are needed to better understand the impact of socioeconomic factors on HIV inflammation and comorbidities.

KEYWORDS:

• Pediatric HIV
• HIV exposed uninfected
• economic vulnerability
• inflammation
• immune activation
• intestinal integrity
• Uganda

Acknowledgements

Competing Interests: GAM served as a consultant for Gilead, GSK/Viiv, and Merck, and has received research funding from Gilead, Merck, GSK/Viiv, Roche, Astellas, Tetraphase, and BMS. NF serves as a consultant for Gilead. All other authors had no conflict of interest. SDF and GAM designed the study and obtained funding. RN and VM oversaw study evaluations and monitoring. AS, ZA provided statistical support. MK, EB and NF performed the biomarker assays. SDF wrote the first draft of the manuscript. All authors contributed to data analysis and reviewed the manuscript for intellectual content.

Disclosure statement

No potential conflict of interest was reported by the author(s).

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The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Additional information

Funding

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD ) to SDF (K23HD088295-01A1).