Food Insecurity and Undernutrition are Associated with Distinct Immunologic Profiles in People with Tuberculosis and Advanced HIV Starting Antiretroviral Therapy.

Food Insecurity and Undernutrition are Associated with Distinct Immunologic Profiles in People with Tuberculosis and Advanced HIV Starting Antiretroviral Therapy.

Publication date: Feb 12, 2024

Food insecurity and undernutrition are related but distinct concepts contributing to poor HIV and tuberculosis outcomes. Pathways linking them with immunologic profile, which may relate to clinical outcomes, remain understudied. We analyzed data from a cohort study of 165 ART-nacEFve adults with advanced HIV and newly diagnosed tuberculosis in Botswana from 2009-2013. 29 plasma biomarkers were measured pre-ART and four weeks post-ART initiation. We used principal components analysis (PCA) and multivariable linear regression models to assess relationships between immunological profiles and food insecurity (based on the Household Food Insecurity Access Scale), undernutrition (Body Mass Index < 18. 5 kg/m2), and clinical outcomes. PCA identified 5 principal components (PCs) with eigenvalues >1. After adjustment, food insecurity was associated with PC3 pre-ART (0. 19 per increased category of severity, 95% CI 0. 02 to 0. 36) and post-ART (0. 24, 95% CI 0. 07 to 0. 41). PC3 was driven by higher levels of IFN-α, IFN-γ, IL-12p40, VEGF, IL-1α, and IL-8, and decreased concentrations of IL-3. Undernutrition was associated with PC5 post-ART (0. 49, 95% CI 0. 16 to 0. 82). PC5 was driven by higher levels of IL-8, MIP-1α, IL-6, and IL-10, and decreased concentrations in IP-10 and IFN-α. Post-ART PC3 (4. 3 percentage point increased risk per increased score of 1, 95% CI 0. 3 to 8. 9) and post-ART PC5 (4. 8, 95% CI 0. 6 to 8. 9) were associated with death in adjusted models. We identified two distinct immunologic profiles associated with food insecurity, undernutrition, and clinical outcomes in patients with advanced HIV and TB. Different pathophysiologic processes may link food insecurity and undernutrition with poor outcomes in this vulnerable patient population. Future studies should assess the impact of improving food access and intake on immune function and clinical outcomes.

Concepts Keywords
Botswana Advanced
Pc5 Art
Therapy Clinical
Tuberculosis Distinct
Food
Hiv
Il
Immunologic
Insecurity
Outcomes
Pc3
Post
Profiles
Tuberculosis
Undernutrition

Semantics

Type Source Name
disease MESH Undernutrition
disease MESH Tuberculosis
pathway KEGG Tuberculosis
drug DRUGBANK Pidolic Acid
drug DRUGBANK Interleukin-10
disease MESH death

Original Article

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