PMID- 34432828 OWN - NLM STAT- MEDLINE DCOM- 20211207 LR - 20211214 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 16 IP - 8 DP - 2021 TI - Inflammatory pathways amongst people living with HIV in Malawi differ according to socioeconomic status. PG - e0256576 LID - 10.1371/journal.pone.0256576 [doi] LID - e0256576 AB - BACKGROUND: Non-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. METHODS: We recruited Malawian adults with CD4<100 cells/ul two weeks after starting ART in the REALITY trial (NCT01825031), as well as volunteers without HIV infection. Clinical assessment, socioeconomic evaluation, blood draw for immune activation markers and carotid femoral pulse wave velocity (cfPWV) were carried out at 2- and 42-weeks post-ART initiation. Socioeconomic risk factors for immune activation and arterial stiffness were assessed using linear regression models. RESULTS: Of 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 (MIP1beta, sICAM1 and sVCAM1 p = 0.047, 0.026 and 0.031 respectively). CONCLUSIONS: Socioeconomic 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. FAU - Kelly, Christine AU - Kelly C AUID- ORCID: 0000-0002-3239-7714 AD - Cente for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland. AD - Malawi Liverpool Wellcome Trust Clinical Research Program, Blantyre, Malawi. AD - Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom. FAU - Tinago, Willard AU - Tinago W AD - Cente for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland. FAU - Alber, Dagmar AU - Alber D AD - Institute of Child Health, University College London, London, United Kingdom. FAU - Hunter, Patricia AU - Hunter P AD - Institute of Child Health, University College London, London, United Kingdom. FAU - Luckhurst, Natasha AU - Luckhurst N AD - Kingston University, London, United Kingdom. FAU - Connolly, Jake AU - Connolly J AD - Kingston University, London, United Kingdom. FAU - Arrigoni, Francesca AU - Arrigoni F AUID- ORCID: 0000-0001-8179-4700 AD - Kingston University, London, United Kingdom. FAU - Garcia Abner, Alejandro AU - Garcia Abner A AD - Cente for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland. FAU - Kamn'gona, Raphael AU - Kamn'gona R AD - Malawi Liverpool Wellcome Trust Clinical Research Program, Blantyre, Malawi. FAU - Sheha, Irene AU - Sheha I AD - Malawi Liverpool Wellcome Trust Clinical Research Program, Blantyre, Malawi. FAU - Chammudzi, Mishek AU - Chammudzi M AD - Malawi Liverpool Wellcome Trust Clinical Research Program, Blantyre, Malawi. FAU - Jambo, Kondwani AU - Jambo K AD - Malawi Liverpool Wellcome Trust Clinical Research Program, Blantyre, Malawi. FAU - Mallewa, Jane AU - Mallewa J AD - College of Medicine, University of Malawi, Blantyre, Malawi. FAU - Rapala, Alicja AU - Rapala A AD - Institute of Cardiovascular Science, University College London, London, United Kingdom. FAU - Mallon, Patrick W G AU - Mallon PWG AD - Cente for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland. FAU - Mwandumba, Henry AU - Mwandumba H AD - Malawi Liverpool Wellcome Trust Clinical Research Program, Blantyre, Malawi. FAU - Klein, Nigel AU - Klein N AD - Institute of Child Health, University College London, London, United Kingdom. FAU - Khoo, Saye AU - Khoo S AD - Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom. LA - eng SI - ClinicalTrials.gov/NCT01825031 GR - 099934/Z/12/A/WT_/Wellcome Trust/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210825 PL - United States TA - PLoS One JT - PloS one JID - 101285081 RN - 0 (Biomarkers) RN - 059QF0KO0R (Water) SB - IM MH - Adult MH - Biomarkers/metabolism MH - Carotid-Femoral Pulse Wave Velocity MH - Educational Status MH - Family Characteristics MH - Female MH - HIV Infections/*epidemiology/immunology/*pathology/physiopathology MH - Humans MH - Income MH - Inflammation/*epidemiology/immunology/*pathology/physiopathology MH - Malawi/epidemiology MH - Male MH - *Social Class MH - Water PMC - PMC8386842 COIS- The authors have declared that no competing interests exist. EDAT- 2021/08/26 06:00 MHDA- 2021/12/15 06:00 PMCR- 2021/08/25 CRDT- 2021/08/25 17:24 PHST- 2020/07/15 00:00 [received] PHST- 2021/08/11 00:00 [accepted] PHST- 2021/08/25 17:24 [entrez] PHST- 2021/08/26 06:00 [pubmed] PHST- 2021/12/15 06:00 [medline] PHST- 2021/08/25 00:00 [pmc-release] AID - PONE-D-20-21907 [pii] AID - 10.1371/journal.pone.0256576 [doi] PST - epublish SO - PLoS One. 2021 Aug 25;16(8):e0256576. doi: 10.1371/journal.pone.0256576. eCollection 2021.