Abstract
Aflatoxin suppresses cellular immunity and accentuates HIV-associated changes in T- cell phenotypes and B- cells. This prospective study was conducted to examine the association of aflatoxin levels with CD4 T-cell count and antiretroviral therapy uptake over time. Sociodemographic and food data were collected from antiretroviral therapy naïve HIV-infected patients. CD4+ counts were collected from participants' medical records. Plasma samples were tested for aflatoxin B1 albumin adducts, hepatitis B surface antigen, and HIV viral load. Participants were separated into high and low aflatoxin groups based on the median aflatoxin B1 albumin adduct level of 10.4 pg/ml for data analysis. Participants with high aflatoxin B1 albumin adduct levels had lower mean CD4 at baseline and at each follow-up period. Adjusted multivariable logistic regression analysis showed that higher baseline aflatoxin B1 adduct levels were associated with statistically significant lower CD4 counts (est = -66.5, p = 0.043). Not starting ART and low/middle socioeconomic status were associated with higher CD4 counts (est = 152.2, p<0.001) and (est = 86.3, p = 0.027), respectively. Consistent correlations of higher aflatoxin B1 adduct levels with lower CD4 over time indicate that there is an independent early and prolonged effect of aflatoxin on CD4 even with the initiation of antiretroviral therapy. The prospective study design, evaluation of baseline and follow-up measures, extensive control for potential confounders, and utilization of objective measures of aflatoxin exposure and CD4 count provide compelling evidence for a strong epidemiologic association that deserves careful attention in HIV care and treatment programs.
Highlights
Aflatoxins are carcinogenic metabolites produced in food crops primarily by two species of Aspergillus fungi, namely A. flavus and A. parasiticus [1]
Adjusted multivariable logistic regression analysis showed that higher baseline aflatoxin B1 adduct levels were associated with statistically significant lower CD4 counts
Investigation of immune status of HIVpositive people chronically exposed to aflatoxin in their diets, showed significantly lower percentages of CD4+ T regulatory cells, naïve CD4+ T-cells, perforin-expressing CD8+ T-cells, and B-cells in those with high AF-ALB compared to those with lower AF-ALB levels [19]. These findings indicate that changes in T-cell phenotypes and B-cells that occur in Human immunodeficiency virus (HIV) are amplified by aflatoxin exposure
Summary
Aflatoxins are carcinogenic metabolites produced in food crops primarily by two species of Aspergillus fungi, namely A. flavus and A. parasiticus [1]. These fungi are ubiquitous in soil and on vegetation and produce toxins in a variety of staple food crops such as cereals (e.g. maize, millet, rice, and wheat), legumes and oilseeds (soybean and groundnuts), and a number of other crops such as tree nuts, root and tuber crops and spices [2]. Studies conducted in humans with chronic exposure to dietary aflatoxin show that blood levels of aflatoxin B1 albumin adducts (AF-ALB) are associated with antibody and cellular immunity [17,18,19]. Aflatoxin suppresses cellular immunity and accentuates HIV-associated changes in T- cell phenotypes and B- cells
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