Abstract
The introduction of non-breastmilk foods to HIV-infected infants is associated with increased levels of immune activation, which can impact the rate of HIV disease progression. This is particularly relevant in countries where mother-to-child transmission of HIV still occurs at unacceptable levels. The goal of this study was to evaluate the levels of the toxic food contaminant ochratoxin A (OTA) in HIV-exposed South African infants that are either breastfed or consuming non-breast milk foods. OTA is a common mycotoxin, found in grains and soil, which is toxic at high doses but has immunomodulatory properties at lower doses. Samples from HIV-exposed and HIV-unexposed infants enrolled in prospective observational cohort studies were collected and analyzed at birth through 14 weeks of age. We observed that infants consuming non-breast milk foods had significantly higher plasma levels of OTA at 6 weeks of age compared to breastfed infants, increasing until 8 weeks of age. The blood levels of OTA detected were comparable to levels observed in OTA-endemic communities. OTA plasma levels correlated with HIV target cell activation (CCR5 and HLADR expression on CD4+ T cells) and plasma levels of the inflammatory cytokine CXCL10. These findings provide evidence that elevated OTA levels in South African infants are associated with the consumption of non-breastmilk foods and activation of the immune system. Reducing infant OTA exposure has the potential to reduce immune activation and provide health benefits, particularly in those infants who are HIV-exposed or HIV-infected.
Highlights
Exclusive breastfeeding is strongly recommended by the World Health Organization for all infants, irrespective of HIV status
We provide evidence that ochratoxin A (OTA) levels are elevated in non-breastfed South African infants and that this elevation is associated with T cell activation in HIV-exposed South African infants
To assess plasma levels of the mycotoxin OTA in HIV-exposed, uninfected infants, we evaluated samples from infants enrolled in two studies in Khayelitsha, South Africa [37], an informal settlement just outside of Cape Town, South Africa, which followed infants until 14 weeks of age
Summary
Exclusive breastfeeding is strongly recommended by the World Health Organization for all infants, irrespective of HIV status. Exclusive breastfeeding has been associated with reductions in rates of gastrointestinal infections, childhood asthma, obesity, and childhood leukemia [1]. Exclusively breastfed infants have been shown to have lower levels of pro-inflammatory bacterial taxa in their stool and reduced gut permeability when compared to formula-fed infants [2,3,4]. In addition to providing unique nutritional and immunological benefits, exclusive breastfeeding is especially beneficial in areas where access to safe, clean food, and water is compromised [5]. Many infants in low-income settings are introduced to non-breast milk foods early in life [6].
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