Abstract
The association between aflatoxin exposure and alteration in immune responses observed in humans suggest that aflatoxin could suppress the immune system and work synergistically with HIV to increase disease severity and progression to AIDS. No longitudinal study has been conducted to assess exposure to aflatoxin (AF) among HIV positive individuals. We examined temporal variation in AFB1 albumin adducts (AF-ALB) in HIV positive Ghanaians, and assessed the association with socioeconomic and food consumption factors. We collected socioeconomic and food consumption data for 307 HIV positive antiretroviral naive adults and examined AF-ALB levels at recruitment (baseline) and at six (follow-up 1) and 12 (follow-up 2) months post-recruitment, by age, gender, socioeconomic status (SES) and food consumption patterns. Generalized linear models were used to examine the influence of socioeconomic and food consumption factors on changes in AF-ALB levels over the study period, adjusting for other covariates. AF-ALB levels (pg/mg albumin) were lower at baseline (mean AF-ALB: 14.9, SD: 15.9), higher at six months (mean AF-ALB: 23.3, SD: 26.6), and lower at 12 months (mean AF-ALB: 15.3, SD: 15.4). Participants with the lowest SES had the highest AF-ALB levels at baseline and follow up-2 compared with those with higher SES. Participants who bought less than 20% of their food and who stored maize for less than two months had lower AF-ALB levels. In the adjusted models, there was a statistically significant association between follow up time and season (dry or rainy season) on AF-ALB levels over time (p = 0.04). Asymptomatic HIV-positive Ghanaians had high plasma AF-ALB levels that varied according to season, socioeconomic status, and food consumption patterns. Steps need to be taken to ensure the safety and security of the food supply for the population, but in particular for the most vulnerable groups such as HIV positive people.
Highlights
The human immunodeficiency virus (HIV) suppresses the immune system leading to the development of Acquired Immune Deficiency Syndrome (AIDS)
Aflatoxins are a group of extremely toxic metabolites, produced in staple food crops by the common fungi Aspergillus flavus and A. parasiticus, that have been shown to impair the immune system in animal studies [4,5,6,7,8,9,10] resulting in increased susceptibility to infections, reactivation of chronic infections [8,11,12,13,14,15,16,17,18], and decreased antibody responses to vaccination [8,18]
The majority of study participants were between ages 30–39 years, male participants were slightly older compared with the females (36% of males were ě40 years compared with 22% of females, p = 0.0001)
Summary
The human immunodeficiency virus (HIV) suppresses the immune system leading to the development of Acquired Immune Deficiency Syndrome (AIDS). Chronic dietary exposure to aflatoxin has been shown to interfere with metabolism of proteins [21], food conversion [22], growth [23,24] and a number of micronutrients that are critical to health and immune functioning [25,26,27,28] Since both HIV and aflatoxin suppress the immune system they could work synergistically to increase HIV disease severity and result in faster progression to AIDS. No longitudinal study has been conducted to examine variation in AF-ALB levels among HIV positive people who are chronically exposed to aflatoxin in the diet, changes in aflatoxin levels have been associated with immune suppression, increase in viral load, and HIV disease progression [20,29,30]. We hypothesized that aflatoxin exposure would vary according to the season/time of the year depending on whether predominantly fresh or stored food was being eaten and that socioeconomic status and food consumption factors would be associated with aflatoxin levels in participants
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