The interaction between nutrition, immunity and coinfections with human immunodeficiency virus and intestinal parasites in South African adults: investigating the use of prealbumin as a tool for nutritional assessment.

Abstract

Highly prevalent HIV and helminth single infections continue to plague a significant proportion of the South African population. The geographic overlap of these infections lands to the expectation that high prevalence of co-infection with HIV and intestinal helminths exists, although this data for the South African adult population is lacking. Each of these single infections has an impact on the immune system, resulting in impaired responses due to the chronic activation. Also, both infections have an impact on the nutritional status, which may affect the potency of the immune responses, further compromising the immunity. A potent immune system requires adequate nutrition. Obesity, a form of malnutrition may mask micro- and macronutrient deficiency. Furthermore, obesity may result in low-grade inflammation, which may result is dysregulated responses. Therefore, malnutrition may start a cyclical process that may further predispose to infection, which in turn may result in malnutrition, where the cause-and-effect thread between malnutrition, infection and immune deficiency is indiscernible. Based on this, it was hypothesized that the HIV-intestinal helminth co-infection may have a deleterious effect on the nutrition and immunity of affected individuals, which may accelerate HIV progression. Thus, the aim of the study was to investigate the interaction between HIV and intestinal helminth single and co-infection with nutrition and immunity in an adult population (n = 263) in KwaZulu-Natal, a province with high prevalence of both HIV and intestinal helminths infections. The study expected to find an association between the co-infection with lower micro- and macro-nutrient levels, higher HIV viral load, increased immune activation, increased gene expression of Th2 and Treg cytokine responses and decreased Th1 cytokine responses compared to those singly infected and those uninfected with HIV and intestinal helminths. However, the study found no significant association between HIV and intestinal helminth single or co-infection with micro- and macronutrient deficiency, although a general pattern of low intake of the nutrients was noted among the investigated cohort, who had a substantial proportion being overweight and obese. Difficulty in the assessment of nutritional status in the milieu of HIV and intestinal helminth co-infection, obesity and inflammation was noted. Furthermore, HIV-intestinal helminth co-infection was associated with an antiviral cytokine response profile of highly expressed IFN-γ and TNF-α cytokine genes and reduced viral load. The co-infected individuals with the IgEhiIgG4hi intestinal helminth infection phenotype had a compromised immune profile of low CD4 counts. We recommend that antihelminthic interventions are included in the HIV management programmes, particularly in adults.