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Ojo T, Ruan C, Hameed T, Malburg C, Thunga S, Smith J, Vieira D, Snyder A, Tampubolon SJ, Gyamfi J, Ryan N, Lim S, Santacatterina M, Peprah E. HIV, Tuberculosis, and Food Insecurity in Africa—A Syndemics-Based Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031101. [PMID: 35162131 PMCID: PMC8834641 DOI: 10.3390/ijerph19031101] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/16/2022] [Accepted: 01/16/2022] [Indexed: 12/13/2022]
Abstract
The double burden of HIV/AIDS and tuberculosis (TB), coupled with endemic and problematic food insecurity in Africa, can interact to negatively impact health outcomes, creating a syndemic. For people living with HIV/AIDS (PWH), food insecurity is a significant risk factor for acquiring TB due to the strong nutritional influences and co-occurring contextual barriers. We aim to synthesize evidence on the syndemic relationship between HIV/AIDS and TB co-infection and food insecurity in Africa. We conducted a scoping review of studies in Africa that included co-infected adults and children, with evidence of food insecurity, characterized by insufficient to lack of access to macronutrients. We sourced information from major public health databases. Qualitative, narrative analysis was used to synthesize the data. Of 1072 articles screened, 18 articles discussed the syndemic effect of HIV/AIDS and TB co-infection and food insecurity. Reporting of food insecurity was inconsistent, however, five studies estimated it using a validated scale. Food insecure co-infected adults had an average BMI of 16.5–18.5 kg/m2. Negative outcomes include death (n = 6 studies), depression (n = 1 study), treatment non-adherence, weight loss, wasting, opportunistic infections, TB-related lung diseases, lethargy. Food insecurity was a precursor to co-infection, especially with the onset/increased incidence of TB in PWH. Economic, social, and facility-level factors influenced the negative impact of food insecurity on the health of co-infected individuals. Nutritional support, economic relief, and psychosocial support minimized the harmful effects of food insecurity in HIV–TB populations. Interventions that tackle one or more components of a syndemic interaction can have beneficial effects on health outcomes and experiences of PWH with TB in Africa.
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Affiliation(s)
- Temitope Ojo
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
- Correspondence: ; Tel.: +1-203-690-9449
| | - Christina Ruan
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Tania Hameed
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Carly Malburg
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Sukruthi Thunga
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Jaimie Smith
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Dorice Vieira
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
- NYU Health Sciences Library, 550 First Avenue, New York, NY 10016, USA
| | - Anya Snyder
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Siphra Jane Tampubolon
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Joyce Gyamfi
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Nessa Ryan
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
| | - Sahnah Lim
- Section for Health Equity, Department of Population Health, NYU Langone Health, 180 Madison Avenue, New York, NY 10016, USA;
| | - Michele Santacatterina
- Division of Biostatistics, Department of Population Health, NYU Langone Health, 180 Madison Avenue, New York, NY 10016, USA;
| | - Emmanuel Peprah
- Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA; (C.R.); (T.H.); (C.M.); (S.T.); (J.S.); (D.V.); (A.S.); (S.J.T.); (J.G.); (N.R.); (E.P.)
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Naidoo CC, Nyawo GR, Sulaiman I, Wu BG, Turner CT, Bu K, Palmer Z, Li Y, Reeve BWP, Moodley S, Jackson JG, Limberis J, Diacon AH, van Helden PD, Clemente JC, Warren RM, Noursadeghi M, Segal LN, Theron G. Anaerobe-enriched gut microbiota predicts pro-inflammatory responses in pulmonary tuberculosis. EBioMedicine 2021; 67:103374. [PMID: 33975252 PMCID: PMC8122180 DOI: 10.1016/j.ebiom.2021.103374] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/07/2021] [Accepted: 04/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The relationship between tuberculosis (TB), one of the leading infectious causes of death worldwide, and the microbiome, which is critical for health, is poorly understood. METHODS To identify potential microbiome-host interactions, profiling of the oral, sputum and stool microbiota [n = 58 cases, n = 47 culture-negative symptomatic controls (SCs)] and whole blood transcriptome were done in pre-treatment presumptive pulmonary TB patients. This was a cross-sectional study. Microbiota were also characterised in close contacts of cases (CCCs, n = 73) and close contacts of SCs (CCSCs, n = 82) without active TB. FINDINGS Cases and SCs each had similar α- and β-diversities in oral washes and sputum, however, β-diversity differed in stool (PERMANOVA p = 0•035). Cases were enriched with anaerobes in oral washes, sputum (Paludibacter, Lautropia in both) and stool (Erysipelotrichaceae, Blautia, Anaerostipes) and their stools enriched in microbial genes annotated as amino acid and carbohydrate metabolic pathways. In pairwise comparisons with their CCCs, cases had Megasphaera-enriched oral and sputum microbiota and Bifidobacterium-, Roseburia-, and Dorea-depleted stools. Compared to their CCSCs, SCs had reduced α-diversities and many differential taxa per specimen type. Cases differed transcriptionally from SCs in peripheral blood (PERMANOVA p = 0•001). A co-occurrence network analysis showed stool taxa, Erysipelotrichaceae and Blautia, to negatively co-correlate with enriched "death receptor" and "EIF2 signalling" pathways whereas Anaerostipes positively correlated with enriched "interferon signalling", "Nur77 signalling" and "inflammasome" pathways; all of which are host pathways associated with disease severity. In contrast, none of the taxa enriched in SCs correlated with host pathways. INTERPRETATION TB-specific microbial relationships were identified in oral washes, induced sputum, and stool from cases before the confounding effects of antibiotics. Specific anaerobes in cases' stool predict upregulation of pro-inflammatory immunological pathways, supporting the gut microbiota's role in TB. FUNDING European & Developing Countries Clinical Trials Partnership, South African-Medical Research Council, National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Charissa C Naidoo
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Georgina R Nyawo
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Imran Sulaiman
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, United States
| | - Benjamin G Wu
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, United States
| | - Carolin T Turner
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Kevin Bu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Zaida Palmer
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Yonghua Li
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, United States
| | - Byron W P Reeve
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Suventha Moodley
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Jennifer G Jackson
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Jason Limberis
- Division of Experimental Medicine, University of California, San Francisco, United States
| | - Andreas H Diacon
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Paul D van Helden
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Jose C Clemente
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Robin M Warren
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Leopoldo N Segal
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, United States
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa.
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