Lack of HIV suppression is associated with plasma aflatoxin B1 in Kenyan women living with HIV and receiving anti-retroviral therapy

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Background Aflatoxins are carcinogenic and immunosuppressive compounds found in Aspergillus-contaminated corn. Kenyan women living with HIV (WLWH) receiving antiretroviral therapy (ART) were studied to examine associations of aflatoxin exposure and HIV immune control. Methods Sixty WLWH were enrolled; 56 completed the Month-12 visit. Blood samples were collected for aflatoxin, CD4 cell counts and HIV viral load. Logistic regression and linear regression models were fitted to examine factors associated with (1) detectable HIV viral load, and (2) HIV viral load in copies/mL. Results All WLWH were receiving ART (mean 9.9 years). Eight women (14.3%) had a detectable HIV viral load (mean 12,439 copies/mL). Aflatoxin B1 was detected in 23 of 56 WLWH (41.7%); 17 of 48 (35.4%) with an undetectable HIV viral load, and 6 of 8 (75.0%) with a detectable HIV viral load ( p = 0.053). The mean plasma aflatoxin B1 concentration for all WLWH was 0.0403 pg/μL; 0.0341 pg/μL and 0.0771 pg/μL for WLWH with undetectable or detectable HIV viral loads, respectively ( p = 0.039). Conclusions Aflatoxin B1 detection is associated with lack of HIV viral load suppression, defined as a detectable HIV viral load, among a cohort of Kenyan WLWH, all receiving ART. Studies are needed to determine the mechanisms involved.

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