Elevated stress-responsive biomarkers are associated with HIV acquisition in young women in rural South Africa

• Published in: AIDS (London) Vol. 38; no. 13; pp. 1866 - 1873
• Main Authors: Stoner, Marie C D, Kelly, Nicole K, Gomez-Olive, F Xavier, Mall, Sumaya, Wagner, Danielle, Aiello, Allison E, Bhushan, Nivedita, Kahn, Kathleen, Pettifor, Audrey E
• Format: Journal Article
• Language: English
• Published: England 01.11.2024
• Subjects: Adolescent; Adult; Antibodies, Viral - blood; Biomarkers - blood; C-Reactive Protein - analysis; Case-Control Studies; Cytomegalovirus - immunology; Female; Herpesvirus 1, Human - immunology; HIV Infections - epidemiology; Humans; Incidence; Rural Population; South Africa - epidemiology; Young Adult; South Africa
• ISSN: 0269-9370; 1473-5571; 1473-5571
• DOI: 10.1097/QAD.0000000000003981

Biological markers of stress have been associated with HIV progression and pathogenesis but not with HIV incidence. We sought to determine if elevated stress-responsive biomarkers would be associated with incident HIV among adolescent girls and young women (AGYW). We conducted a case-cohort study within the HIV Prevention Trials Network (HPTN) 068 study among 949 AGYW in South Africa. Cases were AGYW who tested HIV-positive during the eight-year follow-up. Unmatched controls were randomly selected from the HIV-negative population at enrollment. Dried blood spots from cases and controls were tested from enrollment (2011-2012) for C-reactive protein (CRP), herpes simplex virus type-1 (HSV-1) antibody titers, and cytomegalovirus (CMV) antibody titers. Cox proportional hazards models estimated the association between each biomarker and time to incident HIV. Compared to AGYW with the lowest CRP levels, those with medium and high CRP levels had a higher hazard ratio (HR) of incident HIV [HR: 1.45, 95% confidence interval (CI): 0.95, 2.21; HR: 1.50, 95% CI: 0.98, 2.30, respectively], although not statistically significant. The relative hazard of incident HIV was also higher among AGYW who were CMV seropositive vs. seronegative (low antibodies HR: 2.18, 95% CI: 1.2, 3.87; medium HR: 2.25, 95% CI: 1.28, 3.95; high HR: 1.78, 95% CI: 0.99, 3.21). Those with the highest HSV-1 antibody levels experienced an increased hazard of HIV compared to those who were HSV-1 seronegative (HR: 1.58, 95% CI: 1.03, 2.44). Biological stress may increase AGYW's susceptibility to HIV acquisition through changes in immune function, viral infection, and increased biological vulnerability to disease.