Intimate Partner Violence is Associated with Increased CD4+ T-Cell Activation Among HIV-Negative High-Risk Women

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Published: Sep 15, 2016
DOI: https://doi.org/10.20411/pai.v1i1.120
Keywords:
intimate partner violence, gender-based violence, spouse abuse, CD4-positive T-lymphocytes, lymphocyte activation, HIV infections, risk, humans, regulatory T-lymphocytes

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Ameeta Shivdas Kalokhe
Emory University School of Medicine, Division of Infectious Diseases; Emory Rollins School of Public Health, Department of Global Health
Chris C. Ibegbu
Yerkes National Primate Research Center, Emory University, Atlanta, GA; Emory Vaccine Center, Department of Microbiology and Immunology, Atlanta, GA
Surinder P. Kaur
Emory Vaccine Center, Department of Microbiology and Immunology, Atlanta, GA
Rama R. Amara
Yerkes National Primate Research Center, Emory University, Atlanta, GA; Emory Vaccine Center, Department of Microbiology and Immunology, Atlanta, GA
http://orcid.org/0000-0002-6309-6797
Mary E. Kelley
Emory Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, GA
Carlos del Rio
Emory School of Medicine, Division of Infectious Diseases, Atlanta, GA; Emory Rollins School of Public Health, Department of Global Health, Atlanta, GA
Rob Stephenson
University of Michigan School of Nursing, Department of Health Behavior and Biological Sciences, Ann Arbor, MI

Abstract

Background: Biological pathways mediating the link between intimate partner violence (IPV) and increased HIV risk remain unexplored. We hypothesized that IPV-induced stress negatively affects HIV systemic immune defenses and aimed to evaluate whether IPV was associated with immune profiles linked to HIV susceptibility: CD4 activation and diminished regulatory T-cell (Treg) frequency.

Methods: Seventy-five HIV-negative high-risk women were surveyed regarding their IPV experience. They provided blood, urine, and (if present) genital ulcer samples for cortisol, immune assays, and STI testing. Using flow cytometry, we assessed activated CD4+ T-cell (%HLA-DR+/CD38+) and Treg (%CD4+CD25+FoxP3+) frequencies and phenotyping. Nonparametric tests evaluated the association between IPV and immune outcomes. Multivariate regression explored confounding and moderation of the IPV-CD4 activation pathway.

Results: Lifetime IPV was associated with increased CD4+ activation (r=0.331, P=0.004), a shift in CD4+ phenotype from naïve to effector memory (r=0.343, P=0.003), and a decrease in naive (%HLA-DR+/CD45RA-) Treg frequency (r=-0.337, P=0.003). Experiencing IPV over the past year had similar trends. After controlling for sexual IPV, lifetime physical and psychological abuse remained significantly associated with CD4+ activation (P=0.004 and P=0.033, respectively). After controlling for race (the only covariate linked to activation), the lifetime IPV-CD4 activation association remained significant (P=0.012). Alcohol use and depression were identified as potential pathway moderators.

Conclusion: Our data is the first to suggest an immune link between IPV and HIV, and may help explain differences at the individual level in HIV susceptibility and response to biological HIV prevention strategies. The association of psychological and physical abuse with CD4 activation independent of sexual abuse further supports the existence of a stress-induced immune pathway.

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Author Biography

Ameeta Shivdas Kalokhe, Emory University School of Medicine, Division of Infectious Diseases; Emory Rollins School of Public Health, Department of Global Health

CD4+ T-cell Activation May Mediate the Effect of Intimate Partner Violence on HIV Susceptibility: a Cross-sectional Study

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