Journal Article

The impact of western versus agrarian diet consumption on gut microbiome composition and immune dysfunction in people living with HIV in rural and urban Zimbabwe

Nusbacher, Nichole M., Borok, Margaret, Marden, Tyson, Higgins, Janine, Campbell, Thomas B., Fiorillo, Suzanne, O’Connor, John, Neff, Charles Preston, Burkhart Colorado, Angela Sofia, Boyd, Kathryn, Palmer, Brent E., Lozupone, Catherine, Sterrett, John

2026

Overview

Background People living with HIV (PLWH) suffer from chronic inflammation even with effective antiretroviral therapy (ART). A high-fat, low-fiber western-type diet has been linked with inflammation, in part through gut microbiome changes. In sub-Saharan Africa (SSA), a region with high HIV burden, urbanization has been linked with a shift from traditional agrarian towards westernized diets, and with changes in food security. To explore the relationship between diet, inflammation, and the gut microbiome in PLWH, we enrolled 1) ART Naïve PLWH who provided samples before and after 24 weeks of ART, 2) PLWH on ART at both timepoints and 3) HIV-seronegative controls. Individuals were evenly recruited from rural and urban Zimbabwe. Using a food frequency survey designed to measure intake of agrarian versus western-type food items in Zimbabwe, we determined how diet differs with urbanization, HIV-infection and treatment, and is related to inflammation and the gut microbiome. Results Individuals residing in a rural area of Zimbabwe less frequently consumed high-fat, low-fiber western type food items and had lower consumption of diverse food items overall, except for sadza, a subsistence staple, processed from home-grown grains. Consumption of a more western-type diet correlated with lower CD4 + T cell percentage in untreated and treated PLWH and increased T cell exhaustion in PLWH on ART. PLWH on ART at time of enrollment also consumed diverse food items at a lower frequency and more often were underweight. Low food consumption correlated with muted improvements in T cell exhaustion after 24 weeks of ART. Individuals residing in the rural area had more Prevotella -rich/ Bacteroides -poor microbiomes, but this was not significantly mediated by diet. Carbohydrate substrate degradation capabilities in the microbiome, based on predictions made using metagenomic polysaccharide utilization loci, correlated with dietary intake patterns. Conclusions Taken together, this work supports that consumption of more high-fat/low-fiber type food items has the potential to exacerbate HIV pathogenesis in a sub-Saharan setting where HIV burden is high and reinforces the importance of nutritional support for promoting immunologic response to ART in PLWH in SSA. 35TT7j443dinAMBYPs5hTa Video Abstract

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Adult / Antibiotics / Antiretroviral therapy / Bioinformatics / Biomedical and Life Sciences / Biomedicine / Body mass index / Body weight / CD4 antigen / Diet / Dietary fiber / Dietary intake / Disease / Female / Food consumption / Food security / Gastrointestinal Microbiome / Gut microbiome / Gut microbiota / High fat diet / HIV / HIV Infections - drug therapy / HIV Infections - immunology / HIV Infections - microbiology / Human immunodeficiency virus / Humans / Immune response / Immune system / Infections / Inflammation / Intestinal microflora / Low fat diet / Lymphocytes / Lymphocytes T / Male / Medical Microbiology / Metagenomics / Microbial Ecology / Microbial Genetics and Genomics / Microbiology / Microbiomes / Middle Aged / Nutrient deficiency / Nutrition research / Polysaccharides / Principal components analysis / Processed foods / Rural / Rural areas / Rural Population / Underweight / Urban / Urban areas / Urban Population / Urbanization / Virology / Zimbabwe