Skip to main content

Advertisement

SpringerLink
Log in

Food Insecurity Is Associated with Cognitive Deficits Among HIV-Positive, But Not HIV-Negative, Individuals in a United States Sample

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

People living with HIV/AIDS (PLWHA) in the United States (US) have disproportionately high rates of food insecurity (FI). In the general population, FI has been associated with cognitive impairment among older adults and may exacerbate HIV-associated neurocognitive disorders. The current study assessed the effects of FI and HIV infection on the neuropsychological performance of 61 HIV-positive and 36 HIV-negative adults in the US. While the main effects were minimal, the interactive effects revealed that FI was related to deficits in speed of information processing, learning, memory, motor function, and overall cognitive impairment for the HIV-positive group, but not the HIV-negative group. The interactive effects remained after controlling for relevant sociodemographic characteristics. Although bidirectional associations cannot be ruled out in a cross-sectional study, the results suggest that FI may contribute to cognitive impairment among HIV-positive adults in the US. Given the high rates of socioeconomic disadvantage among PLWHA in the US, addressing FI as part of routine clinical care may be warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Pellowski JA, Kalichman SC, Matthews KA, Adler N. A pandemic of the poor: social disadvantage and the U.S. HIV epidemic. Am Psychol. 2013;68(4):197–209.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Singh GK, Azuine RE, Siahpush M. Widening Socioeconomic, Racial, and Geographic Disparities in HIV/AIDS Mortality in the United States, 1987-2011. Adv Prev Med. 2013;2013:657961.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Centers for Disease Control and Prevention. HIV Surveillance Report. 2014;26. http://www.cdc.gov/hiv/library/reports/surveillance/. Accessed 5 Mar 2016.

  4. Adimora AA, Ramirez C, Schoenbach VJ, Cohen MS. Policies and politics that promote HIV infection in the Southern United States. AIDS. 2014;28(10):1393–7.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Katz IT, Ryu AE, Onuegbu AG, et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J Int AIDS Soc. 2013;16(3 Suppl 2):18640.

    PubMed  PubMed Central  Google Scholar 

  6. Siemieniuk RA, Krentz HB, Gill MJ. Intimate partner violence and HIV: a review. Curr HIV/AIDS Rep. 2013;10(4):380–9.

    Article  PubMed  Google Scholar 

  7. Coleman-Jensen A, Rabbitt MP, Gregory C, Singh A. Household food insecurity in the United States in 2014. US Department of Agriculture, Health Services Research. September 2015.

  8. Weiser SD, Bangsberg DR, Kegeles S, Ragland K, Kushel MB, Frongillo EA. Food insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco. AIDS Behav. 2009;13(5):841–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wang EA, McGinnis KA, Fiellin DA, et al. Food insecurity is associated with poor virologic response among HIV-infected patients receiving antiretroviral medications. J Gen Intern Med. 2011;26(9):1012–8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Coleman-Jensen A, Rabbitt MP, Gregory C, Singh A. Household food security in the United States in 2014, ERR-194. US Department of Agriculture, Health Services Research. September 2015.

  11. Campa A, Yang Z, Lai S, et al. HIV-related wasting in HIV-infected drug users in the era of highly active antiretroviral therapy. Clin Infect Dis. 2005;41:1179–85.

    Article  PubMed  Google Scholar 

  12. Kalichman SC, Cherry C, Amaral C, et al. Health and treatment implications of food insufficiency among people living with HIV/AIDS, Atlanta. Georgia. J Urban Health. 2010;87(4):631–41.

    Article  PubMed  Google Scholar 

  13. Weiser SD, Fernandes KA, Brandson EK, et al. The association between food insecurity and mortality among HIV-infected individuals on HAART. J Acquir Immune Defic Syndr. 2009;52(3):342–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Weiser SD, Frongillo EA, Ragland K, Hogg RS, Riley ED, Bangsberg DR. Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco. J Gen Intern Med. 2009;24(1):14–20.

    Article  PubMed  Google Scholar 

  15. Rollins N. Food insecurity–a risk factor for HIV infection. PLoS Med. 2007;4(10):1576–7.

    Article  PubMed  Google Scholar 

  16. Singer AW, Weiser SD, McCoy SI. Does food insecurity undermine adherence to antiretroviral therapy? A systematic review. AIDS Behav. 2015;19(8):1510–26.

    Article  PubMed  Google Scholar 

  17. Young S, Wheeler AC, McCoy SI, Weiser SD. A review of the role of food insecurity in adherence to care and treatment among adult and pediatric populations living with HIV and AIDS. AIDS Behav. 2014;18(Suppl 5):S505–15.

    Article  PubMed  Google Scholar 

  18. Weiser SD, Young SL, Cohen CR, et al. Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. Am J Clin Nutr. 2011;94(6):1729S–39S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Anema A, Vogenthaler N, Frongillo EA, Kadiyala S, Weiser SD. Food insecurity and HIV/AIDS: current knowledge, gaps, and research priorities. Curr HIV/AIDS Rep. 2009;6:224–31.

    Article  PubMed  Google Scholar 

  20. Huang YL, Frazier EL, Sansom SL, et al. Nearly half of US adults living with hiv received federal disability benefits in 2009. Health Aff (Millwood). 2015;34(10):1657–65.

    Article  Google Scholar 

  21. Normen L, Chan K, Braitstein P, et al. Food insecurity and hunger are prevalent among HIV-positive individuals in British Columbia, Canada. J Nutr. 2005;135:820–5.

    CAS  PubMed  Google Scholar 

  22. Wawrzyniak AJ, Rodriguez AE, Falcon AE, et al. Association of individual and systemic barriers to optimal medical care in people living with HIV/AIDS in Miami-Dade County. J Acquir Immune Defic Syndr. 2015;69:S63–72.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ivers LC, Cullen KA, Freedberg KA, Block S, Coates J, Webb P. HIV/AIDS, undernutrition, and food insecurity. Clin Infect Dis. 2009;49(7):1096–102.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hsu JW-C, Pencharz PB, Macallan D, Tomkins A. Macronutrients and HIV/AIDS: a review of current evidence. World Health Organization, Department of Nutrition for Health and Development. 2005.

  25. Shevitz AH, Knox TA, Spiegelman D, Roubenoff R, Gorbach SL, Skolnik PR. Elevated resting energy expenditure among HIV-seropositive persons receiving highly active antiretroviral therapy. AIDS. 1999;13:1351–7.

    Article  CAS  PubMed  Google Scholar 

  26. Kim JH, Spiegelman D, Rimm E, Gorbach SL. The correlates of dietary intake among HIV-positive adults. Am J Clin Nutr. 2001;74:852–61.

    CAS  PubMed  Google Scholar 

  27. Hong S, Banks WA. Role of the immune system in HIV-associated neuroinflammation and neurocognitive implications. Brain Behav Immun. 2015;45:1–12.

    Article  CAS  PubMed  Google Scholar 

  28. Moore DJ, Masliah E, Rippeth JD, et al. Cortical and subcortical neurodegeneration is associated with HIV neurocognitive impairment. AIDS. 2006;20:879–87.

    Article  PubMed  Google Scholar 

  29. Du Plessis S, Vink M, Joska JA, Koutsilieri E, Stein DJ, Emsley R. HIV infection and the fronto-striatal system: a systematic review and meta-analysis of fMRI studies. AIDS. 2014;28(6):803–11.

    Article  PubMed  Google Scholar 

  30. Wilson TW, Heinrichs-Graham E, Robertson KR, et al. Functional brain abnormalities during finger-tapping in HIV-infected older adults: a magnetoencephalography study. J Neuroimmune Pharmacol. 2013;8(4):965–74.

    Article  PubMed  Google Scholar 

  31. Zhu T, Zhong J, Hu R, et al. Patterns of white matter injury in HIV infection after partial immune reconstitution: a DTI tract-based spatial statistics study. J Neurovirol. 2013;19(1):10–23.

    Article  PubMed  Google Scholar 

  32. Gongvatana A, Schweinsburg BC, Taylor MJ, et al. White matter tract injury and cognitive impairment in human immunodeficiency virus-infected individuals. J Neurovirol. 2009;15(2):187–95.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Heaton RK, Franklin DR, Ellis RJ, et al. HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol. 2011;17(1):3–16.

    Article  CAS  PubMed  Google Scholar 

  34. Heaton RK, Clifford DB, Franklin DR Jr, et al. HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy. CHARTER Study. Neurology. 2010;75:2087–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Meade CS, Towe SL, Skalski LM, Robertson KR. Independent effects of HIV infection and cocaine dependence on neurocognitive impairment in a community sample living in the southern United States. Drug Alcohol Depend. 2015;149:128–35.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Heaton RK, Marcotte TD, Mindt MR, et al. The impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc. 2004;10(3):317–31.

    Article  PubMed  Google Scholar 

  37. Hinkin CH, Hardy DJ, Mason KI, et al. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS. 2004;18(Suppl 1):S19–25.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Park CY, Eicher-Miller HA. Iron deficiency is associated with food insecurity in pregnant females in the United States: national health and nutrition examination survey 1999–2010. J Acad Nutr Diet. 2014;114(12):1967–73.

    Article  PubMed  Google Scholar 

  39. Bourre JM. Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients. J Nutr Health Aging. 2006;10(5):377–85.

    CAS  PubMed  Google Scholar 

  40. Alaimo K, Olson CM, Frongillo EA. Food insufficiency and American school-aged children’s cognitive, academic, and psychosocial development. Pediatrics. 2001;108:44–53.

    Article  CAS  PubMed  Google Scholar 

  41. Gao X, Scott T, Falcon LM, Wilde PE, Tucker KL. Food insecurity and cognitive function in Puerto Rican adults. Am J Clin Nutr. 2009;89(4):1197–203.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Jyoti DF, Frongillo EA, Jones SJ. Food insecurity affects school children’s academic performance, weight gain, and social skills. J Nutr. 2005;135:2831–9.

    CAS  PubMed  Google Scholar 

  43. Rose-Jacobs R, Black MM, Casey PH, et al. Household food insecurity: associations with at-risk infant and toddler development. Pediatrics. 2008;121(1):65–72.

    Article  PubMed  Google Scholar 

  44. Block RI, Erwin WJ, Ghoneim MM. Chronic drug use and cognitive impairments. Pharmacol Biochem Be. 2002;73:491–504.

    Article  CAS  Google Scholar 

  45. Antinori A, Arendt G, Becker JT, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69:1789–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. McLellan AT, Kushner H, Metzger D, et al. The fifth edition of the addiction severity index. J Subst Abuse Treat. 1992;9(3):199–213.

    Article  CAS  PubMed  Google Scholar 

  47. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV Axis I disorders, research version, patient/non-patient edition: biometrics research. New York: New York State Psychiatric Institute; 1996.

    Google Scholar 

  48. Robinson SM, Sobell LC, Sobell MB, Leo GI. Reliability of the timeline followback for cocaine, cannabis, and cigarette use. Psychol Addict Behav. 2014;28(1):154–62.

    Article  PubMed  Google Scholar 

  49. Sobell LC, Sobell MB. Timeline follow-back user’s guide: a calendar method for assessing alcohol and drug use. Toronto: Addiction Research Foundation; 1996.

    Google Scholar 

  50. Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 30):22–33.

    PubMed  Google Scholar 

  51. Corporation RAND. HIV cost and services utilization study (HCSUS) baseline questionnaire. Santa Monica: RAND Corporation; 2007.

    Google Scholar 

  52. Kalichman SC, Amaral CM, Swetzes C, et al. A simple single-item rating scale to measure medication adherence: further evidence for convergent validity. J Int Assoc Physicians AIDS Care (Chic). 2009;8(6):367–74.

    Google Scholar 

  53. Wechsler D. Wechsler test of adult reading (WTAR) manual. San Antonio: Harcourt Assessment; 2001.

    Google Scholar 

  54. Coates J, Swindale A, Bilinsky P. household food insecurity access scale (HFIAS) for measurement of food access: indicator guide version 3. Washington, DC: Academy for Educational Development; 2007.

    Google Scholar 

  55. Wechsler D. Wechsler adult intelligence scale-third edition: administration and scoring manual. San Antonio: Harcourt Brace; 1997.

    Google Scholar 

  56. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: Theory and clinical interpretation. 2nd ed. Tucson: Neuropsycholgy; 1993.

    Google Scholar 

  57. Brandt J, Benedict RHB. Hopkins verbal learning test—revised professional manual. Lutz: Psychological Assessment Resources, Inc; 2001.

    Google Scholar 

  58. Benedict RHB. brief visuospatial memory test-revised professional manual. Odessa: Psychological Assessment Resources, Inc.; 1997.

    Google Scholar 

  59. Golden CJ. Stroop color and word test. Chicago: Stoelting; 1978.

    Google Scholar 

  60. Benton A, Hamsher K, Sivan A. Multilingual Aphasia Examination (3rd edition). Iowa City: AJA Associates; 1983.

    Google Scholar 

  61. Diehr MC, Cherner M, Wolfson TJ, Miller SW, Grant I, Heaton RK. The 50 and 100-item short forms of the paced auditory serial addition task (PASAT): demographically corrected norms and comparisons with the full PASAT in normal and clinical samples. J Clin Exp Neuropsychol. 2003;25(4):571–85.

    Article  PubMed  Google Scholar 

  62. Stern RA, White T. NAB digits forward/digits backward test: professional manual. Lutz: Psychological Assessment Resources, Inc (PAR); 2009.

    Google Scholar 

  63. Klove H. Grooved pegboard. Lafayette: Lafayette Instruments; 1963.

    Google Scholar 

  64. Heaton RK, Miller SW, Taylor MJ, Grant I. Revised comprehensive norms for an expanded halstead-reitan battery: demographically adjusted neuropsychological norms for african american and caucasian adults. Lutz: Psychological Assessment Resources, Inc; 2004.

    Google Scholar 

  65. Norman MA, Moore DJ, Taylor M, et al. Demographically corrected norms for African Americans and Caucasians on the hopkins verbal learning test-revised, brief visuospatial memory test-revised, stroop color and word test, and wisconsin card sorting test 64-card version. J Clin Exp Neuropsychol. 2011;33(7):793–804.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Carey CL, Woods SP, Gonzalez R, et al. Predictive validity of global deficit scores in detecting neuropsychological impairment in HIV infection. J Clin Exp Neuropsychol. 2004;26(3):307–19.

    Article  PubMed  Google Scholar 

  67. McDermott AY, Shevitz A, Must A, Harris S, Roubenoff R, Gorbach S. Nutrition treatment for HIV wasting: a prescription for food as medicine. Nutr Clin Pract. 2003;18:86–96.

    Article  PubMed  Google Scholar 

  68. Rabeneck L, Palmer ANN, Knowles JB, et al. A randomized controlled trial evaluating nutrition counseling with or without oral supplementation in malnourished hiv-infected patients. J Am Diet Assoc. 1998;98(4):434–8.

    Article  CAS  PubMed  Google Scholar 

  69. Clark RH, Feleke G, Din M, et al. Nutritional treatment for acquired immunodeficiency virus-associated wasting using β-hydroxy β-methylbutyrate, glutamine, and arginine: a randomized, double-blind, placebo-controlled study. J Parenter Enteral Nutr. 2000;24(3):133–9.

    Article  CAS  Google Scholar 

  70. Shabert JK, Winslow C, Lacey JM, Wilmore DW. Glutamine-antioxidant supplementation increases body cell mass in AIDS patients with weight loss: a randomized, double-blind controlled trial. Nutrition. 1999;15(11/12):860–4.

    Article  CAS  PubMed  Google Scholar 

  71. Stack JA, Bell SJ, Burke PA, Forse RA. High-energy, high-protein, oral, liquid, nutrition supplementation in patients with HIV infection. J Acad Nutr Diet. 1996;96(4):337–41.

    CAS  Google Scholar 

  72. Sattler FR, Rajicic N, Mulligan K, et al. Evaluation of high-protein supplementation in weight-stable HIV-positive subjects with a history of weight loss: a randomized, double-blind, multicenter trial. Am J Clin Nutr. 2008;88(5):1313–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  73. Keithley JK, Swanson B, Zeller JM, et al. Comparison of standard and immune-enhancing oral formulas in asymptomatic HIV-infected persons: a multicenter randomized controlled clinical trial. J Parenter Enteral Nutr. 2002;26(1):6–14.

    Article  Google Scholar 

  74. Koethe JR, Chi BH, Megazzini KM, Heimburger DC, Stringer JS. Macronutrient supplementation for malnourished HIV-infected adults: a review of the evidence in resource-adequate and resource-constrained settings. Clin Infect Dis. 2009;49(5):787–98.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Mahlungulu S, Grobler LA, Visser ME, Volmink J. Nutritional interventions for reducing morbidity and mortality in people with HIV. Cochrane Database Syst Rev. 2007;18(3). doi:10.1002/14651858.CD004536.pub2.

Download references

Acknowledgments

This study was funded by Grants K23-DA028660 and F32-DA038519 from the National Institute on Drug Abuse. We would like to thank the staff and students who assisted with this project, and we are grateful to the participants who volunteered their time for this study.

Author information

Authors and Affiliations

  1. Duke Global Health Institute, Duke University, 333, Trent Hall, 310 Trent Drive, Box 90519, Durham, NC, 27708, USA

    Andréa L. Hobkirk, Sheri L. Towe, Puja Patel & Christina S. Meade

  2. Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA

    Andréa L. Hobkirk, Sheri L. Towe & Christina S. Meade

Authors
  1. Andréa L. Hobkirk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sheri L. Towe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Puja Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christina S. Meade
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andréa L. Hobkirk.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants enrolled in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hobkirk, A.L., Towe, S.L., Patel, P. et al. Food Insecurity Is Associated with Cognitive Deficits Among HIV-Positive, But Not HIV-Negative, Individuals in a United States Sample. AIDS Behav 21, 783–791 (2017). https://doi.org/10.1007/s10461-016-1514-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-016-1514-7

Keywords

Search

Navigation