Food Insecurity is Associated with Incomplete HIV RNA Suppression Among Homeless and Marginally Housed HIV-infected Individuals in San Francisco
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Background and Objectives
There is growing international concern that food insecurity may negatively impact antiretroviral (ARV) treatment outcomes, but no studies have directly evaluated the effect of food insecurity on viral load suppression and antiretroviral adherence. We hypothesized that food insecurity would be associated with poor virologic response among homeless and marginally housed HIV-positive ARV-treated patients.
This is a cross-sectional study.
Participants and Setting
Participants were ARV-treated homeless and marginally housed persons receiving adherence monitoring with unannounced pill counts in the Research on Access to Care in the Homeless (REACH) Cohort.
Food insecurity was measured by the Household Food Insecurity Access Scale (HFIAS). The primary outcome was suppression of HIV viral RNA to <50 copies/ml. We used multivariate logistic regression to assess whether food insecurity was associated with viral suppression.
Among 104 participants, 51% were food secure, 24% were mildly or moderately food insecure and 25% were severely food insecure. Severely food insecure participants were less likely to have adherence >=80%. In adjusted analyses, severe food insecurity was associated with a 77% lower odds of viral suppression (95% CI = 0.06–0.82) when controlling for all covariates. In analyses stratified by adherence level, severe food insecurity was associated with an 85% lower odds of viral suppression (95% CI = 0.02–0.99) among those with <=80% adherence and a 66% lower odds among those with >80% adherence (95% CI = 0.06–1.81).
Food insecurity is present in half of the HIV-positive urban poor in San Francisco, one of the best resourced settings for HIV-positive individuals in the United States, and is associated with incomplete viral suppression. These findings suggest that ensuring access to food should be an integral component of public health HIV programs serving impoverished populations.
- Robertson MJ, Clark RA, Charlebois ED, et al. HIV seroprevalence among homeless and marginally housed adults in San Francisco. Am J Public Health. 2004;94(7):1207–17. Jul. CrossRef
- Moss AR, Hahn JA, Perry S, et al. Adherence to highly active antiretroviral therapy in the homeless population in San Francisco: a prospective study. Clin Infect Dis. 2004;39(8):1190–8. Oct 15. CrossRef
- Mills EJ, Nachega JB, Buchan I, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. Jama. 2006;296(6):679–90. Aug 9. CrossRef
- Ammassari A, Trotta MP, Murri R, et al. Correlates and predictors of adherence to highly active antiretroviral therapy: overview of published literature. J Acquir Immune Defic Syndr. 2002;31(Suppl 3):S123–7. Dec 15.
- Altice FL, Mostashari F, Friedland GH. Trust and the acceptance of and adherence to antiretroviral therapy. J Acquir Immune Defic Syndr. 2001;28(1):47–58. Sep 1.
- Lucas GM, Cheever LW, Chaisson RE, Moore RD. Detrimental effects of continued illicit drug use on the treatment of HIV-1 infection. J Acquir Immune Defic Syndr. 2001;27(3):251–9. Jul 1.
- Mills EJ, Nachega JB, Bangsberg DR, et al. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med. 2006;311e438. Nov. CrossRef
- 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(4):820–5. Apr.
- Dachner N, Tarasuk V. Homeless “squeegee kids”: food insecurity and daily survival. Soc Sci Med. 2002;54(7):1039–49. Apr. CrossRef
- Furness BW, Simon PA, Wold CM, Asarian-Anderson J. Prevalence and predictors of food insecurity among low-income households in Los Angeles County. Public Health Nutr. 2004;7(6):791–4. Sep. CrossRef
- Seume-Fosso E, Rajabiun S, Cogill B, Elder L, Castleman T, Sheckler A. Food and Nutrition Technical Assistance. HIV/AIDS: A Guide For Nutritional Care and Support. Washington, DC October 2004. http://www.fantaproject.org/publications/HIVguide.shtml. Accessed September 23, 2008.
- World Health Organization. Nutrient Requirements for People Living with HIV/AIDS: Report of a Technical Consultation. Geneva, Switzerland 13–15 May 2003. http://www.who.int/nutrition/publications/Content_nutrient_requirements.pdf. Accessed September 23, 2008.
- Programming in the Era of AIDS: WPF’s Response to HIV/AIDS. Rome, Italy: World Food Programme; February 5–7 2003. http://reliefweb.int/rw/lib.nsf/db900sid/PANA-7DSFKW/$file/wfp_jan2003.pdf?openelement. Accessed September 23, 2008.
- Siefert K, Heflin CM, Corcoran ME, Williams DR. Food insufficiency and physical and mental health in a longitudinal survey of welfare recipients. J Health Soc Behav. 2004;45(2):171–86. Jun. CrossRef
- Heflin CM, Siefert K, Williams DR. Food insufficiency and women’s mental health: findings from a 3-year panel of welfare recipients. Soc Sci Med. 2005;61(9):1971–82. Nov. CrossRef
- Che J, Chen J. Food insecurity in Canadian households. Health Rep. 2001;12(4):11–22. Aug.
- Alaimo K, Olson CM, Frongillo EA. Family food insufficiency, but not low family income, is positively associated with dysthymia and suicide symptoms in adolescents. J Nutr. 2002;132(4):719–25. Apr.
- Seligman HK, Bindman AB, Vittinghoff E, Kanaya AM, Kushel MB. Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999–2002. J Gen Intern Med. 2007;22(7):1018–23. Jul. CrossRef
- Vozoris NT, Tarasuk VS. Household food insufficiency is associated with poorer health. J Nutr. 2003;133(1):120–6. Jan.
- Kushel MB, Gupta R, Gee L, Haas JS. Housing instability and food insecurity as barriers to health care among low-income Americans. J Gen Intern Med. 2006;21(1):71–7. Jan. CrossRef
- Kersey MA, Beran MS, McGovern PG, Biros MH, Lurie N. The prevalence and effects of hunger in an emergency department patient population. Acad Emerg Med. 1999;6(11):1109–14. Nov. CrossRef
- Campbell CC. Food insecurity: a nutritional outcome or a predictor variable? J Nutr. 1991;121(3):408–15. Mar.
- Weiser S, Wolfe W, Bangsberg D, et al. Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana. J Acquir Immune Defic Syndr. 2003;34(3):281–8. Nov 1. CrossRef
- Au JT, Kayitenkore K, Shutes E, et al. Access to adequate nutrition is a major potential obstacle to antiretroviral adherence among HIV-infected individuals in Rwanda. Aids. 2006;20(16):2116–8. Oct 24. CrossRef
- Hardon AP, Akurut D, Comoro C, et al. Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa. AIDS Care. 2007;19(5):658–65. May. CrossRef
- 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(8):1179–85. Oct 15. CrossRef
- Kotler DP, Tierney AR, Wang J, Pierson RN Jr. Magnitude of body-cell-mass depletion and the timing of death from wasting in AIDS. Am J Clin Nutr. 1989;50(3):444–7. Sep.
- Melchior JC, Niyongabo T, Henzel D, Durack-Bown I, Henri SC, Boulier A. Malnutrition and wasting, immunodepression, and chronic inflammation as independent predictors of survival in HIV-infected patients. Nutrition. 1999;15(11–12):865–9. Nov–Dec. CrossRef
- van der Sande MA, van der Loeff MF, Aveika AA, et al. Body mass index at time of HIV diagnosis: a strong and independent predictor of survival. J Acquir Immune Defic Syndr. 2004;37(2):1288–94. Oct 1. CrossRef
- Castleman T, Seumo-Fosso E, Cogill B. Food and Nutrition Implications of Antiretroviral Therapy in Resource Limited Settings. Washington, DC: Food and Nutrition Technical Assistance Project. Academy for Educational Development; May 2004. http://www.fantaproject.org/downloads/pdfs/tn7_ARVs.pdf. Accessed September 23, 2008.
- Gustavson L, Lam W, Bertz R, et al. Assessment of the bioequivalence and food effects for liquid and soft gelatin capsule co-formulations of ABT-378/ritonavir (ABT-378/r) in healthy subjects. Paper presented at: 40th Interscience Conference on Antimicrobial Agents and Chemotherapy, 2000; Toronto, Canada.
- Bardsley-Elliot A, Plosker GL. Nelfinavir: an update on its use in HIV infection. Drugs. 2000;59(3):581–620. Mar. CrossRef
- Zolopa AR, Hahn JA, Gorter R, et al. HIV and tuberculosis infection in San Francisco’s homeless adults. Prevalence and risk factors in a representative sample. Jama. 1994;272(6):455–61. Aug 10. CrossRef
- Bangsberg DR, Hecht FM, Charlebois ED, et al. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. Aids. 2000;14(4):357–66. Mar 10. CrossRef
- Petersen ML, Wang Y, van der Laan MJ, Guzman D, Riley E, Bangsberg DR. Pillbox organizers are associated with improved adherence to HIV antiretroviral therapy and viral suppression: a marginal structural model analysis. Clin Infect Dis. 2007;45(7):908–15. Oct 1. CrossRef
- Bangsberg DR, Bronstone A, Hofmann R. A computer-based assessment detects regimen misunderstandings and nonadherence for patients on HIV antiretroviral therapy. AIDS Care. 2002;14(1):3–15. Feb. CrossRef
- Descamps D, Flandre P, Calvez V, et al. Mechanisms of virologic failure in previously untreated HIV-infected patients from a trial of induction-maintenance therapy. Trilege (Agence Nationale de Recherches sur le SIDA 072) Study Team). Jama. 2000;283(2):205–11. Jan 12. CrossRef
- Bangsberg DR, Perry S, Charlebois ED, et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. Aids. 2001;15(9):1181–3. Jun 15. CrossRef
- Bangsberg DR. Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clin Infect Dis. 2006;43(7):939–41. Oct 1. CrossRef
- Shuter J, Sarlo JA, Kanmaz TJ, Rode RA, Zingman BS. HIV-infected patients receiving lopinavir/ritonavir-based antiretroviral therapy achieve high rates of virologic suppression despite adherence rates less than 95%. J Acquir Immune Defic Syndr. 2007;45(1):4–8. May 1. CrossRef
- Coates J, Swindale A, Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide. Version 3. Washington, D.C.: Food and Nutrition Technical Assistance. Academy for Educational Development; August 2007. http://www.foodsec.org/tr/nut/hfias.pdf. Accessed September 23, 2008.
- Swindale A, Bilinsky P. Development of a universally applicable household food insecurity measurement tool: process, current status, and outstanding issues. J Nutr. 2006;136(5):1449S–52S2. May.
- Frongillo EA, Nanama S. Development and validation of an experience-based measure of household food insecurity within and across seasons in Northern Burkina Faso. J Nutr. 2006;136(5):1409S–19S. May.
- Coates J, Frongillo EA, Rogers BL, Webb P, Wilde PE, Houser R. Commonalities in the experience of household food insecurity across cultures: what are measures missing? J Nutr. 2006;136(5):1438S–48S. May.
- Beck A, Steer R, Garbin M. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988;8:77–100. CrossRef
- Riley ED, Bangsberg DR, Perry S, Clark RA, Moss AR, Wu AW. Reliability and validity of the SF-36 in HIV-infected homeless and marginally housed individuals. Qual Life Res. 2003;12(8):1051–8. Dec. CrossRef
- Storch EA, Roberti JW, Roth DA. Factor structure, concurrent validity, and internal consistency of the Beck Depression Inventory-Second Edition in a sample of college students. Depress Anxiety. 2004;19(3):187–9. CrossRef
- Weiser SD, Riley ED, Ragland K, Hammer G, Clark R, Bangsberg DR. Brief report: factors associated with depression among homeless and marginally housed HIV-infected men in San Francisco. J Gen Intern Med. 2006;21(1):61–4. Jan. CrossRef
- Kidder DP, Wolitski RJ, Campsmith ML, Nakamura GV. Health status, health care use, medication use, and medication adherence among homeless and housed people living with HIV/AIDS. Am J Public Health. 2007;97(12):2238–45. Dec. CrossRef
- Kushel MB, Colfax G, Ragland K, Heineman A, Palacio H, Bangsberg DR. Case management is associated with improved antiretroviral adherence and CD4 + cell counts in homeless and marginally housed individuals with HIV infection. Clin Infect Dis. 2006;43(2):234–42. Jul 15. CrossRef
- Parienti JJ, Das-Douglas M, Massari V, et al. Not all missed doses are the same: sustained NNRTI treatment interruptions predict HIV rebound at low-to-moderate adherence levels. PLoS ONE. 2008;37e2783. CrossRef
- Abbot Laboratories. Kaletra, US package insert. Available at: http://www.fda.gov/cder/foi/label/2005/021226s016lbl.pdf Accessed November 14, 2007.
- Gillespie S, Kadiyala S. HIV/AIDS and Food and Nutrition Security: From Evidence to Action. Washington, DC: International Food Policy Reseach Institute; 2005.
- Batterham MJ, Garsia R, Greenop P. Prevalence and predictors of HIV-associated weight loss in the era of highly active antiretroviral therapy. Int J STD AIDS. 2002;13(11):744–7. Nov. CrossRef
- Tang AM, Forrester J, Spiegelman D, Knox TA, Tchetgen E, Gorbach SL. Weight loss and survival in HIV-positive patients in the era of highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2002;31(2):230–6. Oct 1.
- Food Insecurity is Associated with Incomplete HIV RNA Suppression Among Homeless and Marginally Housed HIV-infected Individuals in San Francisco
Journal of General Internal Medicine
Volume 24, Issue 1 , pp 14-20
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- food insecurity
- HIV viral load suppression
- San Francisco
- Industry Sectors
- Author Affiliations
- 1. Positive Health Program,, San Francisco General Hospital, UCSF, San Francisco, USA
- 2. Center for AIDS Prevention Studies,, University of California, San Francisco (UCSF), San Francisco, USA
- 3. Department of Health Promotion, Education, and Behavior, Arnold School of Public Health,, University of South Carolina, Columbia, USA
- 4. Department of General Internal Medicine,, San Francisco General Hospital, UCSF, San Francisco, USA
- 5. Faculty of Health Sciences,, Simon Fraser University, Burnaby, BC, Canada
- 6. BC Center for Excellence in HIV/AIDS, Vancouver, BC, Canada
- 7. Massachusetts General Hospital, Harvard Medical School, Harvard Initiative for Global Health, Boston, MA, USA