Original Research

Journal of General Internal Medicine

, Volume 26, Issue 9, pp 1012-1018

First online:

Food Insecurity is Associated with Poor Virologic Response among HIV-Infected Patients Receiving Antiretroviral Medications

  • Emily A. WangAffiliated withDepartment of Internal Medicine, Yale University School of Medicine Email author 
  • , Kathleen A. McGinnisAffiliated withPittsburgh VA Healthcare System
  • , David A. FiellinAffiliated withDepartment of Internal Medicine, Yale University School of Medicine
  • , Joseph L. GouletAffiliated withDepartment of Internal Medicine, Yale University School of MedicineVA Connecticut Healthcare System
  • , Kendall BryantAffiliated withNational Institute on Alcohol Abuse and Alcoholism, National Institutes of Health
  • , Cynthia L. GibertAffiliated withVA Medical Center and George Washington University Medical Center
  • , David A. LeafAffiliated withVA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA
  • , Kristin MattocksAffiliated withDepartment of Internal Medicine, Yale University School of Medicine
  • , Lynn E. SullivanAffiliated withDepartment of Internal Medicine, Yale University School of Medicine
    • , Nicholas VogenthalerAffiliated withDivision of Infectious Diseases, Emory University School of Medicine
    • , Amy C. JusticeAffiliated withDepartment of Internal Medicine, Yale University School of MedicineVA Connecticut Healthcare System
    • , for the VACS Project Team

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ABSTRACT

BACKGROUND AND OBJECTIVE

Food insecurity negatively impacts HIV disease outcomes in international settings. No large scale U.S. studies have investigated the association between food insecurity and severity of HIV disease or the mechanism of this possible association. The objective of this study was to examine the impact of food insecurity on HIV disease outcomes in a large cohort of HIV-infected patients receiving antiretroviral medications.

DESIGN

This is a cross-sectional study.

PARTICIPANTS AND SETTING

Participants were HIV-infected patients enrolled in the Veterans Aging Cohort Study between 2002–2008 who were receiving antiretroviral medications.

MAIN MEASUREMENTS

Participants reporting “concern about having enough food for you or your family in the past 30 days” were defined as food insecure. Using multivariable logistic regression, we explored the association between food insecurity and both low CD4 counts (<200 cells/μL) and unsuppressed HIV-1 RNA (>500 copies/mL). We then performed mediation analysis to examine whether antiretroviral adherence or body mass index mediates the observed associations.

KEY RESULTS

Among 2353 HIV-infected participants receiving antiretroviral medications, 24% reported food insecurity. In adjusted analyses, food insecure participants were more likely to have an unsuppressed HIV-1 RNA (AOR 1.37, 95% CI 1.09, 1.73) compared to food secure participants. Mediation analysis revealed that neither antiretroviral medication adherence nor body mass index contributes to the association between food insecurity and unsuppressed HIV-1 RNA. Food insecurity was not independently associated with low CD4 counts.

CONCLUSIONS

Among HIV-infected participants receiving antiretroviral medications, food insecurity is associated with unsuppressed viral load and may render treatment less effective. Longitudinal studies are needed to test the potential causal association between food insecurity, lack of virologic suppression, and additional HIV outcomes.

KEY WORDS

food insecurity HIV patients antiretrovirals