Food Insecurity is Associated with Poor Virologic Response among HIV-Infected Patients Receiving Antiretroviral Medications
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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.
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.
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.
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.
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.
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- Food Insecurity is Associated with Poor Virologic Response among HIV-Infected Patients Receiving Antiretroviral Medications
Journal of General Internal Medicine
Volume 26, Issue 9 , pp 1012-1018
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- food insecurity
- Industry Sectors
- Emily A. Wang MD, MAS (1)
- Kathleen A. McGinnis MS (2)
- David A. Fiellin MD (1)
- Joseph L. Goulet PhD (1) (3)
- Kendall Bryant PhD (4)
- Cynthia L. Gibert MD (5)
- David A. Leaf MD (6)
- Kristin Mattocks PhD (1)
- Lynn E. Sullivan MD (1)
- Nicholas Vogenthaler MD (7)
- Amy C. Justice MD, PhD (1) (3)
- for the VACS Project Team
- Author Affiliations
- 1. Department of Internal Medicine, Yale University School of Medicine, Harkness Hall Building A 367 Cedar Street, Suite 410A, New Haven, CT, 06510, USA
- 2. Pittsburgh VA Healthcare System, Pittsburgh, PA, USA
- 3. VA Connecticut Healthcare System, West Haven, CT, USA
- 4. National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, MD, USA
- 5. VA Medical Center and George Washington University Medical Center, Washington, DC, USA
- 6. VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- 7. Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA