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Food Insecurity, HIV Disease Progression and Access to Care Among HIV-Infected Russians not on ART

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Abstract

Food insecurity (FI) has been associated with HIV disease progression among people on antiretroviral therapy (ART), presumably a consequence of poor medication adherence. We assessed whether there is a longitudinal association between FI and two primary outcomes reflecting on HIV disease progression (i.e., CD4 count and time to ART initiation) among people not on ART. Analyses used linear mixed effects and Cox models controlling for confounders. In this cohort (n = 310) FI was common (53%). Most (71.3%) reported past month heavy alcohol use and 37.1% reported past month injection drug use. Only 50 participants initiated ART during the study and mean time to ART was 128 days (SD 120). There were no significant differences in CD4 cell count between the groups with mild/moderate FI or severe FI versus those with no FI [adjusted mean difference, mild/moderate insecurity versus no FI −32.5 (95% CI −94.3, 29.3); severe versus no FI −45.5 (95% CI −124.1, 33.0); global p = 0.42]. We found no significant association between FI and longer time to ART initiation (p = 0.36). Food security is a desirable goal for overall health and shown beneficial for those on ART, however it does not appear to be associated with HIV disease progression among those with high prevalence of substance use and not yet on ART.

Resumen

La inseguridad alimentaria (IF) se ha asociado con la progresión de la enfermedad del VIH entre las personas que reciben terapia antirretroviral (ART), presumiblemente como consecuencia de la mala adherencia al tratamiento. En este estudio se evaluó si existe una asociación longitudinal entre FI y la progresión de la enfermedad del VIH medido por el recuento de CD4 y el tiempo de iniciación del tratamiento antirretroviral entre las personas que no lo recibían. Para los análisis utilizamos efectos mixtos lineales y modelos de regresión de Cox controlando por potenciales factores de confusión. En esta cohorte (n = 310) la FI era frecuente (53%). La mayoría (71,3%) había consumido alcohol durante el mes anterior y el 37,1% había consumido drogas inyectadas el mes anterior. Sólo 50 participantes iniciaron tratamiento antirretroviral durante el estudio y el tiempo medio de TAR fue de 128 días (DE 120). No hubo diferencias significativas en el recuento de células CD4 entre los grupos con FI leve/moderada o FI grave versus aquellos sin FI (diferencia de medias ajustada, inseguridad leve/moderada vs. no FI -32,5 [IC del 95%: -94,3, 29,3], Grave vs no FI -45,5 [IC del 95%: -124,1, 33,0], global p = 0,42). No se encontró asociación significativa entre FI y mayor tiempo para la iniciación del TAR (p = 0,36). La seguridad alimentaria es un objetivo deseable para la salud en general y es beneficiosa para los que reciben tratamiento antirretroviral. Sin embargo, no parece estar asociada con la progresión de la infección por el VIH entre aquellos con alta prevalencia de uso de drogas que todavía no reciben tratamiento antirretroviral.

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Acknowledgements

Dr. Idrisov was funded by The National Institute on Drug Abuse (NIDA) International Program INVEST Drug Abuse Research Fellowship. The study was supported by the following NIH Grant funding: U01AA020780, U24AA020778, U24AA020779, U01AA021989, R01DA032082, K99DA041245.

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Authors and Affiliations

  1. Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, 02118, USA

    Bulat Idrisov, Karsten Lunze & Jeffrey H. Samet

  2. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA

    Debbie M. Cheng

  3. Laboratory of Clinical Pharmacology of Addictions, First Pavlov State Medical University, St. Petersburg, Russia

    Elena Blokhina & Evgeny Krupitsky

  4. Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA

    Natalia Gnatienko & Carly Bridden

  5. Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA

    Gregory J. Patts

  6. Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA

    Ronald E. Kleinman

  7. Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, UCSF, San Francisco, USA

    Sheri D. Weiser

  8. Department of Addictions, Bekhterev Research Psychoneurological Institute, St. Petersburg, Russia

    Evgeny Krupitsky

  9. Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA

    Jeffrey H. Samet

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  1. Bulat Idrisov
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Idrisov, B., Lunze, K., Cheng, D.M. et al. Food Insecurity, HIV Disease Progression and Access to Care Among HIV-Infected Russians not on ART. AIDS Behav 21, 3486–3495 (2017). https://doi.org/10.1007/s10461-017-1885-4

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