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Association Between Food Insecurity and HIV Viral Suppression: A Systematic Review and Meta-Analysis

Abstract

Although an increasing number of HIV infected people are accessing antiretroviral treatment, many do not achieve complete HIV viral suppression and remain at risk for AIDS and capable of HIV transmission. Food insecurity has been identified as a potential risk factor for poor virologic response, but the association between these factors has been inconsistently documented in the literature. We systematically searched five electronic databases and bibliographies of relevant studies through April 2015 and retrieved 11 studies that met our inclusion criteria, of which nine studies were conducted in North America and the remaining two studies were in Brazil and Uganda respectively. Meta-analyzed results indicated that experiencing food insecurity resulted in 29% lower odds of achieving complete HIV viral suppression (OR = 0.71, 95% CI 0.61–0.82) and this significant inverse association was consistently found regardless of study design, exposure measurement, and confounder adjustment methods. These findings suggest that food insecurity is a potential risk factor for incomplete HIV viral suppression in people living with HIV.

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Funding

Supported in part by the Food Security & HIV-HCV Study of the Canadian Co-infection Cohort, which is funded by the Canadian Institutes of Health Research (CIHR) and the CIHR Canadian HIV Trials Network (CTN 264).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Paul Brassard.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Appendices

Appendix A

PubMed

  1. 1.

    (Human immunodeficiency viruses[MeSH Terms] OR hiv[Title/Abstract] OR aids[Title/Abstract] OR human immunodeficiency virus[Title/Abstract] OR human immuno deficiency virus[Title/Abstract] OR human immuno-deficiency virus[Title/Abstract] OR human immunodeficiency viruses[Title/Abstract] OR human immuno deficiency viruses[Title/Abstract] OR human immuno-deficiency viruses[Title/Abstract] OR acquired immunodeficiency syndrome[Title/Abstract] OR acquired immuno deficiency syndrome[Title/Abstract] OR acquired immuno-deficiency syndrome[Title/Abstract] OR acquired immunodeficiency syndromes[Title/Abstract] OR acquired immuno deficiency syndromes[Title/Abstract] OR acquired immuno-deficiency syndromes[Title/Abstract]).

  2. 2.

    (Food security[MeSH Terms] OR hunger[MeSH Terms] OR malnutrition[MeSH Terms] OR food security[Title/Abstract] OR malnutrition[Title/Abstract] OR hunger[Title/Abstract] OR food insufficienc*[Title/Abstract]).

  3. 3.

    (Viral load[MeSH Terms] OR viral rna[MeSH Terms] OR viral load[Title/Abstract] OR viral rna[Title/Abstract] OR virus load[Title/Abstract] OR virus rna[Title/Abstract]).

1 AND 2 AND 3.

101 citations as of April 15th, 2015.

Web of Science

TS = (hiv OR human immunodeficiency virus* OR human immuno deficiency virus* OR human immuno-deficiency virus* OR aids OR acquired immunodeficiency syndrome* OR acquired immuno deficiency syndrome* OR acquired immuno-deficiency syndrome*).

TS = (food security* OR food insecurity* OR nutrition* OR hunger* OR food insufficiency*).

TS = (viral load* OR viral rna* OR virus load OR virus rna).

1 AND 2 AND 3.

223 citations as of April 15th, 2015.

ProQuest ABI/INFORM Complete

(Hiv OR human immunodeficiency virus* OR human immuno deficiency virus* OR human immunodeficiency virus* OR aids OR acquired immunodeficiency syndrome* OR acquired immuno deficiency syndrome* OR acquired immunodeficiency syndrome*) AND (food security* OR food insecurity* OR hunger* OR food insufficient*) AND (viral load* OR viral rna* OR virus rna*).

Source type: Conference Papers & Proceedings, Dissertations & Theses, Scholarly Journals.

342 citations as of April 15th, 2015.

Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, Ovid MEDLINE(R) and Ovid OLDMEDLINE(R) 1946 to Present

  1. 1.

    HIV Antigen/or HIV Infection/or HIV Seropositivity/or HIV/or HIV Antibody/.

  2. 2.

    Acquired Immunodeficiency Syndrome/bl, cf, di, me, mo, nu [Blood, Cerebrospinal Fluid, Diagnosis, Metabolism, Mortality, Nursing].

  3. 3.

    1 OR 2.

  4. 4.

    Food insecurity.mp.

  5. 5.

    Food insufficiency.mp.

  6. 6.

    Exp Malnutrition/or exp Hunger/or exp Food Supply/or exp Poverty/.

  7. 7.

    4 OR 5 OR 6.

  8. 8.

    Exp HIV/or exp Viral Load/.

  9. 9.

    Exp RNA, Viral/an, bl, du, de, im, ip, tu [Analysis, Blood, Diagnostic Use, Drug Effects, Immunology, Isolation & Purification, Therapeutic Use].

  10. 10.

    8 OR 9.

  11. 11.

    3 AND 7 AND 10.

270 Citations as of April 15th, 2015.

Embase classic + Embase

  1. 1.

    Hiv.mp. or exp Human immunodeficiency virus/.

  2. 2.

    Exp acquired immune deficiency syndrome/di, dm, dr, dt, ep, et, pc [Diagnosis, Disease Management, Drug Resistance, Drug Therapy, Epidemiology, Etiology, Prevention].

  3. 3.

    1 OR 2.

  4. 4.

    Exp malnutrition/or exp hunger/or exp food insecurity/or exp starvation/or exp socioeconomics/or exp nutritional status/or exp food intake/or food insufficiency.mp.

  5. 5.

    Viral load.mp. or exp virus load/.

  6. 6.

    Viral rna.mp. or exp virus RNA/.

  7. 7.

    5 OR 6.

  8. 8.

    3 AND 4 AND 7.

1198 citations as of April 15th, 2015.

Appendix B

Adapted version of Newcastle Ottawa Scale (NOS) for assessing cross sectional study quality (Adaptation was based on work by Herzog et al. [31] with slight modification)

Selection: (Maximum 4 stars)

  1. 1)

    Representativeness of the sample:

    1. a

      Truly representative of the average in the target population. * (all subjects or random sampling).

    2. b

      Somewhat representative of the average in the target population. * (non-random sampling).

    3. c

      Selected group of users.

    4. d

      No description of the sampling strategy.

  2. 2)

    Sample size:

    1. a.

      Justified and satisfactory. *

    2. b.

      Not justified.

  3. 3)

    Non-respondents:

    1. a.

      Comparability between respondents and non-respondents characteristics is established, and the response rate is satisfactory. *

    2. b.

      The comparability between respondents and non-respondents is unsatisfactory.

    3. c.

      No description of the response rate or the characteristics of the responders and the non-responders.

    4. d.

      No description of respondents and non-respondents regarding important confounders.

  4. 4)

    Ascertainment of the exposure (risk factor):

    1. a.

      Validated measurement tool or the tool is available or described. *

    2. b.

      No description of the measurement tool.

Comparability: (Maximum 2 stars)

  1. 1)

    Comparability of different exposure groups except that exposure variable on the basis of the design or analysis:

    1. a.

      The study controls for the most important factor through regression or matching.*

    2. b.

      The study control for any additional factor. *

Outcome: (Maximum 3 stars)

  1. 1)

    Assessment of outcome.

    1. a.

      Independent blind assessment. **

    2. b.

      Record linkage. **

    3. c.

      Self-report. *

    4. d.

      No description.

  2. 2)

    Statistical test:

    1. a.

      The statistical test used to analyze the data is clearly described and appropriate, and the measurement of the association is presented, including confidence intervals and the probability level (p value). *

    2. b.

      The statistical test is not appropriate, not described or incomplete.

Appendix C

See Table 3.

Table 3 Scoring details for each included studies

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Aibibula, W., Cox, J., Hamelin, AM. et al. Association Between Food Insecurity and HIV Viral Suppression: A Systematic Review and Meta-Analysis. AIDS Behav 21, 754–765 (2017). https://doi.org/10.1007/s10461-016-1605-5

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  • DOI: https://doi.org/10.1007/s10461-016-1605-5

Keywords

  • Food insecurity
  • HIV
  • Viral suppression
  • Meta-analysis