Food insecurity is associated with poor virologic response among HIV-infected patients receiving antiretroviral medications
Authors
Wang, Emily A.McGinnis, Kathleen A.
Fiellin, David A.
Goulet, Joseph
Bryant, Kendall J.
Gibert, Cynthia L L.
Leaf, David A A.
Mattocks, Kristin M.
Sullivan, Lynn E
Vogenthaler, Nicholas
Justice, Amy C.
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2011-09-01Keywords
Adult*Antiretroviral Therapy, Highly Active
Cohort Studies
Cross-Sectional Studies
Female
*Food Supply
HIV Infections
*HIV-1
Humans
Male
*Medication Adherence
Middle Aged
Treatment Outcome
Viral Load
food insecurity
HIV
patients
antiretrovirals
Immune System Diseases
Metadata
Show full item recordAbstract
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 (/muL) 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.Source
2011 May 15. Link to article on publisher's site
DOI
10.1007/s11606-011-1723-8Permanent Link to this Item
http://hdl.handle.net/20.500.14038/51027PubMed ID
21573882Related Resources
ae974a485f413a2113503eed53cd6c53
10.1007/s11606-011-1723-8