Lack of food security impacts on viral loads

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People who don’t have enough food to eat are less likely to have an undetectable viral load than other people living with HIV, according to a longitudinal study from New York City. The findings underscore the relevance of interventions to reduce poverty and help people living with HIV meet their basic needs. In New York City, one in six people experience food insecurity each year. Food insecurity is more common among ethnic minorities who are also disproportionately affected by HIV. A lack of appropriate food could make adherence to HIV treatment more difficult.

Researchers analysed data from individuals who received food and nutrition services funded by the Ryan White Part A programme between 2011 and 2013. These services include communal meals, home-delivered meals, grocery supplies and food vouchers. The 2,118 people included in the analysis had all completed at least two periodic assessments of their access to food as well as having viral load data recorded in the six months after their last food assessment. Individuals were considered to have “food insufficiency” if they reported sometimes or often not having enough money for food, not having enough to eat, or recently going a whole day without eating.

As study participants were all receiving food-related services, it’s not surprising that most reported problems: 61% had food insufficiency at both assessments, 25% had food insufficiency at one of the two assessments and 14% did not have food insufficiency. There was a link between food insufficiency and poor treatment outcomes. A detectable viral load (above 200 copies/ml) was reported by: 29% of those with food insufficiency at both assessments; 22% of those with food insufficiency at one assessment; and 11% of those who did not have food insufficiency.

Clearly, a number of other factors could impact this association, including unemployment, low income, unstable housing, low levels of education and drug use. After statistical adjustment for these and other confounders, there was an independent association between detectable viral load and food insufficiency: adjusted odds ratio 1.6. There were also independent associations between detectable viral load and unstable housing (adjusted odds ratio 1.5) and an income below the poverty level (adjusted odds ratio 1.5). Low CD4 cell counts weren’t significantly associated with food insufficiency in the multivariate analysis.

The researchers say that their findings strengthen the evidence for a causal relationship between food insufficiency and poor HIV treatment outcomes. Future studies should examine the factors which might explain this relationship – including the biological (weight loss, malnutrition) and the behavioural (retention in care, adherence). “Understanding the relationship between food insecurity and clinical health outcomes among people living with HIV is critical in planning interventions for this population, particularly among the urban poor and marginally housed individuals who are at significant risk for food insecurity,” they write.

Background: To date, there have been few longitudinal studies of food insecurity among people living with HIV (PLWH). Food insufficiency (FI) is one dimension of the food insecurity construct that refers to periods of time during which individuals have an inadequate amount of food intake because of limited resources. The aim of this analysis was to examine the relationship between FI and HIV treatment outcomes among HIV-infected individuals in New York City (NYC).
Methods: Associations between FI (“consistent”—food insufficient on both of the last 2 assessments, “inconsistent”—food insufficient on 1 of the last 2 assessments, or neither) and clinical indicators of HIV disease progression (viral load > 200 copies per milliliter, CD4 count < 200 cells per cubic millimeter) were analyzed for NYC Ryan White Part A food and nutrition program clients who were matched to the NYC HIV Surveillance Registry and completed 2 FI assessments between November 2011 and June 2013.
Results: Among 2,118 PLWH in food and nutrition programs, 61% experienced consistent FI and 25% experienced inconsistent FI. In multivariate analyses controlling for sociodemographic characteristics, consistent FI was independently associated with unsuppressed viral load (adjusted odds ratio = 1.6, confidence interval: 1.1 to 2.5). Consistent FI was only associated with low CD4 counts at the bivariate level.
Conclusions: Future studies should examine biological, structural, and psychosocial factors that may explain the relationship between FI and HIV treatment outcomes to inform intervention development. Persistent FI among food and nutrition program clients suggests that services are needed to address underlying needs for financial stability (eg, vocational counseling) for PLWH.

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Journal of Acquired Immune Deficiency Syndromes abstract

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