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Hair study strengthens link between food insecurity, ART non-adherence

Among women living with HIV, study findings showed that food insecurity was associated with lower antiretroviral treatment (ART) concentrations in hair, suggesting that it impacts ART adherence and/or drug absorption, Healio reports researchers said.

“HIV should be solved by now,” Dr Monica Gandhi, who was not involved in the study is quoted in the report as saying. “We should be done with HIV and the reason we are not done with HIV is because of the social determinants of health that keep leading to new HIV infections and people living with HIV not doing as well as they should. One of those social determinants is lack of access to food or nutritious food.”

Food insecurity is “widespread” in the US, affecting an estimated 40m people, said University of California San Francisco researchers Dr Anna M Leddy and Dr Sheri Weiser. “Low-income populations and people living with HIV/Aids are generally impacted the most,” they are quoted in the report as saying

In their study, Leddy, Weiser and colleagues aimed to investigate the association between food insecurity and ART adherence using objective adherence measures – namely, by testing ART concentrations in hair.

The Womens Interagency HIV Study is a multisite prospective cohort study of women living with HIV (WLHIV) and HIV-negative controls. The researchers analysed longitudinal data from the cohort collected semi-annually between 2013 and 2015, which included 1,944 person-visits from 677 WLHIV.

“We’ve known from other studies that food insecurity reduces self-reported adherence to drugs,” said Gandhi, a professor of medicine at the University of California San Francisco, and medical director of the “Ward 86” HIV Clinic at Zuckerberg San Francisco General Hospital. “However, this is the largest study that has looked at adherence using objective metrics, which I think is the most unique aspect of the study.”

At baseline, viral suppression was recorded for 59% of participants and food insecurity was reported by 45%. Using the base multivariable model, Leddy, Weiser and colleagues observed that every three-point increase in food insecurity was associated with 0.94-fold lower ART concentrations in hair (95% CI, 0.89-0.99).

When adjusted for self-reported adherence, the association remained unchanged, according to the study.

“This study provides the first evidence to suggest that food insecurity is associated with lower concentrations of ART in hair, which is the most objective measure of adherence and drug absorption,” Leddy and Weiser said. “This finding strengthens the rationale for intervening on food insecurity to improve adherence and absorption among people living with HIV.”

Background: Food insecurity is a well-established determinant of sub-optimal self-reported antiretroviral therapy (ART) adherence, but few studies have investigated this association using objective adherence measures. Concentration of ART in hair is an objective and validated measure of drug adherence and exposure. We examined the association of food insecurity with levels of ART concentrations in hair among women living with HIV (WLHIV) in the United States (US).

Methods: We analyzed longitudinal data collected semi-annually from 2013- 2015 from the Women's Interagency HIV Study, a multi-site prospective cohort study of WLHIV and HIV-negative controls. Our sample comprised 1,944 person-visits from 677 WLHIV. Food insecurity was measured using the US Household Food Security Survey Module. ART concentrations in hair were measured using high performance liquid chromatography with mass spectrometry detection for regimens including darunavir, atazanavir, raltegravir or dolutegravir. We conducted multiple three-level linear regressions that accounted for repeated measures and the ART medication(s) taken at each visit, adjusting for sociodemographic and clinical characteristics.
Results: At baseline, 59% of participants were virally suppressed and 45% reported food insecurity. In the base multivariable model, each 3-point increase in food insecurity was associated with 0.94-fold lower ART concentration in hair (95% CI: 0.89, 0.99). This effect remained unchanged after adjusting for self-reported adherence.
Conclusions: Food insecurity was associated with lower ART concentrations in hair, suggesting that food insecurity may be associated with sub-optimal ART adherence and/or drug absorption. Interventions that aim to improve ART adherence among WLHIV should consider and address the role of food insecurity.

Anna M Leddy, Leila A Sheira, Bani Tamraz, Craig Sykes

[link url=""]Healio report[/link]

[link url=""]Clinical Infectious Diseases abstract[/link]

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