Document Detail


Food insecurity is associated with poor virologic response among HIV-infected patients receiving antiretroviral medications.
MedLine Citation:
PMID:  21573882     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 (<200 cells/μL) 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.
Authors:
Emily A Wang; Kathleen A McGinnis; David A Fiellin; Joseph L Goulet; Kendall Bryant; Cynthia L Gibert; David A Leaf; Kristin Mattocks; Lynn E Sullivan; Nicholas Vogenthaler; Amy C Justice;
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2011-05-15
Journal Detail:
Title:  Journal of general internal medicine     Volume:  26     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-08-18     Completed Date:  2012-06-06     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1012-8     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Yale University School of Medicine, Harkness Hall Building A 367 Cedar Street, Suite 410A, New Haven, CT 06510, USA. emily.wang@yale.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Antiretroviral Therapy, Highly Active*
Cohort Studies
Cross-Sectional Studies
Female
Food Supply*
HIV Infections / drug therapy*,  epidemiology
HIV-1* / drug effects,  isolation & purification
Humans
Male
Medication Adherence*
Middle Aged
Treatment Outcome
Viral Load / drug effects,  physiology
Grant Support
ID/Acronym/Agency:
K23 AG00826/AG/NIA NIH HHS; U01 AA 13566/AA/NIAAA NIH HHS; U10 AA 13566/AA/NIAAA NIH HHS
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