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Food Insecurity is Associated with Poor Virologic Response among HIV-Infected Patients Receiving Antiretroviral Medications

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ABSTRACT

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.

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Acknowledgements

This work was funded by National Institute on Alcohol and Alcohol Abuse (U01 AA 13566 and U10 AA 13566), National Institute of Aging (K23 AG00826), Robert Wood Johnson Generalist Faculty Scholar Award, an Inter-agency Agreement between NIA, National Institute of Mental Health, and VA HSR&D Research Enhancement Award Program (REAP) PRIME Project (REA 08-266). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Yale University School of Medicine, Harkness Hall Building A 367 Cedar Street, Suite 410A, New Haven, CT, 06510, USA

    Emily A. Wang MD, MAS, David A. Fiellin MD, Joseph L. Goulet PhD, Kristin Mattocks PhD, Lynn E. Sullivan MD & Amy C. Justice MD, PhD

  2. Pittsburgh VA Healthcare System, Pittsburgh, PA, USA

    Kathleen A. McGinnis MS

  3. VA Connecticut Healthcare System, West Haven, CT, USA

    Joseph L. Goulet PhD & Amy C. Justice MD, PhD

  4. National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, MD, USA

    Kendall Bryant PhD

  5. VA Medical Center and George Washington University Medical Center, Washington, DC, USA

    Cynthia L. Gibert MD

  6. VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    David A. Leaf MD

  7. Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA

    Nicholas Vogenthaler MD

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  1. Emily A. Wang MD, MAS
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for the VACS Project Team

Corresponding author

Correspondence to Emily A. Wang MD, MAS.

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Wang, E.A., McGinnis, K.A., Fiellin, D.A. et al. Food Insecurity is Associated with Poor Virologic Response among HIV-Infected Patients Receiving Antiretroviral Medications. J GEN INTERN MED 26, 1012–1018 (2011). https://doi.org/10.1007/s11606-011-1723-8

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  • DOI: https://doi.org/10.1007/s11606-011-1723-8

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