Food insecurity and low CD4 count among HIV-infected people: a systematic review and meta-analysis

Abstract

Food insecurity is defined as a limited or uncertain ability to acquire acceptable foods in socially acceptable ways, or limited or uncertain availability of nutritionally adequate and safe foods. While effective antiretroviral treatment can significantly increase CD4 counts in the majority of patients, there are certain populations who remain at relatively low CD4 count levels. Factors possibly associated with poor CD4 recovery have been extensively studied, but the association between food insecurity and low CD4 count is inconsistent in the literature. The objective is to systematically review published literature to determine the association between food insecurity and CD4 count among HIV-infected people. PubMed, Web of Science, ProQuest ABI/INFORM Complete, Ovid Medline and EMBASE Classic, plus bibliographies of relevant studies were systematically searched up to May 2015, where the earliest database coverage started from 1900. Studies that quantitatively assessed the association between food insecurity and CD4 count among HIV-infected people were eligible for inclusion. Study results were summarized using random effects model. A total of 2093 articles were identified through electronic database search and manual bibliographic search, of which 8 studies included in this meta-analysis. Food insecure people had 1.32 times greater odds of having lower CD4 counts compared to food secure people (OR = 1.32, 95% CI: 1.15-1.53) and food insecure people had on average 91 fewer CD4 cells/µl compared to their food secure counterparts (mean difference = -91.09, 95% CI: -156.16, -26.02). Food insecurity could be a potential barrier to immune recovery as measured by CD4 counts among HIV-infected people.

Food insecurity may lead to incomplete HIV viral suppression and less immune reconstitution among HIV/hepatitis C virus‐coinfected people

“…The results indicated that severe FI was associated with increased risk of having detectable HIV viral load and lower CD4 count among HIV/HCV-coinfected individuals. Our findings are consistent with the results of recent meta-analyses that summarized associations between FI and both HIV viral load and CD4 count among HIV-infected people with an unknown proportion of HCV coinfection [51,52], and provide evidence that FI is a risk factor for poor treatment outcomes among people coinfected with HIV/HCV. While the potential pathways through which FI affects HIV viral suppression and immune reconstitution remain unknown, it is very likely that poor medication adherence mediates the effect.…”

Prevalence and Predictors of Food Insecurity among People Living with HIV Enrolled in Antiretroviral Therapy and Livelihood Programs in Two Rural Zambian Hospitals

“…At the very least, food insecurity is highly predictive of severe malnutrition and wasting (Kadiyala and Rawat 2013). At its worst, food insecurity increases risk of morbidity and mortality (Aibibula et al 2016; Koethe et al 2013; Rawat, McCoy, and Kadiyala 2013; Weiser et al 2012). In addition, food insecurity is a significant barrier to treatment adherence (Hong et al 2014; Singer, Weiser, and McCoy 2015; Young et al 2014).…”

Insegurança alimentar moderada e grave em famílias integradas por pessoas vivendo com HIV/Aids: validação da escala e fatores associados

“…FI in the context of PLHA may be a key risk factor for the occurrence of negative outcomes 28 . FI has been associated with a 1.3 times increased likelihood of showing a worse CD4 cell count, according to a recent meta-analysis 29 , and is associated with depression symptoms, worse treatment compliance and exacerbation of side effects 30 . PLHA experiencing FI have a 1.29 times higher likelihood of showing incomplete viral load suppression and a 1.48 times higher likelihood of failing to comply with the treatment 31 .…”