The Association Between Food Insecurity and Mortality Among HIV-Infected Individuals on HAART

Abstract

Background Food insecurity is increasingly recognized as a barrier to optimal treatment outcomes but there is little data on this issue. We assessed associations between food insecurity and mortality in HIV-infected antiretroviral therapy (ART)-treated individuals in Vancouver, British Columbia (BC), and whether body max index (BMI) modified associations. Methods Individuals were recruited from the BC HIV/AIDS drug treatment program in 1998 and 1999, and were followed until June 2007 for outcomes. Food insecurity was measured with the Radimer/Cornell questionnaire. Cox proportional hazard models were used to determine associations between food insecurity, BMI and non-accidental deaths when controlling for confounders. Results Among 1119 participants, 536 (48%) were categorized as food insecure and 160 (14%) were categorized as underweight (BMI <18.5). After a median follow-up time of 8.2 years, 153 individuals (14%) had died from non-accidental deaths. After controlling for adherence, CD4 counts, and socioeconomic variables, people who were food insecure and underweight were nearly two times more likely to die (Adjusted hazard ratio [AHR]=1.94, 95% Confidence interval [CI]=1.10-3.40) compared with people who were not food insecure or underweight. There was also a trend towards increased risk of mortality among people who were food insecure and not underweight (AHR= 1.40, 95% CI=0.91-2.05). In contrast, people who were underweight but food secure were not more likely to die. Conclusions Food insecurity is a risk factor for mortality among ART-treated individuals in BC, particularly among individuals who are underweight. Innovative approaches to address food insecurity should be incorporated into HIV treatment programs.

Food Insecurity Is Associated with Greater Acute Care Utilization among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco

“…40 This is consistent with studies showing that impacts of food insecurity on HIV-related health outcomes, including immunologic and virologic outcomes, physical health status, and other measures of morbidity, are quite similar in resource-rich and resource-poor countries. 33,34,[39][40][41]59 Such consistency across different settings suggests that food insecurity is a robust and seemingly universal predictor of worse outcomes, which may contribute to the increased need for acute care services.…”

“…Previous studies have also shown adverse impacts of food insecurity on morbidity, mortality, and quality of life among HIV-infected individuals. 14,[32][33][34]39,41 Interventions are needed to address food insecurity and its negative impacts on the health and health-care utilization patterns of HIV-infected individuals. Related interventions that address other subsistence needs have shown promise in improving health-care use and treatment outcomes.…”

“…32,34,38 A few longitudinal studies have reported negative health impacts of food insecurity among HIVinfected individuals, including worse physical health status and increased opportunistic infections in Uganda, lower CD4 counts in a study in the Boston area, and higher risk of mortality in British Columbia. [39][40][41] There is little understanding of how food insecurity impacts patterns of health-care utilization among HIVinfected individuals, particularly in resource-rich countries without universal health care such as the US. Such understanding is critical because use of health services reflects both population-level morbidity and overall costs to the health-care system.…”

Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health

“…Food insecurity increases the risk of acquisition of and poor outcomes associated with both infectious and non-communicable diseases [4,5]. In HIV, food insecurity is associated with increased risk of HIV acquisition [6] and transmission [7,8], poor medication adherence [9,10], worse immunologic [10,11] and virologic outcomes [10,12,13], morbidity [14], and mortality [15]. In diabetes, food insecurity is associated with increased risk of type 2 diabetes mellitus (T2DM) [4], poorer diabetes self-management [16,17], poorer glycemic (i.e., blood sugar) control [4], and increased hypoglycemic events [18].…”

The Enabling Effect of Food Assistance in Improving Adherence and/or Treatment Completion for Antiretroviral Therapy and Tuberculosis Treatment: A Literature Review

“…Food insecurity is one of the multiple barriers that individuals face in initiating and adhering to long-term medical therapies such as ART and DOTS, especially in resourcelimited settings [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Other patient-related barriers include the complexity of the medication regimen [18], emotional distress [7], illness costs to households [19], stigma [20], health beliefs and poverty [4], limited knowledge of the disease [21], difficulty remembering [22], intentional non-adherence due to adverse drug reactions [23] and harmful use of alcohol [24].…”