Treatment Outcomes Among People Living With HIV Who Are Food Insecure and Prescribed Antiretrovirals Taken With Food

Abstract

Background Food insecurity is a known barrier to medication adherence among people living with HIV. Antiretroviral therapies (ART) that require food for maximum benefit likely pose added challenges to patients who do not have reliable access to food. This study examines the health implications of prescribing ART that requires food to patients who are food insecure. Method A community sample of 538 men and 221 women currently taking ART to treat their HIV infection completed computerized interviews, biweekly-unannounced pill count adherence assessments, and obtained their CD4 cell count and HIV RNA from medical records. Results Sixty-three percent of participants experienced at least one indicator of food insecurity during the previous month, of which 274 (57%) were prescribed an ART regimen that requires food. Among participants who were food insecure, individuals taking ART requiring food indicated significantly greater HIV symptoms, lower CD4 cell counts, and poorer HIV suppression. For participants who were food secure, those taking ART that requires food were significantly less adherent than those whose ART regimen does not require food. Conclusions People living with HIV who experience food insecurity are significantly more likely to be prescribed ART regimens that require food and experience poorer treatment outcomes. Determination of optimal ART regimens should take patient access to food into account and treatment guidelines should highlight the importance of food access in selecting ART regimens.

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

“…Four studies (Kalichman et al, 2015;Wang et al, 2011;Weiser et al, 2013) used CD4 cutoffs of 200, and one study (Weiser et al, 2014) used a cutoff of 350. However, the study using 350 as the cutoff found the second highest OR among all five studies (Figure 2).…”

“…However, non-differential exposure misclassification may diminish statistical power, and probably explains why an association between food insecurity and CD4 count was not found in that study. Second, the studies by Kalichman et al (2010Kalichman et al ( , 2015 provided mean CD4 counts and the numbers of subjects with CD4<200, according to food insecurity status. We have computed mean CD4 count differences and ORs according to the information provided.…”

“…The number of study subjects whose CD4 counts <200 among exposed (food insecure) and unexposed (food secure) groups was available in one study (Kalichman et al, 2015). Therefore, we calculated the OR by constructing a two by two table and used this OR in constructing the forest plot.…”

Forget about forgetting: structural barriers and severe non-adherence to antiretroviral therapy

“…For example, a substantial number of active substance users are intentionally non-adherent out of fear of mixing alcohol and drugs with ART (Kalichman et al, 2013; Kalichman, Kalichman, et al, 2015). In addition, structural barriers, particularly those associated with poverty, including food insecurity, (Kalichman, Washington, Grebler, Hoyt, Welles, Merely, et al, 2015), lack of transportation (Kalichman et al, 2014; Tuller et al, 2009), and unstable housing (Leaver, Bargh, Dunn, & Hwang, 2007; Surratt, O’Grady, Levi-Minzi, & Kurtz, 2015) should be directly addressed by case management interventions.…”

Food Insecurity, HIV Disease Progression and Access to Care Among HIV-Infected Russians not on ART

“…However, our findings showed no associations between FI and HIV disease progression or initiation of ART among a population not on ART at enrollment, in contrast to findings from the existing literature from other geographic regions among people on ART. The majority of previous studies demonstrated an association between FI and HIV disease progression and access to HIV care (11, 15, 45, 48–51). To our knowledge, only one study did not demonstrate a statistically significant association in adjusted analyses between FI and virologic suppression among participant receiving ART (16); authors of this study attributed the lack of association to methodological factors, such as confounding and misclassification.…”