Not having enough food linked to poor treatment outcomes in New York

People who don’t have enough food to eat are less likely to have an undetectable viral load than other people living with HIV, according to a longitudinal study from New York City, published in the July 1 issue of the Journal of Acquired Immune Deficiency Syndromes. The findings underscore the relevance of interventions to reduce poverty and help people living with HIV meet their basic needs.

In New York City, one in six people experience food insecurity each year. Food insecurity is more common among ethnic minorities who are also disproportionately affected by HIV. A lack of appropriate food could make adherence to HIV treatment more difficult.

Researchers analysed data from individuals who received food and nutrition services funded by the Ryan White Part A programme between 2011 and 2013. These services include communal meals, home-delivered meals, grocery supplies and food vouchers.

Glossary

odds ratio

Comparing one group with another, expresses differences in the odds of something happening. An odds ratio above 1 means something is more likely to happen in the group of interest; an odds ratio below 1 means it is less likely to happen. Similar to ‘relative risk’. 

multivariate analysis

An extension of multivariable analysis that is used to model two or more outcomes at the same time.

longitudinal study

A study in which information is collected on people over several weeks, months or years. People may be followed forward in time (a prospective study), or information may be collected on past events (a retrospective study).

retention in care

A patient’s regular and ongoing engagement with medical care at a health care facility. 

Ryan White HIV/AIDS Program

In the United States, the largest federally funded programme providing HIV-related services to low-income, uninsured, and underinsured people with HIV/AIDS.

The 2118 people included in the analysis had all completed at least two periodic assessments of their access to food as well as having viral load data recorded in the six months after their last food assessment.

Individuals were considered to have ‘food insufficiency’ if they reported sometimes or often not having enough money for food, not having enough to eat, or recently going a whole day without eating.

As study participants were all receiving food-related services, it’s not surprising that most reported problems: 61% had food insufficiency at both assessments, 25% had food insufficiency at one of the two assessments and 14% did not have food insufficiency.

There was a link between food insufficiency and poor treatment outcomes. A detectable viral load (above 200 copies/ml) was reported by:

  • 29% of those with food insufficiency at both assessments,
  • 22% of those with food insufficiency at one assessment, and
  • 11% of those who did not have food insufficiency.

Clearly, a number of other factors could impact this association, including unemployment, low income, unstable housing, low levels of education and drug use. After statistical adjustment for these and other confounders, there was an independent association between detectable viral load and food insufficiency: adjusted odds ratio 1.6.

There were also independent associations between detectable viral load and unstable housing (adjusted odds ratio 1.5) and an income below the poverty level (adjusted odds ratio 1.5).

Low CD4 cell counts weren’t significantly associated with food insufficiency in the multivariate analysis.

The researchers say that their findings strengthen the evidence for a causal relationship between food insufficiency and poor HIV treatment outcomes. Future studies should examine the factors which might explain this relationship – including the biological (weight loss, malnutrition) and the behavioural (retention in care, adherence).

“Understanding the relationship between food insecurity and clinical health outcomes among people living with HIV is critical in planning interventions for this population, particularly among the urban poor and marginally housed individuals who are at significant risk for food insecurity,” they write.

References

Feldman MB et al. The Association Between Food Insufficiency and HIV Treatment Outcomes in a Longitudinal Analysis of HIV-Infected Individuals in New York City. Journal of Acquired Immune Deficiency Syndromes 69: 329-337, 2015. (Abstract).