Food Insecurity is Associated with Poor HIV Outcomes Among Women in the United States

Spinelli, Matthew A; Frongillo, Edward A.; Sheira, Lila A; Palar, Kartika; Tien, Phyllis C.; Wilson, Tracey E.; Merenstein, Daniel; Cohen, Mardge H.; Adedimeji, Adebola; Wentz, Eryka L.; Adimora, Adaora A.; Metsch, Lisa R.; Turan, Janet M.; Kushel, Margot; Weiser, Sheri D.

doi:10.1007/s10461-017-1968-2

Cited by 34 publications

(27 citation statements)

References 12 publications

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“…In this longitudinal study among 1803 WLWH, FI was associated with higher viral nonsuppression, lower CD4 cell counts, and worse PHS. These findings support previous research that has documented worse HIV outcomes among food insecure individuals, [3][4][5][6][7]9,11 including a cross-sectional study in the same cohort, 51 and extend previous findings in several important ways. First, while most previous work from the United States has focused on populations comprised largely of men or are cross sectional, 51 we report that these associations hold in a national longitudinal sample of women with HIV.…”

Section: Discussionsupporting

confidence: 91%

Mechanisms from Food Insecurity to Worse HIV Treatment Outcomes in US Women Living with HIV

Weiser

Sheira

Palar

et al. 2020

AIDS Patient Care and STDs

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Food insecurity (FI) contributes to HIV-related morbidity and mortality, but the mechanisms whereby FI negatively impacts HIV health are untested. We tested the hypothesis that FI leads to poor HIV clinical outcomes through nutritional, mental health, and behavioral paths. We analyzed data from Women's Interagency HIV Study (WIHS) among 1803 women living with HIV (WLWH) (8225 person-visits) collected from 2013 to 2015 biannually from nine sites across the United States participating in the WIHS. FI was measured with the US Household Food Security Survey Module. Outcomes included HIV viral nonsuppression, CD4 cell counts, and physical health status (PHS). We used longitudinal logistic and linear regression models with random effects to examine associations adjusting for covariates and path analysis to test nutritional, mental health, and behavioral paths. Increasing severity of FI was associated with unsuppressed viral load, lower CD4 counts, and worse PHS (all p < 0.05). Report of FI 6 months earlier was independently associated with most outcomes after adjusting for concurrent FI. For viral nonsuppression, the nutritional and behavioral paths accounted for 2.09% and 30.66% of the total effect, with the mental health path operating via serial mediation through the behavioral path. For CD4 count, the mental health and behavioral paths accounted for 15.21% and 17.0% of the total effect, respectively. For PHS, depressive symptoms accounted for 60.2% of the total effect. In conclusion, FI is associated with poor health among WLWH through different paths depending on the outcome. Interventions should target FI and its behavioral and mental health mechanisms to improve HIV outcomes.

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Section: Discussionsupporting

confidence: 91%

Mechanisms from Food Insecurity to Worse HIV Treatment Outcomes in US Women Living with HIV

Weiser

Sheira

Palar

et al. 2020

AIDS Patient Care and STDs

Self Cite

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“…Although using factors, based on measurement of multiple biomarkers, to risk stratify individuals is not practical in a clinical setting when compared to single markers that are also predictive, our results can inform interventions that seek to reduce inflammation. The utility of such an approach can be seen in assessment of food insecurity, where responses from multiple questions are reduced to a single variable (although not through EFA) of food insecurity, which has shown to be associated with various adverse health outcomes in HIV [ 29 – 31 ] and is a target for intervention [ 32 ]. While confirming the important role of these specific cytokines, our results also suggest that a more effective approach to reduce adverse HIV outcomes might be to focus on interventions that reduce the underlying inflammation (factor) represented by various correlated markers rather than focusing on only one of the markers which might represent a more specific type of inflammation (e.g., sCD14 for monocyte activation).…”

Section: Discussionmentioning

confidence: 99%

“…Another limitation of our study is that we did not assess food insecurity. Given the literature on the association of food insecurity with adverse HIV outcomes [ 29 – 31 ] along with its link to nutrition and immunity [ 47 ], a better understanding of the relationship between the extracted factors and food insecurity may have provided further insight into potential interventions.…”

Section: Discussionmentioning

confidence: 99%

Inflammation and micronutrient biomarkers predict clinical HIV treatment failure and incident active TB in HIV-infected adults: a case-control study

Shivakoti

Gupte

Tripathy

et al. 2018

BMC Med

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BackgroundVarious individual biomarkers of inflammation and micronutrient status, often correlated with each other, are associated with adverse treatment outcomes in human immunodeficiency virus (HIV)-infected adults. The objective of this study was to conduct exploratory factor analysis (EFA) on multiple inflammation and micronutrient biomarkers to identify biomarker groupings (factors) and determine their association with HIV clinical treatment failure (CTF) and incident active tuberculosis (TB).MethodsWithin a multicountry randomized trial of antiretroviral therapy (ART) efficacy (PEARLS) among HIV-infected adults, we nested a case-control study (n = 290; 124 cases, 166 controls) to identify underlying factors, based on EFA of 23 baseline (pre-ART) biomarkers of inflammation and micronutrient status. The EFA biomarker groupings results were used in Cox proportional hazards models to study the association with CTF (primary analysis where cases were incident World Health Organization stage 3, 4 or death by 96 weeks of ART) or incident active TB (secondary analysis).ResultsIn the primary analysis, based on eigenvalues> 1 in the EFA, three factors were extracted: (1) carotenoids), (2) other nutrients, and (3) inflammation. In multivariable-adjusted models, there was an increased hazard of CTF (adjusted hazard ratio (aHR) 1.47, 95% confidence interval (CI)1.17–1.84) per unit increase of inflammation factor score. In the secondary incident active TB case-control analysis, higher scores of the high carotenoids and low interleukin-18 factor was protective against incident active TB (aHR 0.48, 95% CI 0.26–0.87).ConclusionFactors identified through EFA were associated with adverse outcomes in HIV-infected individuals. Strategies focused on reducing adverse HIV outcomes through therapeutic interventions that target the underlying factor (e.g., inflammation) rather than focusing on an individual observed biomarker might be more effective and warrant further investigation.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1150-3) contains supplementary material, which is available to authorized users.

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“…105 Systematic screening for ART medication adherence via patient self-report using validated instruments or using pharmacy refill measures, and not relying solely on plasma viral load, is recommended. 1 Individuals with suboptimal adherence should be assessed for inadequate housing, 106–108 food insecurity, 109–111 active substance use, 110 psychiatric disorders, medication adverse effects, and pill burden.…”

Section: Engagement In Care and Art Adherencementioning

confidence: 99%

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Saag

Benson

Gandhi

et al. 2018

JAMA

518

287

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IMPORTANCE Antiretroviral therapy (ART) is the cornerstone of prevention and management of HIV infection. OBJECTIVE To evaluate new data and treatments and incorporate this information into updated recommendations for initiating therapy, monitoring individuals starting therapy, changing regimens, and preventing HIV infection for individuals at risk. EVIDENCE REVIEW New evidence collected since the International Antiviral Society–USA 2016 recommendations via monthly PubMed and EMBASE literature searches up to April 2018; data presented at peer-reviewed scientific conferences. A volunteer panel of experts in HIV research and patient care considered these data and updated previous recommendations. FINDINGS ART is recommended for virtually all HIV-infected individuals, as soon as possible after HIV diagnosis. Immediate initiation (eg, rapid start), if clinically appropriate, requires adequate staffing, specialized services, and careful selection of medical therapy. An integrase strand transfer inhibitor (InSTI) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) is generally recommended for initial therapy, with unique patient circumstances (eg, concomitant diseases and conditions, potential for pregnancy, cost) guiding the treatment choice. CD4 cell count, HIV RNA level, genotype, and other laboratory tests for general health and co-infections are recommended at specified points before and during ART. If a regimen switch is indicated, treatment history, tolerability, adherence, and drug resistance history should first be assessed; 2 or 3 active drugs are recommended for a new regimen. HIV testing is recommended at least once for anyone who has ever been sexually active and more often for individuals at ongoing risk for infection. Preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and appropriate monitoring is recommended for individuals at risk for HIV. CONCLUSIONS AND RELEVANCE Advances in HIV prevention and treatment with antiretroviral drugs continue to improve clinical management and outcomes for individuals at risk for and living with HIV.

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Food Insecurity is Associated with Poor HIV Outcomes Among Women in the United States

Cited by 34 publications

References 12 publications

Mechanisms from Food Insecurity to Worse HIV Treatment Outcomes in US Women Living with HIV

Mechanisms from Food Insecurity to Worse HIV Treatment Outcomes in US Women Living with HIV

Inflammation and micronutrient biomarkers predict clinical HIV treatment failure and incident active TB in HIV-infected adults: a case-control study

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

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