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Food insecurity is associated with poor virologic response among HIV-infected patients receiving antiretroviral medications
Women’s Health Research Faculty Publications
  • Emily A. Wang, Yale University
  • Kathleen A. McGinnis, Pittsburgh VA Healthcare System
  • David A. Fiellin, Yale University
  • Joseph Goulet, Yale University
  • Kendall J. Bryant, National Institute of Alcohol and Alcohol Abuse
  • Cynthia L L. Gibert, George Washington University - School of Medicine and Health Sciences
  • David A A. Leaf, University of California - Los Angeles
  • Kristin M. Mattocks, University of Massachusetts Medical School Worcester
  • Lynn E Sullivan, Yale University
  • Nicholas Vogenthaler, Emory University
  • Amy C. Justice, Yale University
UMMS Affiliation
Department of Quantitative Health Sciences
Publication Date
Document Type
Adult; *Antiretroviral Therapy, Highly Active; Cohort Studies; Cross-Sectional Studies; Female; *Food Supply; HIV Infections; *HIV-1; Humans; Male; *Medication Adherence; Middle Aged; Treatment Outcome; Viral Load
BACKGROUND AND OBJECTIVE: Food insecurity negatively impacts HIV disease outcomes in international settings. No large scale U.S. studies have investigated the association between food insecurity and severity of HIV disease or the mechanism of this possible association. The objective of this study was to examine the impact of food insecurity on HIV disease outcomes in a large cohort of HIV-infected patients receiving antiretroviral medications. DESIGN: This is a cross-sectional study. PARTICIPANTS AND SETTING: Participants were HIV-infected patients enrolled in the Veterans Aging Cohort Study between 2002-2008 who were receiving antiretroviral medications. MAIN MEASUREMENTS: Participants reporting "concern about having enough food for you or your family in the past 30 days" were defined as food insecure. Using multivariable logistic regression, we explored the association between food insecurity and both low CD4 counts (/muL) and unsuppressed HIV-1 RNA (>500 copies/mL). We then performed mediation analysis to examine whether antiretroviral adherence or body mass index mediates the observed associations. KEY RESULTS: Among 2353 HIV-infected participants receiving antiretroviral medications, 24% reported food insecurity. In adjusted analyses, food insecure participants were more likely to have an unsuppressed HIV-1 RNA (AOR 1.37, 95% CI 1.09, 1.73) compared to food secure participants. Mediation analysis revealed that neither antiretroviral medication adherence nor body mass index contributes to the association between food insecurity and unsuppressed HIV-1 RNA. Food insecurity was not independently associated with low CD4 counts. CONCLUSIONS: Among HIV-infected participants receiving antiretroviral medications, food insecurity is associated with unsuppressed viral load and may render treatment less effective. Longitudinal studies are needed to test the potential causal association between food insecurity, lack of virologic suppression, and additional HIV outcomes.
  • food insecurity,
  • HIV,
  • patients,
  • antiretrovirals
DOI of Published Version
Related Resources
Link to Article in PubMed
PubMed ID
Citation Information
Emily A. Wang, Kathleen A. McGinnis, David A. Fiellin, Joseph Goulet, et al.. "Food insecurity is associated with poor virologic response among HIV-infected patients receiving antiretroviral medications" Vol. 26 Iss. 9 (2011) ISSN: 0884-8734 (Linking)
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