Relationship between food insecurity and mortality among HIV-positive injection drug users receiving antiretroviral therapy in British Columbia, Canada.
Relationship between food insecurity and mortality among HIV-positive injection drug users receiving antiretroviral therapy in British Columbia, Canada.
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DOI：
10.1371/journal.pone.0061277
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Hogg RS
中科院分区：
文献类型：
--
作者：
Anema A;Chan K;Chen Y;Weiser S;Montaner JS;Hogg RS
人们对粮食不安全对艾滋病毒/艾滋病感染者死亡率的潜在影响知之甚少。我们研究了不列颠哥伦比亚省（BC）开始抗逆转录病毒治疗（ART）的艾滋病毒阳性注射吸毒者（IDU）中粮食不安全与全因死亡率之间的潜在关系。在参与者开始抗逆转录病毒治疗时对食品安全状况进行了横断面测量。从1998年6月到2011年9月，参与者在完全补贴的ART项目中进行了前瞻性随访。Cox比例风险模型用于确定粮食不安全和死亡率之间的关系，控制潜在的混杂因素。在254名IDU中，181人（71.3%）粮食不安全，108人（42.5%）处于饥饿状态。中位随访13.3年后，105名（41.3%）参与者死亡。在多变量分析中，在对潜在混杂因素进行校正后，粮食不安全仍与死亡率显著相关（校正风险比[AHR] = 1.95, 95% CI: 1.07-3.53）。报告粮食不安全的艾滋病毒阳性注射吸毒者死亡的可能性几乎是粮食安全注射吸毒者的两倍。需要进一步研究以了解粮食不安全如何以及为何与这一人群的高死亡率相关。公共卫生组织应评估食物补充和社会结构支持在减少危害和艾滋病毒治疗方案中对注射吸毒者的可能作用。
Little is known about the potential impact of food insecurity on mortality among people living with HIV/AIDS. We examined the potential relationship between food insecurity and all-cause mortality among HIV-positive injection drug users (IDU) initiating antiretroviral therapy (ART) across British Columbia (BC). Cross-sectional measurement of food security status was taken at participant ART initiation. Participants were prospectively followed from June 1998 to September 2011 within the fully subsidized ART program. Cox proportional hazard models were used to ascertain the association between food insecurity and mortality, controlling for potential confounders. Among 254 IDU, 181 (71.3%) were food insecure and 108 (42.5%) were hungry. After 13.3 years of median follow-up, 105 (41.3%) participants died. In multivariate analyses, food insecurity remained significantly associated with mortality (adjusted hazard ratio [AHR] = 1.95, 95% CI: 1.07–3.53), after adjusting for potential confounders. HIV-positive IDU reporting food insecurity were almost twice as likely to die, compared to food secure IDU. Further research is required to understand how and why food insecurity is associated with excess mortality in this population. Public health organizations should evaluate the possible role of food supplementation and socio-structural supports for IDU within harm reduction and HIV treatment programs.
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