Food Insecurity is Associated with Incomplete HIV RNA Suppression Among Homeless and Marginally Housed HIV-infected Individuals in San Francisco
Food Insecurity is Associated with Incomplete HIV RNA Suppression Among Homeless and Marginally Housed HIV-infected Individuals in San Francisco
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DOI：
10.1007/s11606-008-0824-5
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发表时间：
2009-01-01
影响因子：
5.7
通讯作者：
Bangsberg, David R.
中科院分区：
文献类型：
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作者：
Weiser, Sheri D.;Frongillo, Edward A.;Bangsberg, David R.
国际上越来越多的人担心粮食不安全可能会对抗逆转录病毒（ARV）治疗结果产生负面影响，但没有研究直接评估粮食不安全对病毒载量抑制和抗逆转录病毒治疗依从性的影响。我们假设，粮食不安全与无家可归和边缘安置的艾滋病毒阳性抗逆转录病毒治疗患者的病毒学反应不佳有关。这是一项横断面研究。参与者是接受抗逆转录病毒治疗的无家可归和边缘安置的人，在无家可归者获得护理研究 (REACH) 队列中接受未公布的药物计数依从性监测。粮食不安全是通过家庭粮食不安全获取量表 (HFIAS) 来衡量的。主要结果是将 HIV 病毒 RNA 抑制至 < 50 拷贝/ml。我们使用多变量逻辑回归来评估粮食不安全是否与病毒抑制相关。在 104 名参与者中，51% 的人粮食安全，24% 的人轻度或中度粮食不安全，25% 的人严重粮食不安全。严重粮食不安全的参与者遵守率 >=80% 的可能性较小。在调整分析中，在控制所有协变量时，严重的粮食不安全与病毒抑制几率降低 77% 相关（95% CI = 0.06-0.82）。在按依从性水平分层的分析中，在80%依从性（95% CI = 0.06-1.81）的人中，严重的粮食不安全与病毒抑制几率降低85%（95% CI = 0.02-0.99）相关。旧金山是美国艾滋病毒阳性个体资源最丰富的地区之一，旧金山一半的艾滋病毒阳性城市贫民存在粮食不安全，并与不完全的病毒抑制有关。这些发现表明，确保获得食物应成为为贫困人口服务的公共卫生艾滋病毒项目的一个组成部分。
There is growing international concern that food insecurity may negatively impact antiretroviral (ARV) treatment outcomes, but no studies have directly evaluated the effect of food insecurity on viral load suppression and antiretroviral adherence. We hypothesized that food insecurity would be associated with poor virologic response among homeless and marginally housed HIV-positive ARV-treated patients.This is a cross-sectional study.Participants were ARV-treated homeless and marginally housed persons receiving adherence monitoring with unannounced pill counts in the Research on Access to Care in the Homeless (REACH) Cohort.Food insecurity was measured by the Household Food Insecurity Access Scale (HFIAS). The primary outcome was suppression of HIV viral RNA to < 50 copies/ml. We used multivariate logistic regression to assess whether food insecurity was associated with viral suppression.Among 104 participants, 51% were food secure, 24% were mildly or moderately food insecure and 25% were severely food insecure. Severely food insecure participants were less likely to have adherence >=80%. In adjusted analyses, severe food insecurity was associated with a 77% lower odds of viral suppression (95% CI = 0.06-0.82) when controlling for all covariates. In analyses stratified by adherence level, severe food insecurity was associated with an 85% lower odds of viral suppression (95% CI = 0.02-0.99) among those with 80% adherence (95% CI = 0.06-1.81).Food insecurity is present in half of the HIV-positive urban poor in San Francisco, one of the best resourced settings for HIV-positive individuals in the United States, and is associated with incomplete viral suppression. These findings suggest that ensuring access to food should be an integral component of public health HIV programs serving impoverished populations.