The impact of food insecurity on HIV and hepatitis co-infection.
New research shows that food insecurity can impact treatment outcomes for people living with HIV and hepatitis C (HCV) co-infection.
A new study, published in HIV Medicine, examined the association between food insecurity and treatment outcomes for 725 people living with HIV/HCV co-infection in Canada, with wider implications for lower income countries.
Researchers found severe food insecurity was associated with increased risk of having a detectable HIV viral load and a lower CD4 count.
Around 8% of Canadian households are thought to experience some level of limited access to food. This proportion is estimated to be even higher among people living with HIV, with several studies consistently finding that more than half of the people living with HIV in Canada experience some level of food insecurity.
Treatments for both diseases are normally required to be taken with food, so food insecurity can affect the ability of someone to adhere to treatment.
Although previous studies have examined the link between food insecurity, HIV viral load and CD4 count, this is the first study to focus on HIV/HCV-co-infection. Although HCV infection is declining in developed countries, the current prevalence of HCV infection among people living with HIV in North America is estimated at between 15-30%.
People living with HIV/HCV-co-infection were enrolled in the study between November 2012 and October 2015, and checked-up every six months for a maximum of five study visits. Researchers categorised the food situation each participant faced as secure, moderately insecure or severely insecure.
At the beginning of the study, 57% experienced some form of food insecurity and this percentage remained at around 50% throughout. Of those experiencing food insecurity, 23% experienced moderate food insecurity and 34% experienced severe food insecurity.
Those experiencing severe food insecurity were found to be 1.47 times more likely to have a detectable viral load and a 0.91-fold increase in CD4 count compared to people who were food secure. This means that the treatment they were on was failing to suppress HIV in their body.
Researchers found that a prolonged period of food insecurity, whether moderate or severe (defined as continuing for a period of six months or more), had a similar effect on HIV viral load and CD4 count as a single episode of severe food insecurity.
These results add to mounting evidence on the link between food insecurity and poor treatment outcomes for people living with HIV. A literature review examining the association between HIV and food insecurity, published in AIDS Behaviour in March 2017, found food insecurity resulted in 29% lower odds of achieving complete HIV viral suppression. Similarly, a 2016 literature review of eight food insecurity and HIV studies found people experiencing food insecurity were 1.32 times more likely to have lower CD4 counts than those who were food secure and had on average 91 fewer CD4 cells/µl compared to their food secure counterparts.
Given the evidence of the alarmingly high proportion of people living with HIV who are food insecure, the provision of food supplementation may become a viable strategy for improving treatment adherence and subsequent health outcomes for people living with HIV and people with HIV/HVC co-infections.
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