The association between food insecurity and mortality among HIV-infected individuals on HAART

  • Weiser S
  • Fernandes K
  • Brandson E
 et al. 
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Abstract

BACKGROUND: Food insecurity is increasingly recognized as a barrier to optimal treatment outcomes, but there is little data on this issue. We assessed associations between food insecurity and mortality among HIV-infected antiretroviral therapy-treated individuals in Vancouver, British Columbia, and whether body max index (BMI) modified associations. METHODS: Individuals were recruited from the British Columbia HIV/AIDS drug treatment program in 1998 and 1999 and were followed until June 2007 for outcomes. Food insecurity was measured with the Radimer/Cornell questionnaire. Cox proportional hazard models were used to determine associations between food insecurity, BMI, and nonaccidental deaths when controlling for confounders. RESULTS: Among 1119 participants, 536 (48%) were categorized as food insecure and 160 (14%) were categorized as underweight (BMI < 18.5). After a median follow-up time of 8.2 years, 153 individuals (14%) had died from nonaccidental deaths. After controlling for adherence, CD4 counts, and socioeconomic variables, people who were food insecure and underweight were nearly 2 times more likely to die (adjusted hazard ratio = 1.94, 95% confidence interval = 1.10 to 3.40) compared with people who were not food insecure or underweight. There was also a trend toward increased risk of mortality among people who were food insecure and not underweight (adjusted hazard ratio = 1.40, 95% confidence interval = 0.91 to 2.05). In contrast, people who were underweight but food secure were not more likely to die. CONCLUSIONS: Food insecurity is a risk factor for mortality among antiretroviral therapy-treated individuals in British Columbia, particularly among individuals who are underweight. Innovative approaches to address food insecurity should be incorporated into HIV treatment programs.

Author-supplied keywords

  • *Antiretroviral Therapy, Highly Active
  • *Poverty
  • Adult
  • British Columbia/epidemiology
  • Female
  • Food Supply/*statistics & numerical data
  • HIV Infections/*drug therapy/epidemiology/*mortali
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Thinness

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Authors

  • S D Weiser

  • K A Fernandes

  • E K Brandson

  • V D Lima

  • A Anema

  • D R Bangsberg

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