Food Insecurity in HIV-Hepatitis C Virus Co-infected Individuals in Canada: The Importance of Co-morbidities

Joseph Cox,Marina B Klein,Erica E M Moodie,Aranka Anema,Sharon L Walmsley,Kathleen C Rollet-Kurhajec,Gilles Paradis,Anne-Marie Hamelin,Taylor Mclinden,Sean B Rourke

doi:10.1007/s10461-016-1326-9

Joseph Cox, Marina B Klein + Show 8 more

Open Access

https://doi.org/10.1007/s10461-016-1326-9

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Abstract

While research has begun addressing food insecurity (FI) in HIV-positive populations, knowledge regarding FI among individuals living with HIV-hepatitis C virus (HCV) co-infection is limited. This exploratory study examines sociodemographic, socioeconomic, behavioral, and clinical factors associated with FI in a cohort of HIV-HCV co-infected individuals in Canada. We analyzed longitudinal data from the Food Security and HIV-HCV Co-infection Study of the Canadian Co-infection Cohort collected between November 2012-June 2014 at 15 health centres. FI was measured using the Household Food Security Survey Module and classified using Health Canada criteria. Generalized estimating equations were used to assess factors associated with FI. Among 525 participants, 59 % experienced FI at their first study visit (baseline). Protective factors associated with FI (p < 0.05) included: enrolment at a Quebec study site (aOR: 0.42, 95 % CI: 0.27, 0.67), employment (aOR: 0.55, 95 % CI: 0.35, 0.87), and average personal monthly income (aOR per $100 CAD increase: 0.98, 95 % CI: 0.97, 0.99). Risk factors for FI included: recent injection drug use (aOR: 1.98, 95 % CI: 1.33, 2.96), trading away food (aOR: 5.23, 95 % CI: 2.53, 10.81), and recent experiences of depressive symptoms (aOR: 2.11, 95 % CI: 1.48, 3.01). FI is common in this co-infected population. Engagement of co-infected individuals in substance use treatments, harm reduction programs, and mental health services may mitigate FI in this vulnerable subset of the HIV-positive population.

Highlights

Food insecurity (FI) is an important issue in HIV-positive populations [1,2,3,4]
While research has begun addressing food insecurity (FI) in HIV-positive populations, knowledge regarding FI among individuals living with HIV-hepatitis C virus (HCV) co-infection is limited
Despite HIV-HCV co-infected individuals being an important HIV-positive subpopulation, where we hypothesize that FI may be highly prevalent and more severe, this issue has not been studied in a population of HIV-positive individuals known to be co-infected with HCV. This exploratory study was conducted to identify sociodemographic, socioeconomic, behavioral, and clinical factors associated with FI in a population of HIV-HCV coinfected individuals in Canada

Summary

Introduction

Food insecurity (FI) is an important issue in HIV-positive populations [1,2,3,4]. FI exists ‘‘whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain’’ (e.g., without resorting to emergency food supplies, scavenging, stealing, and other coping strategies) [5]. The prevalence of FI among HIVpositive individuals in Ontario was recently found to be 69 % when measured by the Household Food Security Survey Module (HFSSM) [7] This is in contrast to the annual estimate of 8 % of Canadian adults who experienced FI between 2007 and 2012 [8]. It has been suggested that fear or the actual experience of the side effects of cART are exacerbated in the absence of food, affecting treatment adherence [10]. Biologic mechanisms such as the impact of food on cART pharmacokinetics [11] and subsequent HIV viral load suppression may have a role. Nutritional deficiencies are associated with immunosuppression and lower CD4 cell counts in individuals experiencing FI [14]

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