Abstract
ObjectivesLittle 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).MethodsCross-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.ResultsAmong 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.ConclusionsHIV-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.
Highlights
Despite the tremendous benefits of antiretroviral therapy (ART) use on HIV disease progression and survival [1,2], micro- and macronutrient malnutrition remain strong independent predictors of mortality among HIV-positive individuals in both high and low resource settings [3,4,5,6,7,8,9,10,11,12,13]
In BC, antiretrovirals have been distributed free of charge to HIV-positive individuals since 1986, and coordinated centrally since 1992 by the British Columbia Centre for Excellence in HIV/AIDS (BC-CfE) HIV/AIDS Drug Treatment Program (DTP), located at St
Bivariate comparison of participant characteristics by food security status revealed that individuals with lower incomes, receiving a protease inhibitor (PI)-based regimen, and initiating ART at a later year, were all significantly more likely to be food insecure (p,0.05)
Summary
Despite the tremendous benefits of antiretroviral therapy (ART) use on HIV disease progression and survival [1,2], micro- and macronutrient malnutrition remain strong independent predictors of mortality among HIV-positive individuals in both high and low resource settings [3,4,5,6,7,8,9,10,11,12,13]. A component of food insecurity, has been associated with mortality among ART-naıve individuals in Uganda [17]. These studies suggest that food insecurity warrants prioritization by public health programs and policies for HIV-infected populations. Studies in urban HIV-positive populations receiving HIV treatment, including a high proportion of illicit drug users, have found that food insecurity is associated with HIV-related wasting [19], virologic non-suppression [26,27] and poor immunologic response to ART [27,28,29]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
