The association between food insecurity and mortality among HIV-infected individuals on HAART.
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.
Weiser
Sheri D
SD
Department of Medicine, Positive Health Program, San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94143-1372, USA. sheri.weiser@ucsf.edu
Fernandes
Kimberly A
KA
Brandson
Eirikka K
EK
Lima
Viviane D
VD
Anema
Aranka
A
Bangsberg
David R
DR
Montaner
Julio S
JS
Hogg
Robert S
RS
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001955:British Columbia / Q000453:epidemiology; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012307:Risk Factors; D013851:Thinness
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