Changes in food insecurity, nutritional status, and physical health status after antiretroviral therapy initiation in rural Uganda.
OBJECTIVE
To investigate whether time on antiretroviral therapy (ART) is associated with improvements in food security and nutritional status, and the extent to which associations are mediated by improved physical health status.


METHODS
The Uganda AIDS Rural Treatment Outcomes study, a prospective cohort of HIV-infected adults newly initiating ART in Mbarara, Uganda.


METHODS
Participants initiating ART underwent quarterly structured interview and blood draws. The primary explanatory variable was time on ART, constructed as a set of binary variables for each 3-month period. Outcomes were food insecurity, nutritional status, and PHS. We fit multiple regression models with cluster-correlated robust estimates of variance to account for within-person dependence of observations over time, and analyses were adjusted for clinical and sociodemographic characteristics.


RESULTS
Two hundred twenty-eight ART-naive participants were followed for up to 3 years, and 41% were severely food insecure at baseline. The mean food insecurity score progressively declined (test for linear trend P < 0.0001), beginning with the second quarter (b = -1.6; 95% confidence interval: -2.7 to -0.45) and ending with the final quarter (b = -6.4; 95% confidence interval: -10.3 to -2.5). PHS and nutritional status improved in a linear fashion over study follow-up (P < 0.001). Inclusion of PHS in the regression model attenuated the relationship between ART duration and food security.


CONCLUSIONS
Among HIV-infected individuals in Uganda, food insecurity decreased and nutritional status and PHS improved over time after initiation of ART. Changes in food insecurity were partially explained by improvements in PHS. These data support early initiation of ART in resource-poor settings before decline in functional status to prevent worsening food insecurity and its detrimental effects on HIV treatment outcomes.
Department of Medicine, Division of HIV/AIDS, San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA. sheri.weiser@ucsf.edu
Sheri D
SD
Weiser
Reshma
R
Gupta
Alexander C
AC
Tsai
Edward A
EA
Frongillo
Nils
N
Grede
Elias
E
Kumbakumba
Annet
A
Kawuma
Peter W
PW
Hunt
Jeffrey N
JN
Martin
David R
DR
Bangsberg
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001774:Blood Chemical Analysis; D005247:Feeding Behavior; D015658:HIV Infections / Q000188:drug therapy*; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009752:Nutritional Status; D010809:Physical Fitness; D012424:Rural Population; D013997:Time Factors; D016896:Treatment Outcome; D014454:Uganda
D019380:Anti-HIV Agents