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. 2009 Nov 1;52(3):342-9.
doi: 10.1097/QAI.0b013e3181b627c2.

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

Sheri D Weiser  1 , Kimberly A Fernandes, Eirikka K Brandson, Viviane D Lima, Aranka Anema, David R Bangsberg, Julio S Montaner, Robert S Hogg
Affiliations

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

Sheri D Weiser et al. J Acquir Immune Defic Syndr. .

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.

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Conflict of interest statement

Conflict of Interest Statement: None declared.

Figures

Figure 1
Figure 1
Crude Kaplan-Meier Survival Probabilities for the 1119 Patients Stratified by Food Security and BMI Levels.
People remaining in the study0 months20 months40 months60 months80 months100 months
Food Insecure/Underweight87 (7.8%)75 (6.7%)73 (6.5%)68 (6.1%)62 (5.5%)40 (3.6%)
Food Insecure/Not Underweight449 (40.1%)418 (37.4%)394 (35.2%)362 (32.4%)331 (29.6%)156 (13.9%)
Food Secure/Underweight73 (6.5%)70 (6.3%)68 (6.1%)65 (5.8%)60 (5.4%)38 (3.4%)
Food Secure/Not Underweight510 (45.6%)485 (43.3%)464 (41.5%)442 (39.5%)428 (38.2%)232 (20.7%)
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