• Emily A Wang, Kathleen A McGinnis, David A Fiellin, Joseph L Goulet, Kendall Bryant, Cynthia L Gibert, David A Leaf, Kristin Mattocks, Lynn E Sullivan, Nicholas Vogenthaler, Amy C Justice, and VACS Project Team.
• Department of Internal Medicine, Yale University School of Medicine, Harkness Hall Building A 367 Cedar Street, Suite 410A, New Haven, CT 06510, USA. emily.wang@yale.edu
• J Gen Intern Med. 2011 Sep 1;26(9):1012-8.

Background And ObjectiveFood insecurity negatively impacts HIV disease outcomes in international settings. No large scale U.S. studies have investigated the association between food insecurity and severity of HIV disease or the mechanism of this possible association. The objective of this study was to examine the impact of food insecurity on HIV disease outcomes in a large cohort of HIV-infected patients receiving antiretroviral medications.DesignThis is a cross-sectional study.Participants And SettingParticipants were HIV-infected patients enrolled in the Veterans Aging Cohort Study between 2002-2008 who were receiving antiretroviral medications.Main MeasurementsParticipants reporting "concern about having enough food for you or your family in the past 30 days" were defined as food insecure. Using multivariable logistic regression, we explored the association between food insecurity and both low CD4 counts (<200 cells/μL) and unsuppressed HIV-1 RNA (>500 copies/mL). We then performed mediation analysis to examine whether antiretroviral adherence or body mass index mediates the observed associations.Key ResultsAmong 2353 HIV-infected participants receiving antiretroviral medications, 24% reported food insecurity. In adjusted analyses, food insecure participants were more likely to have an unsuppressed HIV-1 RNA (AOR 1.37, 95% CI 1.09, 1.73) compared to food secure participants. Mediation analysis revealed that neither antiretroviral medication adherence nor body mass index contributes to the association between food insecurity and unsuppressed HIV-1 RNA. Food insecurity was not independently associated with low CD4 counts.ConclusionsAmong HIV-infected participants receiving antiretroviral medications, food insecurity is associated with unsuppressed viral load and may render treatment less effective. Longitudinal studies are needed to test the potential causal association between food insecurity, lack of virologic suppression, and additional HIV outcomes.

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