Kalichman Seth C, Washington Christopher, Grebler Tamar, Hoyt Ginger, Welles Brandi, Kegler Christopher, Kalichman Moira O, Cherry Chauncey
University of Connecticut, Storrs, CT, 06269, USA,
Infect Dis Ther. 2015 Jan 23;4(1):79-91. doi: 10.1007/s40121-015-0057-y.
Food insecurity is a well-established predictor of poor health outcomes. Antiretroviral therapies (ARTs) that should be taken with food to increase bioavailability may further challenge food insecure patients. This study examined factors associated with antiretroviral adherence and HIV viral suppression among people living with HIV who are food insecure and prescribed medications that require food.
A community sample of 313 men and 105 women who experienced food insecurity in the previous month and were currently taking ART completed computerized interviews, urine screening for drug use, prospective biweekly unannounced pill count adherence assessments, and obtained their HIV viral load and CD4 cell counts from medical records.
Individuals taking ART regimens that should be taken with food were significantly more likely to be unemployed, were living longer with an HIV diagnosis, had lower CD4 cell counts, poorer HIV suppression, and endorsed more beliefs that taking medications was necessary for their health. Multivariable regression models controlling for potential confounding factors showed that receiving ART that requires food was significantly related to poorer ART adherence and unsuppressed HIV in this food insecure sample.
People living with HIV who are food insecure likely experience multiple facets of poverty that challenge their medication adherence, but food insecurity is the only such factor that is directly related to the pharmacokinetics of some antiretroviral medications. Achieving optimal treatment outcomes for HIV infection will require routine assessment of access to food when determining patient-tailored ART regimens.
粮食不安全是健康状况不佳的一个公认预测指标。需要与食物同服以提高生物利用度的抗逆转录病毒疗法（ART）可能会给粮食不安全的患者带来更多挑战。本研究调查了粮食不安全且所开药物需要与食物同服的HIV感染者中，与抗逆转录病毒治疗依从性和HIV病毒抑制相关的因素。
选取上个月经历过粮食不安全且目前正在接受抗逆转录病毒治疗的313名男性和105名女性组成社区样本，完成计算机化访谈、药物使用尿液筛查、前瞻性双周不通知的药丸计数依从性评估，并从病历中获取他们的HIV病毒载量和CD4细胞计数。
服用需要与食物同服的抗逆转录病毒治疗方案的个体更有可能失业，感染HIV后存活时间更长，CD4细胞计数更低，HIV抑制效果更差，并且更认同服药对其健康至关重要的观点。控制潜在混杂因素的多变量回归模型显示，在这个粮食不安全样本中，接受需要与食物同服的抗逆转录病毒治疗与较差的抗逆转录病毒治疗依从性和未被抑制的HIV显著相关。
粮食不安全的HIV感染者可能面临多重贫困因素，这些因素对他们的药物依从性构成挑战，但粮食不安全是唯一与某些抗逆转录病毒药物的药代动力学直接相关的此类因素。在确定针对患者的抗逆转录病毒治疗方案时，要实现HIV感染的最佳治疗效果，需要对食物获取情况进行常规评估。
