Feldman Matthew B, Alexy Emily R, Thomas Jacinthe A, Gambone Gina F, Irvine Mary K
New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, Queens, NY.
J Acquir Immune Defic Syndr. 2015 Jul 1;69(3):329-37. doi: 10.1097/QAI.0000000000000596.
To date, there have been few longitudinal studies of food insecurity among people living with HIV (PLWH). Food insufficiency (FI) is one dimension of the food insecurity construct that refers to periods of time during which individuals have an inadequate amount of food intake because of limited resources. The aim of this analysis was to examine the relationship between FI and HIV treatment outcomes among HIV-infected individuals in New York City (NYC).
Associations between FI ("consistent"--food insufficient on both of the last 2 assessments, "inconsistent"--food insufficient on 1 of the last 2 assessments, or neither) and clinical indicators of HIV disease progression (viral load > 200 copies per milliliter, CD4 count < 200 cells per cubic millimeter) were analyzed for NYC Ryan White Part A food and nutrition program clients who were matched to the NYC HIV Surveillance Registry and completed 2 FI assessments between November 2011 and June 2013.
Among 2,118 PLWH in food and nutrition programs, 61% experienced consistent FI and 25% experienced inconsistent FI. In multivariate analyses controlling for sociodemographic characteristics, consistent FI was independently associated with unsuppressed viral load (adjusted odds ratio = 1.6, confidence interval: 1.1 to 2.5). Consistent FI was only associated with low CD4 counts at the bivariate level.
Future studies should examine biological, structural, and psychosocial factors that may explain the relationship between FI and HIV treatment outcomes to inform intervention development. Persistent FI among food and nutrition program clients suggests that services are needed to address underlying needs for financial stability (eg, vocational counseling) for PLWH.
迄今为止，针对艾滋病毒感染者（PLWH）粮食不安全状况的纵向研究较少。粮食不足（FI）是粮食不安全概念的一个维度，指个体因资源有限而在一段时间内食物摄入量不足的情况。本分析的目的是研究纽约市（NYC）艾滋病毒感染者中粮食不足与艾滋病毒治疗结果之间的关系。
对与纽约市艾滋病毒监测登记处匹配且在2011年11月至2013年6月期间完成两次粮食不足评估的纽约市瑞安·怀特A部分粮食和营养项目客户，分析粮食不足（“持续”——在最近两次评估中均粮食不足，“不持续”——在最近两次评估中的一次粮食不足，或两次均无粮食不足）与艾滋病毒疾病进展的临床指标（病毒载量>200拷贝/毫升，CD4细胞计数<200个/立方毫米）之间的关联。
在参与粮食和营养项目的2118名艾滋病毒感染者中，61%经历了持续的粮食不足，25%经历了不持续的粮食不足。在控制社会人口学特征的多变量分析中，持续的粮食不足与病毒载量未得到抑制独立相关（调整后的优势比=1.6，置信区间：1.1至2.5）。仅在双变量水平上，持续的粮食不足与低CD4细胞计数相关。
未来的研究应探讨可能解释粮食不足与艾滋病毒治疗结果之间关系的生物学、结构和心理社会因素，以为干预措施的制定提供信息。粮食和营养项目客户中持续存在的粮食不足表明，需要提供服务来满足艾滋病毒感染者对财务稳定的潜在需求（例如职业咨询）。
