Hirsh Molly L, Edwards Jonathan A, Robichaux Chad, Brijkumar Jaysingh, Moosa Mahomed-Yunus S, Ofotokun Igho, Johnson Brent A, Pillay Selvan, Pillay Melendhran, Moodley Pravi, Sun Yan V, Liu Chang, Dudgeon Mathew R, Ordoñez Claudia, Kuritzkes Daniel R, Sunpath Henry, Morrow Mary, Anderson Peter L, Ellison Lucas, Bushman Lane R, Marconi Vincent C, Castillo-Mancilla Jose R
Augusta University/University of Georgia Medical Partnership, Medical College of Georgia, Athens, Georgia, USA.
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Open Forum Infect Dis. 2023 Jul 13;10(7):ofad360. doi: 10.1093/ofid/ofad360. eCollection 2023 Jul.
Food insecurity has been linked to suboptimal antiretroviral therapy (ART) adherence in persons with HIV (PWH). This association has not been evaluated using tenofovir diphosphate (TFV-DP) in dried blood spots (DBSs), a biomarker of cumulative ART adherence and exposure.
Within a prospective South African cohort of treatment-naive PWH initiating ART, a subset of participants with measured TFV-DP in DBS values was assessed for food insecurity status. Bivariate and multivariate median-based regression analysis compared the association between food insecurity and TFV-DP concentrations in DBSs adjusting for age, sex, ethnicity, medication possession ratio (MPR), and estimated glomerular filtration rate.
Drug concentrations were available for 285 study participants. Overall, 62 (22%) PWH reported worrying about food insecurity and 44 (15%) reported not having enough food to eat in the last month. The crude median concentrations of TFV-DP in DBSs differed significantly between those who expressed food insecurity worry versus those who did not (599 [interquartile range {IQR}, 417-783] fmol/punch vs 716 [IQR, 453-957] fmol/punch; = .032). In adjusted median-based regression, those with food insecurity worry had concentrations of TFV-DP that were 155 (95% confidence interval, -275 to -35; = .012) fmol/punch lower than those who did not report food insecurity worry. Age and MPR remained significantly associated with TFV-DP.
In this study, food insecurity worry is associated with lower TFV-DP concentrations in South African PWH. This highlights the role of food insecurity as a social determinant of HIV outcomes including ART failure and resistance.
粮食不安全与艾滋病毒感染者（PWH）抗逆转录病毒疗法（ART）依从性欠佳有关。尚未使用干血斑（DBS）中的替诺福韦二磷酸（TFV-DP）对这种关联进行评估，TFV-DP是ART累积依从性和暴露情况的生物标志物。
在一个前瞻性的南非初治PWH队列中，对一部分DBS值中测量了TFV-DP的参与者评估其粮食不安全状况。基于中位数的双变量和多变量回归分析比较了粮食不安全与DBS中TFV-DP浓度之间的关联，并对年龄、性别、种族、药物持有率（MPR）和估计肾小球滤过率进行了校正。
285名研究参与者有药物浓度数据。总体而言，62名（22%）PWH报告担心粮食不安全，44名（15%）报告上个月没有足够的食物吃。表达了粮食不安全担忧的参与者与未表达担忧的参与者相比，DBS中TFV-DP的粗中位数浓度有显著差异（599[四分位间距{IQR}，417 - 783]fmol/打孔与716[IQR，453 - 957]fmol/打孔；P = 0.032）。在基于中位数的校正回归中，担心粮食不安全的参与者的TFV-DP浓度比未报告粮食不安全担忧的参与者低155（95%置信区间，-275至-35；P = 0.012）fmol/打孔。年龄和MPR仍然与TFV-DP显著相关。
在本研究中，粮食不安全担忧与南非PWH中较低的TFV-DP浓度相关。这凸显了粮食不安全作为包括ART失败和耐药性在内的艾滋病毒结局的社会决定因素的作用。
