Brief Report: Food Insufficiency Is Associated With Lack of Sustained Viral Suppression Among HIV-Infected Pregnant and Breastfeeding Ugandan Women

Catherine A Koss, Paul Natureeba, Dorcas Nyafwono, Albert Plenty, Julia Mwesigwa, Bridget Nzarubara, Tamara D Clark, Theodore D Ruel, Jane Achan, Edwin D Charlebois, Deborah Cohan, Moses R Kamya, Diane V Havlir, Sera L Young, Catherine A Koss, Paul Natureeba, Dorcas Nyafwono, Albert Plenty, Julia Mwesigwa, Bridget Nzarubara, Tamara D Clark, Theodore D Ruel, Jane Achan, Edwin D Charlebois, Deborah Cohan, Moses R Kamya, Diane V Havlir, Sera L Young

Abstract

Food insecurity is associated with poor virologic outcomes, but this has not been studied during pregnancy and breastfeeding. We assessed sustained viral suppression from 8 weeks on antiretroviral therapy to 48 weeks postpartum among 171 pregnant and breastfeeding Ugandan women; 74.9% experienced food insufficiency. In multivariable analysis, food insufficiency [adjusted odds ratio (aOR) 0.38, 95% confidence interval (CI): 0.16 to 0.91], higher pretreatment HIV-1 RNA (aOR 0.55 per 10-fold increase, 95% CI: 0.37 to 0.82), and lopinavir/ritonavir versus efavirenz (aOR 0.49, 95% CI: 0.24 to 0.96) were associated with lower odds of sustained viral suppression. Interventions to address food security may improve virologic outcomes among HIV-infected women.

Conflict of interest statement

AbbVie Pharmaceuticals donated lopinavir/ritonavir (Aluvia) for the parent study but had no role in study design, data accrual and analysis, or manuscript preparation. Gilead donates medications for participants in a separate NIH-funded study led by D.V.H. but provides no financial support. The other authors have no conflicts of interest to disclose.

References

    1. Food and Agricultural Organization. Rome declaration on world food security and world food summit plan of action. Rome: FAO, 1996. Available from: . Accessed July 20, 2015.
    1. Jones AD, Ngure FM, Pelto G, et al. What are we assessing when we measure food security? A compendium and review of current metrics. Adv Nutr. 2013;4:481–505.
    1. Anema A, Fielden SJ, Castleman T, et al. Food security in the context of HIV: towards harmonized definitions and indicators. AIDS Behav. 2014;18(suppl 5):S476–S489.
    1. Briefel RR, Woteki CE. Development of food sufficiency questions for the 3rd National Health and Nutrition Examination Survey. J Nutr Educ. 1992;24:S24–S28.
    1. Weiser SD, Fernandes KA, Brandson EK, et al. The association between food insecurity and mortality among HIV-infected individuals on HAART. J Acquir Immune Defic Syndr. 2009;52:342–349.
    1. Weiser SD, Young SL, Cohen CR, et al. Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. Am J Clin Nutr. 2011;94:1729S–1739S.
    1. Young S, Wheeler AC, McCoy SI, et al. A review of the role of food insecurity in adherence to care and treatment among adult and pediatric populations living with HIV and AIDS. AIDS Behav. 2014;18(suppl 5):S505–S515.
    1. Feldman MB, Alexy ER, Thomas JA, et al. The association between food insufficiency and HIV treatment outcomes in a longitudinal analysis of HIV-infected individuals in New York City. J Acquir Immune Defic Syndr. 2015;69:329–337.
    1. Wang EA, McGinnis KA, Fiellin DA, et al. Food insecurity is associated with poor virologic response among HIV-infected patients receiving antiretroviral medications. J Gen Intern Med. 2011;26:1012–1018.
    1. Weiser SD, Frongillo EA, Ragland K, et al. Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco. J Gen Intern Med. 2009;24:14–20.
    1. Weiser SD, Palar K, Frongillo EA, et al. Longitudinal assessment of associations between food insecurity, antiretroviral adherence and HIV treatment outcomes in rural Uganda. AIDS. 2014;28:115–120.
    1. Institute of Medicine and National Research Council. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press; 2009.
    1. Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, DC: The National Academies Press; 2006.
    1. Laraia BA, Siega-Riz AM, Gundersen C, et al. Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women. J Nutr. 2006;136:177–182.
    1. McCoy SI, Buzdugan R, Mushavi A, et al. Food insecurity is a barrier to prevention of mother-to-child HIV transmission services in Zimbabwe: a cross-sectional study. BMC Public Health. 2015;15:420.
    1. Mehta S, Manji KP, Young AM, et al. Nutritional indicators of adverse pregnancy outcomes and mother-to-child transmission of HIV among HIV-infected women. Am J Clin Nutr. 2008;87:1639–1649.
    1. Ramlal RT, Tembo M, Soko A, et al. Maternal mid-upper arm circumference is associated with birth weight among HIV-infected Malawians. Nutr Clin Pract. 2012;27:416–421.
    1. Villamor E, Dreyfuss ML, Baylin A, et al. Weight loss during pregnancy is associated with adverse pregnancy outcomes among HIV-1 infected women. J Nutr. 2004;134:1424–1431.
    1. Villamor E, Saathoff E, Msamanga G, et al. Wasting during pregnancy increases the risk of mother-to-child HIV-1 transmission. J Acquir Immune Defic Syndr. 2005;38:622–626.
    1. Bartelink IH, Savic RM, Mwesigwa J, et al. Pharmacokinetics of lopinavir/ritonavir and efavirenz in food insecure HIV-infected pregnant and breastfeeding women in Tororo, Uganda. J Clin Pharmacol. 2014;54:121–132.
    1. Koss CA, Natureeba P, Plenty A, et al. Risk factors for preterm birth among HIV-infected pregnant Ugandan women randomized to lopinavir/ritonavir- or efavirenz-based antiretroviral therapy. J Acquir Immune Defic Syndr. 2014;67:128–135.
    1. Young S, Murray K, Mwesigwa J, et al. Maternal nutritional status predicts adverse birth outcomes among HIV-infected rural Ugandan women receiving combination antiretroviral therapy. PLoS One. 2012;7:e41934.
    1. Webb-Girard A, Cherobon A, Mbugua S, et al. Food insecurity is associated with attitudes towards exclusive breastfeeding among women in urban Kenya. Matern Child Nutr. 2012;8:199–214.
    1. Young SL, Plenty AH, Luwedde FA, et al. Household food insecurity, maternal nutritional status, and infant feeding practices among HIV-infected Ugandan women receiving combination antiretroviral therapy. Matern Child Health J. 2014;18:2044–2053.
    1. World Health Organization. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. Geneva, Switzerland: World Health Organization, 2013.
    1. Bartelink IH, Savic RM, Dorsey G, et al. The effect of malnutrition on the pharmacokinetics and virologic outcomes of lopinavir, efavirenz and nevirapine in food insecure HIV-infected children in Tororo, Uganda. Pediatr Infect Dis J. 2015;34:e63–e70.
    1. Kalichman SC, Washington C, Grebler T, et al. Medication adherence and health outcomes of people living with HIV who are food insecure and prescribed antiretrovirals that should be taken with food. Infect Dis Ther. 2015;4:79–91.
    1. Weiser SD, Tuller DM, Frongillo EA, et al. Food insecurity as a barrier to sustained antiretroviral therapy adherence in Uganda. PLoS One. 2010;5:e10340.
    1. UNAIDS. How AIDS Changed Everything. MDG 6: 15 Years, 15 Lessons of Hope from the AIDS Response. Geneva, Switzerland: UNAIDS, 2015.
    1. World Food Programme. Comprehensive Food Security and Vulnerability Analysis: Uganda. 2013. Available from: . Accessed July 20, 2015.
    1. Natureeba P, Ades V, Luwedde F, et al. Lopinavir/ritonavir-based antiretroviral treatment (ART) versus efavirenz-based ART for the prevention of malaria among HIV-infected pregnant women. J Infect Dis. 2014;210:1938–1945.
    1. Ades V, Mwesigwa J, Natureeba P, et al. Neonatal mortality in HIV-exposed infants born to women receiving combination antiretroviral therapy in rural Uganda. J Trop Pediatr. 2013;59:441–446.
    1. Cohan D, Natureeba P, Koss CA, et al. Efficacy and safety of lopinavir/ritonavir versus efavirenz-based antiretroviral therapy in HIV-infected pregnant Ugandan women. AIDS. 2015;29:183–191.
    1. Gandhi M, Mwesigwa J, Aweeka F, et al. Hair and plasma data show that lopinavir, ritonavir, and efavirenz all transfer from mother to infant in utero, but only efavirenz transfers via breastfeeding. J Acquir Immune Defic Syndr. 2013;63:578–584.
    1. Koss CA, Natureeba P, Mwesigwa J, et al. Hair concentrations of antiretrovirals predict viral suppression in HIV-infected pregnant and breastfeeding Ugandan women. AIDS. 2015;29:825–830.
    1. Deitchler M, Ballard T, Swindale A, et al. Introducing a Simple Measure of Household Hunger for Cross-Cultural Use. Washington, DC: Food and Nutrition Technical Assistance II Project (FANTA-2), AED, 2011.
    1. Coates C, Swindale A, Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide (v. 3). Washington, DC: Food and Nutrition Technical Assistance Project, Academy for Educational Development, August; 2007.
    1. Deitchler M, Ballard T, Swindale A, et al. Validation of a measure of household hunger for cross-cultural use. Washington, DC: Food and Nutrition Technical Assistance II Project (FANTA-2), FHI 360; 2010.
    1. Weiser SD, Tsai AC, Gupta R, et al. Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting. AIDS. 2012;26:67–75.
    1. Mills EJ, Nachega JB, Buchan I, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. JAMA. 2006;296:679–690.
    1. Cohen CR, Steinfeld RL, Weke E, et al. Shamba Maisha: pilot agricultural intervention for food security and HIV health outcomes in Kenya: design, methods, baseline results and process evaluation of a cluster-randomized controlled trial. Springerplus. 2015;4:122.
    1. Grobler L, Siegfried N, Visser ME, et al. Nutritional interventions for reducing morbidity and mortality in people with HIV. Cochrane Database Syst Rev. 2013;2:CD004536.
    1. Nagata JM, Cohen CR, Young SL, et al. Descriptive characteristics and health outcomes of the food by prescription nutrition supplementation program for adults living with HIV in Nyanza Province, Kenya. PLoS One. 2014;9:e91403.
    1. Cantrell RA, Sinkala M, Megazinni K, et al. A pilot study of food supplementation to improve adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia. J Acquir Immune Defic Syndr. 2008;49:190–195.
    1. Ivers LC, Chang Y, Gregory Jerome J, et al. Food assistance is associated with improved body mass index, food security and attendance at clinic in an HIV program in central Haiti: a prospective observational cohort study. AIDS Res Ther. 2010;7:33.
    1. Ivers LC, Teng JE, Jerome JG, et al. A randomized trial of ready-to-use supplementary food versus corn-soy blend plus as food rations for HIV-infected adults on antiretroviral therapy in rural Haiti. Clin Infect Dis. 2014;58:1176–1184.
    1. Ivers LC, Cullen KA, Freedberg KA, et al. HIV/AIDS, undernutrition, and food insecurity. Clin Infect Dis. 2009;49:1096–1102.
    1. Young S, Natamba B, Luwedde F, et al. “I have remained strong because of that food”: acceptability and use of lipid-based nutrient supplements among pregnant HIV-infected ugandan women receiving combination antiretroviral therapy. AIDS Behav. 2015;19:1535–1547.
    1. Siegfried N, Irlam JH, Visser ME, et al. Micronutrient supplementation in pregnant women with HIV infection. Cochrane Database Syst Rev. 2012;3:CD009755.
    1. Flax VL, Bentley ME, Chasela CS, et al. Use of lipid-based nutrient supplements by HIV-infected Malawian women during lactation has no effect on infant growth from 0 to 24 weeks. J Nutr. 2012;142:1350–1356.
    1. Kayira D, Bentley ME, Wiener J, et al. A lipid-based nutrient supplement mitigates weight loss among HIV-infected women in a factorial randomized trial to prevent mother-to-child transmission during exclusive breastfeeding. Am J Clin Nutr. 2012;95:759–765.

Source: PubMed

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