October 4, 2012
Researchers from University of California San Francisco (UCSF) and Massachusetts General Hospital have found in a study focused on sub-Saharan Africa that starting HIV-infected patients on antiretroviral therapy (ART) reduces food insecurity and improves physical health, thus contributing to the disruption of a lethal syndemic. The study was recently published in the Journal of Acquired Immune Deficiency Syndromes. Sub-Saharan Africa is experiencing co-epidemics of food insecurity and HIV/AIDS, with almost 240 million people lacking access to adequate amounts of food and more than 20 million people infected with HIV/AIDS. Researchers noted that these co-epidemics intensify the vulnerability to and increase the severity of each other, creating a deadly vicious cycle.
Food insecurity augments the risk of HIV transmission by fostering practices that increase mother-to-child transmission of HIV, drive risky sexual behaviors, and contribute to poor nutrition and micronutrient deficiencies that diminish mucosal integrity and weaken the body's overall ability to resist infection. For HIV-infected persons, food insecurity is associated with higher rates of opportunistic infections, poorer immune responses, declining mental and physical health, and higher risk of death. In turn, HIV infection worsens food insecurity due to death and illness of productive family members and increased burdens for caregivers. Additionally, the illness and stigma related to HIV/AIDS can make finding and performing work more difficult and lessen social network support for finding food in times of scarcity.
Conducted in Uganda, the study followed 228 untreated HIV-infected patients for up to three years. More than 80 percent had some level of food insecurity, and more than 40 percent were severely food insecure at baseline. Once patients began ART, food insecurity declined and nutritional status and physical status increased in conjunction with time on therapy. Along with a study published in 2011 showing a potent prevention benefit from treatment -- HIV-infected participants on therapy reduced their risk of transmitting HIV to their uninfected partners by 96 percent in the earlier study -- the findings from this study establish additional evidence supporting initiating treatment with antiretrovirals as soon as possible after diagnosis. "In addition to improving health and decreasing HIV transmission, our study adds to the growing evidence that treating with ART is cost-effective by improving health and productivity over the long term," said the study's senior author, David R. Bangsberg, MD, MPH, Director of the Center for Global Health at Massachusetts General Hospital.
Sheri Weiser, MD, the study's principal investigator and assistant professor of medicine in the UCSF HIV/AIDS Division at the San Francisco General Hospital and Trauma Center, stated that "We have also shown in other work that food insecurity leads to worse outcomes for HIV-infected patients." Weiser and Bangsberg concluded that to best address these overlapping epidemics, programs targeting food insecurity should be integrated into HIV treatment programs.
[Editor's Note: This research was published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS): 61 (2):179186, October 1, 2012. doi: 10.1097/QAI.0b013e318261f064]