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

Koss, Catherine A. MD; Natureeba, Paul MBChB; Nyafwono, Dorcas; Plenty, Albert MSPH; Mwesigwa, Julia MBChB, MSc; Nzarubara, Bridget MBChB, MSc; Clark, Tamara D. MHS; Ruel, Theodore D. MD; Achan, Jane MBChB, MMed, PhD; Charlebois, Edwin D. MPH, PhD; Cohan, Deborah MD, MPH; Kamya, Moses R. MBChB, MMed, MPH, PhD; Havlir, Diane V. MD; Young, Sera L. MA, PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 March 2016 - Volume 71 - Issue 3 - p 310–315
doi: 10.1097/QAI.0000000000000860
Clinical Science

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.

*Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA;

Makerere University-University of California, San Francisco Research Collaboration, Kampala, Uganda;

Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA;

§Medical Research Council Unit, The Gambia, Serrekunda, Gambia;

Department of Pediatrics, University of California, San Francisco, San Francisco, CA;

Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA;

#Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; and

**Department of Population Medicine and Diagnostic Sciences, Program in International Nutrition, Cornell University, Ithaca, NY.

Correspondence to: Catherine A. Koss, MD, Division of HIV, Infectious Diseases, and Global Medicine, San Francisco General Hospital, University of California, San Francisco, Box 0874, San Francisco, CA 94143-0874 (e-mail:

This work was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P01 HD059454, D.V.H. and K23 HD60459, T.D.R.), the National Institute of Allergy and Infectious Diseases (T32 AI060530, D.V.H./C.A.K.), and the National Institute of Mental Health (K01 MH098902, S.L.Y.) at the National Institutes of Health. The nutritional substudy was supported by the President's Emergency Plan For AIDS Relief, the Office of the Global AIDS Coordinator, and the Office of AIDS Research.

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.

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D.C., E.D.C., M.R.K., and D.V.H. conceived and designed the parent study. S.L.Y. and D.C. designed this substudy. P.N., D.N., J.M., B.N., T.D.C., T.D.R., and J.A. contributed significantly to the acquisition of data. C.A.K., A.P., E.D.C., D.V.H., and S.L.Y. analyzed and interpreted the data. C.A.K. and S.L.Y. authored the manuscript with input and important revisions from all authors, including P.N., D.N., A.P., J.M., B.N., T.D.C., T.D.R., J.A., E.D.C., D.C., M.R.K., and D.V.H.

Received June 05, 2015

Accepted August 21, 2015

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