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Changes in Food Insecurity, Nutritional Status, and Physical Health Status After Antiretroviral Therapy Initiation in Rural Uganda

Weiser, Sheri D. MD, MPH*; Gupta, Reshma MD; Tsai, Alexander C. MD, PhD‡,§; Frongillo, Edward A. PhD; Grede, Nils MPH; Kumbakumba, Elias MD#; Kawuma, Annet MA#; Hunt, Peter W. MD*; Martin, Jeffrey N. MD, MPH**; Bangsberg, David R. MD, MPH§,#,††

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1st, 2012 - Volume 61 - Issue 2 - p 179–186
doi: 10.1097/QAI.0b013e318261f064
Clinical Science

Objective: To investigate whether time on antiretroviral therapy (ART) is associated with improvements in food security and nutritional status, and the extent to which associations are mediated by improved physical health status.

Design: The Uganda AIDS Rural Treatment Outcomes study, a prospective cohort of HIV-infected adults newly initiating ART in Mbarara, Uganda.

Methods: Participants initiating ART underwent quarterly structured interview and blood draws. The primary explanatory variable was time on ART, constructed as a set of binary variables for each 3-month period. Outcomes were food insecurity, nutritional status, and PHS. We fit multiple regression models with cluster-correlated robust estimates of variance to account for within-person dependence of observations over time, and analyses were adjusted for clinical and sociodemographic characteristics.

Results: Two hundred twenty-eight ART-naive participants were followed for up to 3 years, and 41% were severely food insecure at baseline. The mean food insecurity score progressively declined (test for linear trend P < 0.0001), beginning with the second quarter (b = −1.6; 95% confidence interval: −2.7 to −0.45) and ending with the final quarter (b = −6.4; 95% confidence interval: −10.3 to −2.5). PHS and nutritional status improved in a linear fashion over study follow-up (P < 0.001). Inclusion of PHS in the regression model attenuated the relationship between ART duration and food security.

Conclusions: Among HIV-infected individuals in Uganda, food insecurity decreased and nutritional status and PHS improved over time after initiation of ART. Changes in food insecurity were partially explained by improvements in PHS. These data support early initiation of ART in resource-poor settings before decline in functional status to prevent worsening food insecurity and its detrimental effects on HIV treatment outcomes.

*Department of Medicine, Division of HIV/AIDS, San Francisco General Hospital, University of California San Francisco, San Francisco, CA

Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA

Robert Wood Johnson Health and Society Scholars Program, Harvard University, Cambridge, MA

§Center for Global Health, Massachusetts General Hospital, Boston, MA

Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC

United Nations World Food Programme, Rome, Italy

#Mbarara University of Science and Technology; Mbarara, Uganda

**Department of Epidemiology and Biostatistics, University of California, San Francisco, CA

††Ragon Institute of MGH, MIT and Harvard University, Boston, MA.

Correspondence to: Sheri D. Weiser, MD, MPH, Division of HIV/AIDS, San Francisco General Hospital, POB 0874, University of California San Francisco, San Francisco, CA 94110 (e-mail:

Supported by National Institutes of Health Grants K23 MH079713 MH79713-03S1, R01 MH54907, P30 AI27763 (UCSF-Gladstone Institute Center for AIDS Research), and the Tim and Jane Meyer Family Foundation. Additional funding for study analyses was provided by the World Food Programme. The authors acknowledge the following additional sources of salary support: the Burke Family Foundation (to Dr S. D. Weiser), K24 MH87227 (to Dr D. R. Bangsberg), and the Robert Wood Johnson Health and Society Scholars Program (to Dr. A. C. Tsai).

The authors have no conflicts of interest to disclose.

Received February 28, 2012

Accepted May 29, 2012

© 2012 by Lippincott Williams & Wilkins