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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.
This research was published in the
Journal of Acquired Immune Deficiency Syndromes (JAIDS): 61 (2):179–186,
October 1, 2012. doi: 10.1097/QAI.0b013e318261f064.
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
TOGETHER WE REMAIN STRONG!
