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Type:	Artigo de Evento
Title:	Income-driven food insecurity drives treatment non-adherence and virologic failure in HIV/HCV-coinfected individuals
Authors:	Celline Cardoso Almeida Brasil Erica Eleanor Margret Moodie Marina B. Klein Joseph Cox
Abstract:	Background: Virologic failure, defined as the inability to suppress HIV viral replication, continues to be common among HIV-infected people. Although nonadherence to antiretroviral therapy (ART) is the main determinant of virologic failure, distal variables such as socioeconomic status could lead to this outcome through other factors. Objectives: To identify the distal predictors of HIV virologic failure in HIV/HCV-coinfected people. Methods: We analyzed data from a Canadian multicenter prospective cohort study following HIV-HCV co-infected adults every 6 months between 2012 and 2015. Only participants receiving ART and participating in the Food Security Substudy were included in this analysis (N = 663; 75% male). Self-administered questionnaires collected information on socioeconomics (e.g., age, gender, education, income), behaviour (e.g., drug and alcohol use, mental disorders) and treatment (e.g., ART regimen, time on ART, HCV medications). Clinical measures (e.g., HIV RNA, CD4+) were also recorded. Adherence to ART was assessed through self-report, as were measures of food insecurity using the adult scale of Health Canada’s Household Food Security Survey Module (HFSSM). Generalized estimating equations were used to identify the following: (1) the predictors of virologic failure (defined as HIV-RNA level > 1000copies/ml); (2) the factors associated with its strongest predictor: treatment non-adherence; and (3) the factors associated with predictors of nonadherence. Results: At baseline, 4% of participants had virologic failure and 20% reported having missed any HIV treatment doses in the past 4 days. In a multivariate analysis, the only direct predictor of virologic failure was non-adherence to ART, which increased the odds of virologic failure by almost four times (OR = 3.9; p ≤ 0.01). Non-adherence was predicted by having younger age (OR = 1.6; p ≤ 0.01) and having skipped meals (OR = 1.6; p ≤ 0.01). Skipping meals was in turn associated with having lower monthly income (OR = 1.4; p = 0.03), not working (OR = 2.1; p ≤ 0.01), living alone (OR = 1.5; p ≤ 0.01) and using injection drugs (OR = 5.0; p ≤ 0.01). Conclusions: Although the only direct association with virologic failure was non-adherence, distal factors such as socioeconomic status and drug use may still be relevant when conceptualizing interventions to improve therapeutic success. ART non-adherence may be driven by a constellation of negative factors associated with food insecurity and poverty.
Subject:	HIV AIDS Coinfecção
language:	eng
metadata.dc.publisher.country:	Brasil
Publisher:	Universidade Federal de Minas Gerais
Publisher Initials:	UFMG
metadata.dc.publisher.department:	FAR - DEPARTAMENTO DE PRODUTOS FARMACÊUTICOS
Rights:	Acesso Aberto
metadata.dc.identifier.doi:	https://doi.org/10.1002/pds.4275
URI:	http://hdl.handle.net/1843/46346
Issue Date:	22-Aug-2017
metadata.dc.url.externa:	https://onlinelibrary.wiley.com/doi/full/10.1002/pds.4275
metadata.dc.relation.ispartof:	International Conference on Pharmacoepidemiology & Therapeutic Risk Management
Appears in Collections:	Artigo de Evento

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