Income-driven food insecurity drives treatment non-adherence and virologic failure in HIV/HCV-coinfected individuals
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Universidade Federal de Minas Gerais
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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.
Abstract
Assunto
HIV, AIDS, Coinfecção
Palavras-chave
HIV, AIDS, Coinfecção
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https://onlinelibrary.wiley.com/doi/full/10.1002/pds.4275