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Title: Food insecurity, CD4 counts, and incomplete viral suppression among HIV+ patients from Texas Children's Hospital: A pilot study

Author
item MENDOZA, JASON - Children'S Nutrition Research Center (CNRC)
item PAUL, MARY - University Of Texas Health Science Center
item SCHWARZWALD, HEIDI - Baylor College Of Medicine
item LIU, YAN - Children'S Nutrition Research Center (CNRC)
item MARTINEZ, RICHARD - Children'S Nutrition Research Center (CNRC)
item NICKLAS, THERESA - Children'S Nutrition Research Center (CNRC)
item BARANOWSKI, TOM - Children'S Nutrition Research Center (CNRC)

Submitted to: AIDS and Behavior
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/1/2013
Publication Date: 6/1/2013
Citation: Mendoza, J.A., Paul, M.E., Schwarzwald, H., Liu, Y., Martinez, R., Nicklas, T.A., Baranowski, T. 2013. Food insecurity, CD4 counts, and incomplete viral suppression among HIV+ patients from Texas Children's Hospital: A pilot study. AIDS and Behavior. 17(5): 1683-1687.

Interpretive Summary: HIV infection is an important US public health problem. Identifying risk factors for poor prognosis and optimizing HIV prevention and treatment are public health goals. Food insecurity is an understudied yet important likely cause and consequence of HIV infection. Participants were recruited during routine clinic visits from the TCH HIV specialty clinic, which serves the Houston/Harris County area. Participants or their proxies (usually a parent) completed a questionnaire to obtain child’s age, gender, race/ethnicity, and their parents’ education. Current health insurance status was obtained from each patient’s electronic medical record and coded as none, Medicaid/Medicare, or private. These demographic characteristics have been associated with food insecurity and/or HIV infection or HIV risk-related behaviors and thus were considered important. The results showed that food insecurity was associated with lower CD4 counts and higher odds of incomplete viral suppression. It shows that food insecurity may adversely impact pediatric HIV outcomes. This study documents the high occurence of household food insecurity, the inverse association between food insecurity and CD4 counts, and the positive association between food insecurity and incomplete viral suppression among a mainly pediatric sample of HIV-positive patients. Routine measurement of food insecurity is needed in clinics caring for HIV patients. Furthermore, policies and programs directed at alleviating pediatric food insecurity may improve clinical HIV outcomes.

Technical Abstract: Our goal was to determine the relationship between food insecurity and CD4 counts and viral suppression among pediatric HIV-positive patients. Food insecurity was assessed by validated survey. CD4 counts and viral load were abstracted from patients’ charts. We used linear regression for the dependent variable of the natural log of CD4 counts and logistic regression for viral suppression, with backward deletion of covariates with p greater than 0.1. Food insecurity(B=-0.23, 95% CI [-0.40,-0.01]) was associated with lower CD4 counts and higher odds of incomplete viral suppression (OR= 4.07, 95% CI [1.02, 13.92]). Food insecurity may adversely impact pediatric HIV outcomes.