Household food insecurity associated with antiretroviral therapy adherence among HIV-infected patients in Windhoek, Namibia.

OBJECTIVE: Food insecurity is emerging as an important barrier to antiretroviral therapy (ART) adherence. The objective of this study was to determine if food insecurity is associated with poor ART adherence among HIV-positive adults in a resource-limited setting that uses the public health model of delivery. DESIGN: A cross-sectional study using a 1-time questionnaire and routinely collected pharmacy data. METHODS: Participants were HIV-infected adults on ART at the public ART clinics in Windhoek, Namibia: Katutura State Hospital, Katutura Health Centre, and Windhoek Central Hospital. Food insecurity was measured by the Household Food Insecurity Access Scale (HFIAS). Adherence was assessed by the pharmacy adherence measure medication possession ratio (MPR). Multivariate regression was used to assess whether food insecurity was associated with ART adherence. RESULTS: Among 390 participants, 7% were food secure, 25% were mildly or moderately food insecure and 67% were severely food insecure. In adjusted analyses, severe household food insecurity was associated with MPR <80% [odds ratio (OR), 3.84; 95% confidence interval (CI): 1.65 to 8.95]. Higher household health care spending (OR, 1.92; 95% CI, 1.02 to 3.57) and longer duration of ART (OR, 0.82; 95% CI: 0.70 to 0.97) were also associated with <80% MPR. CONCLUSIONS: Severe household food insecurity is present in more than half of the HIV-positive adults attending a public ART clinic in Windhoek, Namibia and is associated with poor ART adherence as measured by MPR. Ensuring reliable access to food should be an important component of ART delivery in resource-limited settings using the public health model of care.

Metabolic syndrome and serum fatty acid patterns in serum phospholipids in hypertriglyceridemic persons with human immunodeficiency virus.

BACKGROUND: HIV infection and its treatment are associated with abnormal lipid profiles. High triglyceride concentrations and low HDL-cholesterol concentrations are the most common health abnormalities and raise concerns about an increased risk of cardiovascular disease. OBJECTIVE: We compared the fatty acid patterns of serum phospholipids between persons with HIV and non-HIV controls to determine whether there are differences that explain the elevated triglyceride concentrations, insulin resistance, and inflammation that are part of the metabolic syndrome in patients with HIV. DESIGN: Thirty-nine persons with HIV and elevated serum triglycerides (>150 mg/dL) and/or indicators of insulin resistance were recruited to examine fatty acid profiles in serum phospholipid fractions relative to those of 2 control groups without HIV (n = 31). RESULTS: Higher concentrations of 16:1 and 18:0 fatty acids in the phospholipid fraction indicated increased lipogenesis in the HIV patients and in the non-HIV controls at risk of the metabolic syndrome. However, the subjects with HIV had higher concentrations of both n-6 (omega-6) and n-3 fatty acids of higher elongation and desaturation levels, which indicated a greater promotion of these pathways in this population. The nanomolar percentage (%nmol) arachidonic acid was the same in all 3 groups. CONCLUSIONS: Persons with and without HIV, at risk of the metabolic syndrome, show indications of increased lipogenesis, more so in subjects with HIV taking medication. Higher proportions of distal elongation and desaturation fatty acid products were seen only in the phospholipids fatty acid fraction of the subjects with HIV.

A validation study of body composition by bioelectrical impedance analysis in human immunodeficiency virus (HIV)-positive and HIV-negative Hispanic men and women.

Bioelectrical impedance analysis (BIA) is a potentially useful tool for measuring body composition in people with human immunodeficiency virus (HIV). However, it is not clear that equations derived in healthy non-Hispanic whites can be applied to people who are of other races or ethnicities and who are infected with HIV. Body composition measures done by BIA, using the equations of Lukaski, were compared to measures of body composition derived from dual-energy x-ray absorptiometry (DXA) in Hispanic men and women of Caribbean origin (predominantly Puerto Rican) with and without HIV infection. In cross-sectional analyses, body composition was measured by BIA and DXA in four groups of Hispanics: 97 HIV-positive men, 70 HIV-negative men, 38 HIV-positive women, and 14 HIV-negative women. The method of Bland and Altman was used to evaluate the validity of BIA compared to DXA. Compared to DXA, BIA provided accurate measures of fat-free mass in HIV-positive and HIV-negative Hispanic men. Fat-free mass by BIA compared to DXA was overestimated by 2.7 kg (standard deviation=2.5; P<0.0001) in the HIV-positive Hispanic women and by 3.4 kg (standard deviation=2.6; P<0.01) in the HIV-negative women. The magnitude of the bias in fat-free mass was dependent on fat mass in both the men and the women. BIA, using the equations of Lukaski, appears to be useful in this Hispanic population of Caribbean origin with and without HIV, for whom it provided reasonable estimates of body composition. Fat mass affects the accuracy of estimates.