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HIV Med. 2018 Feb;19(2):123-131. doi: 10.1111/hiv.12561. Epub 2017 Nov 2.

Food insecurity may lead to incomplete HIV viral suppression and less immune reconstitution among HIV/hepatitis C virus-coinfected people.

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Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
Department of Medicine, McGill University, Montreal, QC, Canada.
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
Center for Clinical Epidemiology, Jewish General Hospital, Montreal, QC, Canada.



The aim of this study was to determine the impact of food insecurity (FI) on HIV viral load and CD4 count among people coinfected with HIV and hepatitis C virus (HCV).


This study was conducted using data from the Food Security & HIV-HCV Sub-Study of the Canadian Co-Infection Cohort study. FI was measured using the adult scale of Health Canada's Household Food Security Survey Module and was classified into three categories: food security, moderate food insecurity and severe food insecurity. The association between FI, HIV viral load, and CD4 count was assessed using a stabilized inverse probability weighted marginal structural model.


A total of 725 HIV/HCV-coinfected people with 1973 person-visits over 3 years of follow-up contributed to this study. At baseline, 23% of participants experienced moderate food insecurity and 34% experienced severe food insecurity. The proportion of people with undetectable HIV viral load was 75% and the median CD4 count was 460 [interquartile range (IQR): 300-665] cells/μL. People experiencing severe food insecurity had 1.47 times [95% confidence interval (CI): 1.14, 1.88] the risk of having detectable HIV viral load and a 0.91-fold (95% CI: 0.84, 0.98) increase in CD4 count compared with people who were food secure.


These findings provide evidence of the negative impact of food insecurity on HIV viral load and CD4 count among HIV/HCV-coinfected people.


CD4 count; HIV viral load; HIV/HCV coinfection; food insecurity; marginal structural model

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