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Food availability linked with poor outcomes for HIV-positive children

An HIV-positive child whose family does not have enough good food available is more likely to have a poor clinical outcome, researchers at the USDA/ARS Children’s Nutrition Center at Baylor College of Medicine and Texas Children’s Hospital reported.

In a study of HIV-positive patients at the Texas Children’s Hospital HIV Specialty Clinic, researchers found that patients who came from households that were food insecure had worse clinical outcomes than those whose households were food secure. Their report appears in the current issue of AIDS and Behavior.

Insufficient quantity

"Food insecurity refers to not having a sufficient amount of nutritious food, causing families to eat less, skip meals and redirect their time and resources towards obtaining food," said Dr. Jason Mendoza, assistant professor of pediatrics--nutrition at BCM and first author of the paper.

Researchers asked participants in the study or their parents to fill out demographic and food insecurity questionnaires. The types of questions in the survey included: "In the last 12 months, did you ever eat less than you felt you should because there wasn’t enough money for food?" and "In the last 12 months, did you ever not eat for a whole day because there wasn¹t enough money for food?"

Researchers reviewed the participants’ medical records to measure the amount of CD4 white blood cells, the type cells that fight infection but are targeted for destruction by the HIV virus. A lower number indicates a worse clinical outcome. Researchers also reviewed medical records to assess the patients’ HIV viral load, or the amount of HIV virus present in their blood. The higher the number, the less controlled the disease is in the body, despite antiretroviral medications. Once a certain threshold of HIV virus is reached, the patient is considered to have incomplete HIV viral suppression, which means the body cannot adequately suppress the virus.

They divided the study participants into two groups after the survey, food secure and food insecure, and found that those who were in the food insecure group had lower CD4 counts as well as higher chances of incomplete viral suppression.

Nutrient deficiencies

"There are several reasons why it would be the case that those who are food insecure have worse CD4 counts and higher chances of incomplete viral suppression. One is that being food insecure can lead to undernutrition and nutrient deficiencies that impair the immune system," said Mendoza. "There’s also the thought that the antiretroviral medications are probably easier to take when you have sufficient food to help in the digestion process. Food insecurity could predispose patients to skip their antiretroviral medications or the medications themselves may not be absorbed as well on an empty stomach."

Although there have been studies on the relationship between food insecurity and HIV outcomes in adults, no studies have been done prior to this in pediatric patients.

Researchers plan to examine this in a larger pediatric HIV positive sample within the United States to see if this relationship holds true and also plan to see if the relationship holds after six, 12 and 18 months. Additionally, Mendoza and colleagues are studying the pediatric HIV population at the Botswana-Baylor Children’s Clinical Center of Excellence, a part of the Baylor International Pediatric AIDS Initiative, to determine correlations between food insecurity and HIV status there.

Others at BCM who took part in the study include Dr. Mary E. Paul, division head of retrovirology and global health at Texas Children’s Hospital, Dr. Heidi Schwarzwald, head of the section of community pediatrics at BCM, Yan Liu, Richard Martinez, Dr. Theresa A. Nicklas and Dr. Tom Baranowski.

Funding for this study came from the Texas Children’s Hospital Pediatric Pilot Research Fund and the U.S. Department of Agriculture.

Read the full report.