Abstract

Background

Food insecurity has been linked to suboptimal antiretroviral therapy (ART) adherence in persons with HIV (PWH). This association has not been evaluated using tenofovir diphosphate (TFV-DP) in dried blood spots (DBSs), a biomarker of cumulative ART adherence and exposure.

Methods

Within a prospective South African cohort of treatment-naive PWH initiating ART, a subset of participants with measured TFV-DP in DBS values was assessed for food insecurity status. Bivariate and multivariate median-based regression analysis compared the association between food insecurity and TFV-DP concentrations in DBSs adjusting for age, sex, ethnicity, medication possession ratio (MPR), and estimated glomerular filtration rate.

Results

Drug concentrations were available for 285 study participants. Overall, 62 (22%) PWH reported worrying about food insecurity and 44 (15%) reported not having enough food to eat in the last month. The crude median concentrations of TFV-DP in DBSs differed significantly between those who expressed food insecurity worry versus those who did not (599 [interquartile range {IQR}, 417–783] fmol/punch vs 716 [IQR, 453–957] fmol/punch; P = .032). In adjusted median-based regression, those with food insecurity worry had concentrations of TFV-DP that were 155 (95% confidence interval, −275 to −35; P = .012) fmol/punch lower than those who did not report food insecurity worry. Age and MPR remained significantly associated with TFV-DP.

Conclusions

In this study, food insecurity worry is associated with lower TFV-DP concentrations in South African PWH. This highlights the role of food insecurity as a social determinant of HIV outcomes including ART failure and resistance.

Details

Title
Food Insecurity Is Associated With Low Tenofovir Diphosphate in Dried Blood Spots in South African Persons With HIV
Author
Hirsh, Molly L 1 ; Edwards, Jonathan A 2 ; Robichaux, Chad 2 ; Brijkumar, Jaysingh 3 ; Moosa, Mahomed-Yunus S 3 ; Ofotokun, Igho 2 ; Johnson, Brent A 4 ; Pillay, Selvan 3 ; Pillay, Melendhran 5 ; Moodley, Pravi 5 ; Sun, Yan V 6 ; Liu, Chang 6 ; Dudgeon, Mathew R 6 ; Ordoñez, Claudia 6 ; Kuritzkes, Daniel R 7 ; Sunpath, Henry 3 ; Morrow, Mary 8 ; Anderson, Peter L 9 ; Ellison, Lucas 9 ; Bushman, Lane R 9 ; Marconi, Vincent C 2 ; Castillo-Mancilla, Jose R 10   VIAFID ORCID Logo 

1  Augusta University/University of Georgia Medical Partnership, Medical College of Georgia , Athens, Georgia , USA 
2  Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA 
3  Department of Medicine, University of KwaZulu-Natal , Durban , South Africa 
4  Department of Biostatistics and Computational Biology, University of Rochester , Rochester, New York , USA 
5  Department of Medicine, National Health Laboratory Service , Durban , South Africa 
6  Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA 
7  Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts , USA 
8  Department of Biostatistics and Bioinformatics, Colorado School of Public Health , Aurora, Colorado , USA 
9  Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus , Aurora, Colorado , USA 
10  Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado , USA 
Publication year
2023
Publication date
Jul 2023
Publisher
Oxford University Press
e-ISSN
23288957
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1093/ofid/ofad360
ProQuest document ID
3170945678
Copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is published under https://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.