Research Papers

@article{W2020,
title = {The Mediating Role of Depressive Symptoms in the Association Between Food Insecurity and HIV Related Health Outcomes Among HIV-HCV Co-Infected People},
author = {Aibibula W and Cox J and Hamelin AM and Klein MB and Brassard P},
url = {https://pubmed.ncbi.nlm.nih.gov/31950306/},
doi = {10.1007/s10461-020-02784-7},
year = {2020},
date = {2020-07-01},
journal = {AIDS and Behaviour},
abstract = {Food insecurity may lead to depressive symptoms, which are known to be associated with poor HIV related health outcomes. However, it is unclear to what extent food insecurity 'directly' affects these outcomes. We used data from the Food Security & HIV-HCV Sub-Study of the Canadian Co-Infection Cohort to assess the controlled direct effect. People experiencing severe food insecurity had 1.47 (95% CI 1.04-2.09) times the risk of having detectable HIV viral load and 0.94 (95% CI 0.87-1.02) fold change in CD4 count. After holding depressive symptoms constant, the association between severe food insecurity and HIV viral load was attenuated to a statistically non-significant level (RR 1.36, 95% CI: 0.95-1.96), whereas the association between severe food insecurity and CD4 count was unchanged. Depressive symptoms partially mediate the effect of severe food insecurity on HIV viral suppression; interventions focused on depressive symptoms alone may not be sufficient, however, to eliminate this effect.},
keywords = {CD4 count, Food insecurity, HIV viral load, HIV-HCV co-infection, Mediation analysis},
pubstate = {published},
tppubtype = {article}
}

@article{T2018b,
title = {Injection drug use, food insecurity, and HIV-HCV co-infection: a longitudinal cohort analysis},
author = {McLinden T and Moodie EEM and Harper S and Hamelin AM and Anema A and Aibibula W and Klein MB and Cox J},
url = {https://pubmed.ncbi.nlm.nih.gov/29716392/},
doi = {10.1080/09540121.2018.1465171},
year = {2018},
date = {2018-10-01},
journal = {AIDS Care},
abstract = {Injection drug use (IDU) and food insecurity (FI) are highly prevalent among individuals living with HIV-hepatitis C virus (HCV) co-infection. We quantified the association between IDU and FI among co-infected individuals using biannual data from the Canadian Co-infection Cohort (N = 608, 2012-2015). IDU (in the past six months) and IDU frequency (non-weekly/weekly in the past month) were self-reported. FI (in the past six months) and FI severity (marginal FI, moderate FI, and severe FI) were measured using the Household Food Security Survey Module. Generalized estimating equations were used to estimate risk ratios (RR) quantifying the associations between IDU, IDU frequency, and FI with Poisson regression. The associations between IDU, IDU frequency, and FI severity were quantified by relative-risk ratios (RRR) estimated with multinomial regression. At the first time-point in the analytical sample, 54% of participants experienced FI in the past six months, 31% engaged in IDU in the six months preceding the FI measure, and 24% injected drugs in the past month. After adjustment for confounding, IDU in the past six months (RR = 1.15, 95% confidence interval [CI] = 1.04-1.28) as well as non-weekly (RR = 1.15, 95% CI = 1.02-1.29) and weekly IDU (RR = 1.21, 95% CI = 1.07-1.37) in the past month are associated with FI. Weekly IDU in the past month is also strongly associated with severe FI (RRR = 2.68, 95% CI = 1.47-4.91). Our findings indicate that there is an association between IDU and FI, particularly weekly IDU and severe FI. This suggests that reductions in IDU may mitigate FI, especially severe FI, in this vulnerable subset of the HIV-positive population.},
keywords = {Food insecurity, Hepatitis C virus, HIV, Injection drug use},
pubstate = {published},
tppubtype = {article}
}

@article{CC2018,
title = {Medication nonadherence, multitablet regimens, and food insecurity are key experiences in the pathway to incomplete HIV suppression},
author = {Almeida-Brasil CC and Moodie EEM and McLinden T and Hamelin AM and Walmsley SL and Rourke SB and Wong A and Klein MB and Cox J},
url = {https://pubmed.ncbi.nlm.nih.gov/29683846/},
doi = {10.1097/QAD.0000000000001822},
year = {2018},
date = {2018-06-19},
journal = {AIDS},
abstract = {Objective: To identify potential pathways by which a variety of factors act to lead to unsuppressed viral load.

Design: A prospective cohort of HIV-HCV co-infected adults receiving care from 18 HIV clinics across Canada was followed every 6 months between November 2012 and October 2015. Participants with at least two visits while receiving combined antiretroviral treatment (cART) were included.

Methods: A path analysis was conducted on the basis of ordered sequences of multivariate logistic regressions using generalized estimating equations. The first regression model used incomplete viral suppression (viral load >50 copies/ml) as the outcome of interest and all other variables (i.e. nonadherence, food insecurity, treatment attributes, and other sociodemographic, behavioural, and clinical factors) as potential predictors. Any variable determined to be a statistically significant predictor of incomplete viral suppression was then used as the next outcome of interest in the subsequent regression, until all predictors of each selected outcome were purely explanatory variables.

Results: A total of 566 participants had at least two visits. Drivers of incomplete viral suppression included injection drug use, age 45 years or less, living alone, poor health status, longer duration of HIV infection and baseline CD4 cell count less than 200 cells/μl. Nonadherence, food insecurity, and the use of multitablet regimens mediated the effects of these factors on incomplete viral suppression.

Conclusion: Our results suggest that nonadherence, multitablet regimens, and food insecurity are key points in the pathway to incomplete HIV suppression. These are potentially amenable intervention targets that would not be revealed using traditional regression analyses.},
keywords = {Food insecurity, HIV, Viral suppression},
pubstate = {published},
tppubtype = {article}
}

@article{W2018,
title = {Food insecurity may lead to incomplete HIV viral suppression and less immune reconstitution among HIV/hepatitis C virus-coinfected people},
author = {Aibibula W and Cox J and Hamelin AM and Moodie EEM and Naimi AI and McLinden T and Klein MB and Brassard P},
url = {https://pubmed.ncbi.nlm.nih.gov/29094807/},
doi = {10.1111/hiv.12561},
year = {2018},
date = {2018-02-01},
journal = {HIV Medicine},
abstract = {Objectives: 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).

Methods: 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.

Results: 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.

Conclusions: These findings provide evidence of the negative impact of food insecurity on HIV viral load and CD4 count among HIV/HCV-coinfected people.},
keywords = {CD4 count, Food insecurity, HIV viral load, HIV-HCV co-infection, Marginal structural models},
pubstate = {published},
tppubtype = {article}
}

@article{W2017b,
title = {Impact of Food Insecurity on Depressive Symptoms Among HIV-HCV Co-infected People},
author = {Aibibula W and Cox J and Hamelin AM and Moodie EEM and Naimi AI and McLinden T and Klein MB and Brassard P},
doi = {10.1007/s10461-017-1942-z},
year = {2017},
date = {2017-12-01},
journal = {AIDS and Behaviour},
abstract = {Food insecurity (FI) is associated with depressive symptoms among HIV mono-infected people. Our objective was to examine to what extent this association holds among HIV-hepatitis C virus (HCV) co-infected people. We used data from a prospective cohort study of HIV-HCV co-infected people in Canada. FI was measured using the ten-item adult scale of Health Canada's Household Food Security Survey Module and was classified into three categories: food secure, moderate FI, and severe FI. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D-10) and was classified into absence or presence of depressive symptoms. FI, depressive symptoms, and other covariates were updated every 6 months. The association between FI and depressive symptoms was assessed using a stabilized inverse probability weighted marginal structural model. The study sample included 725 HIV-HCV co-infected people with 1973 person-visits over 3 years of follow up. At baseline, 23% of participants experienced moderate food insecurity, 34% experienced severe food insecurity and 52% had depressive symptoms. People experiencing moderate FI had 1.63 times (95% CI 1.44-1.86) the risk of having depressive symptoms and people experiencing severe FI had 2.01 times (95% CI 1.79-2.25) the risk of having depressive symptoms compared to people who were food secure. FI is a risk factor for developing depressive symptoms among HIV-HCV co-infected people. Food supplementation, psychosocial support and counseling may improve patient health outcomes.},
keywords = {Depression, Food insecurity, HIV-HCV co-infection, Marginal structural models},
pubstate = {published},
tppubtype = {article}
}

@article{W2017,
title = {Association Between Food Insecurity and HIV Viral Suppression: A Systematic Review and Meta-Analysis},
author = {Aibibula W and Cox J and Hamelin AM and McLinden T and Klein MB and Brassard P},
url = {https://pubmed.ncbi.nlm.nih.gov/27837425/},
doi = {10.1007/s10461-016-1605-5},
year = {2017},
date = {2017-03-21},
journal = {AIDS and Behaviour},
abstract = {Although an increasing number of HIV infected people are accessing antiretroviral treatment, many do not achieve complete HIV viral suppression and remain at risk for AIDS and capable of HIV transmission. Food insecurity has been identified as a potential risk factor for poor virologic response, but the association between these factors has been inconsistently documented in the literature. We systematically searched five electronic databases and bibliographies of relevant studies through April 2015 and retrieved 11 studies that met our inclusion criteria, of which nine studies were conducted in North America and the remaining two studies were in Brazil and Uganda respectively. Meta-analyzed results indicated that experiencing food insecurity resulted in 29% lower odds of achieving complete HIV viral suppression (OR = 0.71, 95% CI 0.61-0.82) and this significant inverse association was consistently found regardless of study design, exposure measurement, and confounder adjustment methods. These findings suggest that food insecurity is a potential risk factor for incomplete HIV viral suppression in people living with HIV.},
keywords = {Food insecurity, HIV, Meta-analysis, Viral suppression},
pubstate = {published},
tppubtype = {article}
}

@article{Cox2017,
title = {Food Insecurity in HIV-Hepatitis C Virus Co-infected Individuals in Canada: The Importance of Co-morbidities},
author = {Joseph Cox and Anne-Marie Hamelin and Taylor McLinden and Erica E. M. Moodie and Aranka Anema and Kathleen C. Rollet-Kurhajec and Gilles Paradis and Sean B. Rourke and Sharon Walmsley and Marina B. Klein},
url = {https://www.ncbi.nlm.nih.gov/pubmed/26912217},
doi = {10.1007/s10461-016-1326-9},
year = {2017},
date = {2017-03-15},
journal = {AIDS and Behavior},
abstract = {While research has begun addressing food insecurity (FI) in HIV-positive populations, knowledge regarding FI among individuals living with HIV-hepatitis C virus (HCV) co-infection is limited. This exploratory study examines sociodemographic, socioeconomic, behavioral, and clinical factors associated with FI in a cohort of HIV-HCV co-infected individuals in Canada. We analyzed longitudinal data from the Food Security and HIV-HCV Co-infection Study of the Canadian Co-infection Cohort collected between November 2012-June 2014 at 15 health centres. FI was measured using the Household Food Security Survey Module and classified using Health Canada criteria. Generalized estimating equations were used to assess factors associated with FI. Among 525 participants, 59 % experienced FI at their first study visit (baseline). Protective factors associated with FI (p < 0.05) included: enrolment at a Quebec study site (aOR: 0.42, 95 % CI: 0.27, 0.67), employment (aOR: 0.55, 95 % CI: 0.35, 0.87), and average personal monthly income (aOR per $100 CAD increase: 0.98, 95 % CI: 0.97, 0.99). Risk factors for FI included: recent injection drug use (aOR: 1.98, 95 % CI: 1.33, 2.96), trading away food (aOR: 5.23, 95 % CI: 2.53, 10.81), and recent experiences of depressive symptoms (aOR: 2.11, 95 % CI: 1.48, 3.01). FI is common in this co-infected population. Engagement of co-infected individuals in substance use treatments, harm reduction programs, and mental health services may mitigate FI in this vulnerable subset of the HIV-positive population.},
keywords = {Canada, Co-infection, Food insecurity, HCV, HIV},
pubstate = {published},
tppubtype = {article}
}

@article{Aibibula2016,
title = {Food insecurity and low CD4 count among HIV-infected people: a systematic review and meta-analysis.},
author = {Wusiman Aibibula and Joseph Cox and Anne-Marie Hamelin and Hiroshi Mamiya and Marina B. Klein and Paul Brassard},
url = {https://www.ncbi.nlm.nih.gov/pubmed/27306865},
doi = {10.1080/09540121.2016.1191613},
year = {2016},
date = {2016-06-16},
journal = {AIDS Care},
abstract = {Abstract
Food insecurity is defined as a limited or uncertain ability to acquire acceptable foods in socially acceptable ways, or limited or uncertain availability of nutritionally adequate and safe foods. While effective antiretroviral treatment can significantly increase CD4 counts in the majority of patients, there are certain populations who remain at relatively low CD4 count levels. Factors possibly associated with poor CD4 recovery have been extensively studied, but the association between food insecurity and low CD4 count is inconsistent in the literature. The objective is to systematically review published literature to determine the association between food insecurity and CD4 count among HIV-infected people. PubMed, Web of Science, ProQuest ABI/INFORM Complete, Ovid Medline and EMBASE Classic, plus bibliographies of relevant studies were systematically searched up to May 2015, where the earliest database coverage started from 1900. Studies that quantitatively assessed the association between food insecurity and CD4 count among HIV-infected people were eligible for inclusion. Study results were summarized using random effects model. A total of 2093 articles were identified through electronic database search and manual bibliographic search, of which 8 studies included in this meta-analysis. Food insecure people had 1.32 times greater odds of having lower CD4 counts compared to food secure people (OR = 1.32, 95% CI: 1.15-1.53) and food insecure people had on average 91 fewer CD4 cells/µl compared to their food secure counterparts (mean difference = -91.09, 95% CI: -156.16, -26.02). Food insecurity could be a potential barrier to immune recovery as measured by CD4 counts among HIV-infected people.},
keywords = {CD4, Food insecurity, HIV, Natural history, Nutrition/wasting},
pubstate = {published},
tppubtype = {article}
}