Impact of household food insecurity on the nutritional status and the response to therapeutic feeding of people living with human immunodeficiency virus

Abstract

Paluku Bahwere1,2,*, Hedwig Deconinck3,*, Theresa Banda1,*, Angella Mtimuni1,*, Steve Collins1,* 1Valid International, Oxford, United Kingdom; 2Center of Research in Epidemiology, Biostatistics, and Clinical Research, School of Public Health, Free University of Brussels, Brussels, Belgium; 3Save the Children, Westport, CT, USA *These authors contributed equally to this workBackground: The role of household food security (HFS) in the occurrence of wasting and the response to food-based intervention in people living with human immunodeficiency virus (PLHIV), especially adults, is still controversial and needs investigation.Methods: Face-to-face interviews to collect data for Coping Strategies Index score and Dietary Diversity Score estimation were conducted during a noncontrolled and nonrandomized study assessing the effectiveness of ready-to-use therapeutic food in the treatment of wasting in adults with HIV. Coping Strategies Index score and Dietary Diversity Score were used to determine HFS, and the participants and tertiles of Coping Strategies Index score were used to categorize HFS.Results: The study showed that most participants were from food insecure households at admission, only 2.7% (5/187) ate food from six different food groups the day before enrolment, and 93% (180/194) were applying forms of coping strategy. Acute malnutrition was rare among <5-year-old children from participants’ households, but the average (standard deviation) mid-upper arm circumference of other adults in the same households were 272.7 (42.1) mm, 254.8 (33.8) mm, and 249.8 (31.7) mm for those from the best, middle, and worst tertile of HFS, respectively (P = 0.021). Median weight gain was lower in participants from the worst HFS tertile than in those from the other two tertiles combined during therapeutic feeding phase (0.0 [–2.1 to 2.6] kg versus 1.9 [–1.7 to 6.0] kg; P = 0.052) and after ready-to-use therapeutic food discontinuation (–1.9 [–5.2 to 4.2] kg versus 1.8 [–1.4 to 4.7] kg; P = 0.098). Being on antiretroviral therapy influenced the response to treatment and nutritional status after discontinuation of ready-to-use therapeutic food supplementation.Conclusion: Food insecurity is an important contributing factor to the development of wasting in PLHIV and its impact on therapeutic feeding response outlines the importance of food-based intervention in the management of wasting of PLHIV.Keywords: HIV, malnutrition, food security, ready-to-use therapeutic food, chronically sick, antiretroviral