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Not having enough food linked with lower chances of sustained viral suppression for ART-treated breastfeeding mothers in Uganda
Michael Carter, 2016-01-12 07:50:00
Not having enough
food is associated with poorer chances of achieving a sustained viral
suppression among antiretroviral-treated breastfeeding women in Uganda,
investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.
“In this cohort of
HIV-infected women in rural Uganda who initiated ART during pregnancy, food
insufficiency [FI] [defined as inadequate quantities of food available] was
highly prevalent,” comment the authors. “FI was associated with 62% lower odds
of achieving and sustaining viral suppression during pregnancy and
This is the first
study to show an association between food insecurity and poor viral suppression
among pregnant and breastfeeding women, a period “when viral suppression has
implications both for preserving maternal health and reducing the risk of
has shown a relationship between food insecurity (uncertain access to safe and
nutritious food) and lower rates of viral suppression among ART-treated
patients in the US and Uganda.
breastfeeding women may be especially vulnerable to food insecurity and
insufficiency. Moreover, food insecurity during pregnancy and breastfeeding has
been associated with reduced blood levels of antiretrovirals, pre-term delivery
and low birth weight infants. Food insecurity may also be a barrier to
ART is now
recommended for all pregnant and breastfeeding HIV-positive women.
Investigators therefore wanted to establish if food insufficiency was
associated with lower chances of sustained viral suppression among ART-treated
HIV-positive women in the year after giving birth.
recruited from the PROMOTE-Pregnant Women and Infants study, which was designed
to test the hypothesis that therapy with lopinavir/ritonavir would reduce the
prevalence of placental malaria. HIV-positive ART-naïve women were recruited
between weeks 12 and 28 of gestation.
observation between September 2011 and February 2012 were included in the food
insecurity sub-study. Viral load was measured eight weeks after delivery and
then at regular intervals through to week 48. Patients who maintained a viral
load below 400 copies/ml were regarded as having sustained viral suppression.
was assessed using the Household Hunger Scale. Participants were asked how
often: there was no food to eat in their house; they went to bed at night
hungry; and went the whole day and night without eating. Responses were ranked
on a scale of 0 (never) to 6 (often).
A total of 171
women were included in the analysis. Three-quarters reported food insufficiency
and for 9% this was severe.
At 24 weeks
postpartum, almost all the women were breastfeeding. Women with sufficient food
were more likely than women with food insufficiency to report exclusive
breastfeeding (81% vs. 68%). At 48 weeks, 92% of food insufficient women and
95% of food sufficient participants reported partial breastfeeding. Two infants
acquired HIV; both had mothers who reported food insufficiency.
proportions of food-sufficient and food-insufficient women achieved viral
suppression at some point during follow-up (90% vs. 92.5%). However, women with
enough food were more likely than women reporting insufficiency to have
sustained viral suppression (79% vs. 60%, p = 0.03).
In an analysis
that controlled for potential confounders, food insufficiency was associated
with significantly lower chances of sustained viral suppression (aOR = 0.38;
95% CI, 0.16-0.91, p = 0.03). Other risk factors were higher pre-therapy viral
load (p < 0.01) and treatment with lopinavir/ritonavir vs. efavirenz (p =
may be an important and modifiable determinant of adverse virologic outcomes
among pregnant and lactating women,” conclude the authors. “Interventions to
reduce food insufficiency may result in improved outcomes among HIV-infected
women and their children, and merit further attention from the research and