Food insecurity and cardiometabolic diseases among people with HIV in West Africa

OBJECTIVES: This study was conducted in order to evaluate the associations between food insecurity and cardiometabolic diseases among people with HIV in Togo and Côte d'Ivoire, West Africa. DESIGN: Cross-sectional study among ART experienced participants at lest 40 years of age contributing to the Sentinel Research Network (SRN) cohort of IeDEA West Africa. METHODS: Study encounters took place from November 2021 through June 2022. Food insecurity was assessed using the Household Food Insecurity Access Scale (HFIAS). Moderate-to-severe food insecurity was defined as HFIAS category at least 3. Dietary diversity was assessed using the Dietary Diversity Scale (DDS). Poor dietary diversity was defined as DDS 0-6. Clinical data were obtained using standard, validated instruments and clinical assays. Multivariable logistic regression was used to evaluate the associations between food insecurity and clinical outcomes, including HIV outcomes (virologic failure, CD4+ cell count), cardiometabolic outcomes (hypertension, type 2 diabetes, hyperlipidemia, hepatic steatosis, obesity) and other indicators of poor nutritional status (anemia, underweight, poor dietary diversity). RESULTS: Among 584 participants (69% women, median age 52 years), 240 (41%) were moderately-to-severely food insecure. Food insecurity was more prevalent among women (46.3 versus 29.7%; P < 0.001), those who had not received any formal education, and those with an income less than 50k FCFA/month. Food insecurity was associated with higher odds of virologic failure [odds ratio (OR) 1.85; 95% confidence interval (CI) 1.04-3.28], CD4+ cell count less than 200 cells/μl (OR 2.98; 95% CI 1.28-6.90), and hypertension (OR 1.89; 95% CI 1.30-2.73). Food insecurity was associated with lower odds of hyperlipidemia (OR 0.34; 95% CI 0.16-0.72) and lower odds of obesity among men (OR 0.09; 95% CI 0.01-0.69), but not among women (OR 0.78; 95% CI 0.50-1.20). Food insecurity was associated with underweight (OR 2.95; 95% CI 1.09-7.97), and poor dietary diversity (OR 1.60; 95% CI 1.14-2.23) in univariable analysis but not multivariable analysis. Food insecurity was not associated with type 2 diabetes, liver steatosis, or anemia. Women had greater odds of obesity (OR 3.07; 95% CI 1.88-5.04) and anemia (OR 1.80; 95% CI 1.19-2.72) compared to men. CONCLUSION: Among people ageing with HIV in West Africa, food insecurity is common and is associated with poor clinical outcomes, including virologic failure and hypertension. Our findings support the need for integrated programs that address food insecurity and improve the prevention and treatment of cardiometabolic diseases among PWH in the region.