New research suggests that British Columbians with HIV are more likely to be unsure of their next meal as compared to the rest of the Canadian population.

This uncertainty is nearly 5 times higher than the general Canadian population, often leading to HIV- positive individuals not having access to adequate amounts of food.

“We were not expecting this many people to be hungry,” says Lena Normén, from the Canadian HIV Trials Network at St. Paul’s Hospital in Vancouver, BC, and lead author of the new study.

Wasting—loss of strength and weight in a person due to a chronic disease— from malnutrition is already known to be a predictor of mortality in HIV patients. The new findings point to the need to monitor this risk factor in the Canadian Population, and determine if it can be reversed.

“HIV is an extremely complicated disease and medical causes are often looked for in patients with wasting,” says Normén, “but it may just be that they haven’t enough money to buy food.”

HIV infection increases the body’s need for energy and protein, which is thought to be due to increases in the production of cytokines—hormone-like proteins that regulate the inflammatory immune response. People with HIV therefore have higher dietary needs in terms of more protein and nutrients.

Normén and colleagues wondered if patients on antiretroviral therapy in British Columbia were having difficulty coping with their higher dietary needs. They asked just under 4000 HIV-infected people about their access to adequate food.

The questions asked of HIV-infected individuals included whether they were going without food, experience hunger pangs, what their household food supply was like, and their feelings about their food situation. Researchers term people having difficulty with any of these questions as ‘food insecure’.

Normén points out that food insecurity is a measure of what people eat, what kind of food they can afford to buy, and whether people worry about food due to money or other concerns.

For example, “If you’re constantly thinking about how you’re going to survive the day and what am I going to feed my kids,” says Normén, “we would consider that food insecure.”

Of the 1213 people that responded, the bulk of which were men (1116 men and 97 women), Normén and colleagues categorized 48% (584) as being food insecure. In the Canadian population, similar food insecurity is estimated to be approximately 10%, strongly suggesting that British Columbians with HIV are more likely to experience hunger. The results are published in the April, 2005, issue of the Journal of Nutrition.

“From the point of view of a disease [HIV] that has high energy requirements, the fact that you can’t control the amount of energy you get is worrisome,” says Normén. Indeed, the researchers also found that food insecurity is associated with decreased weight in the patients surveyed.

In addition, Normén and colleagues found that the strongest predictors of food insecurity included parameters such as incomes below $10,000 (CAD), unemployment, and sharing a household with children.

Although the researchers point out that their sample size was relatively low, their study is first to look at food insecurity in the Canadian HIV population, and they are currently following up on their findings.

“We are doing more work now,” says Normén, “and we are looking into the risk of HIV mortality if you are food insecure.”

She hopes that as more information is gained, a strategy can be developed to improve support for the HIV patients that need it.

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