Pathways from Food Insecurity to Health and Treatment Outcomes in Women with HIV

艾滋病毒携带者从粮食不安全到健康和治疗结果的途径

基本信息

批准号：
8978338
负责人：
SHERI Dawn WEISER
金额：
$ 47.69万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-01 至 2017-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8978338
关键词：
AIDS/HIV problem Acquired Immunodeficiency Syndrome Adherence Affect American Anti-Retroviral Agents Appointment Behavior Therapy Behavioral Behavioral Sciences Biometry Blood Pressure CD4 Positive T Lymphocytes Cardiovascular Diseases Cardiovascular system Caring Cell Count Central obesity Cessation of life Clinical Nutrition Color Cross-Sectional Studies Data Diabetes Mellitus Diet Drug abuse Dyslipidemias Effectiveness Food Food Access Food Assistance Programs Funding General Population Goals HIV HIV Infections HIV-1 Hair Health Health Planning Heart Diseases High Density Lipoproteins Highly Active Antiretroviral Therapy Household Hyperlipidemia Hypertension Hypertriglyceridemia Immune Immunologics Immunology Individual Infectious Disease Immunology Inflammation Insulin Resistance Interruption Intervention Journals Life Link Longitudinal Studies Low income Low-Density Lipoproteins Measures Mediating Mediator of activation protein Medicine Mental Depression Mental Health Modeling Morbidity - disease rate Nutritional Obesity Outcome Participant Pathway interactions Persons Plasma Probability Prospective Studies Publishing RNA Recovery Research Resources Risk Sampling Socioeconomic Status Stress Techniques Testing Treatment outcome United States United States National Institutes of Health Viremia Woman Work antiretroviral therapy cardiovascular health cardiovascular risk factor cost disorder control ethnic diversity fasting plasma glucose follow-up food challenge food quality food security glucose metabolism health disparity high risk immune activation improved inflammatory marker lipid metabolism medical appointment medical food men microbial mortality multidisciplinary novel nutrition premature programs waist circumference

项目摘要

DESCRIPTION (provided by applicant): HIV-infected women have higher rates of morbidity and mortality compared to men in the United States (U.S.). An important driver of health disparities and worse outcomes among HIV-infected women is food insecurity, or the inability to access food of sufficient quality or quantity in socially acceptable ways. Food insecurity affects 18 million households in the U.S. (40% of low income households), is more prevalent among women, and affects about half of urban poor HIV-infected individuals. Food insecurity is associated with worse immunologic and virologic outcomes in cross-sectional studies, increased HIV-related morbidity and mortality in longitudinal studies, and increased cardiovascular risk factors (hypertension, diabetes, and hyperlipidemia) in cross-sectional studies in the general population. Due to these negative health impacts among HIV-infected individuals, governmental and non-governmental organizations have argued to integrate food security and HIV/AIDS programming activities. A rigorous longitudinal study is urgently needed to quantify the impacts and identify the dominant mechanisms by which food insecurity negatively impacts health in order to improve the effectiveness and reach of food assistance programs and guide their integration with HIV/AIDS programs. The proposed research assembles experts from medicine, infectious disease, immunology, biostatistics, and nutrition for a 4-year longitudinal study to quantify the impacts and identify the pathways linking food insecurity to HIV treatment and cardiovascular health in the Women's Interagency HIV Study (WIHS). WIHS is an ongoing, prospective study in the U.S. of 1500 HIV-infected women and 650 non-infected, but at-risk, women. We plan to leverage the detailed HIV treatment and cardiovascular risk measures collected in WIHS to accomplish 3 aims. In aims 1 and 2, we hypothesize that food insecurity will be associated with worse HIV treatment and cardiovascular risk outcomes and that these relationships will be partially mediated by nutritional (food quality/quantity, obesity), mental health (depression, stress), and behavioral (treatment non-adherence, missed appointments) pathways. To accomplish aims 1 and 2, we will add measures of food insecurity, dietary quality, socio-economic status, competing demands between food and medical care, and antiretroviral (ARV) hair levels (a technique we pioneered as an objective measure of ARV adherence) to WIHS. Our analytic approach will be guided by a novel conceptual model that we recently published in the American Journal of Clinical Nutrition. In aim 3, we hypothesize that food insecurity will be associated with markers of gut microbial translocation (MT), inflammation and immune activation among HIV-infected women, and that this association will be mediated by diet, obesity, and worse HIV control. To accomplish aim 3, we will add measures of gut MT and immune activation for a sub-sample of 250 women on ARV therapy. Our work will be critical to attract funding for this priority issue. The ultimate goal of this work is to develop sustainable solutions to tackle the intersecting challenges of food insecurity and HIV/AIDS morbidity and mortality among women in the U.S.

描述（由申请人提供）：与美国的男性相比，感染HIV的妇女的发病率和死亡率更高。艾滋病毒感染的妇女的健康差异和结果较差的重要驱动力是粮食不安全，或者无法以社会上可接受的方式获得足够质量或数量的食物。粮食不安全影响美国的1800万家庭（占低收入家庭的40％），在妇女中更普遍，并且影响了城市贫困的艾滋病毒感染者中约有一半。粮食不安全与横断面研究中的免疫学和病毒学结局较差，纵向研究中与HIV相关的发病率和死亡率增加，以及在一般人群中横断面研究中的心血管危险因素（高血压，糖尿病和高脂血症）的增加。由于受艾滋病毒感染者对健康的负面影响，政府和非政府组织主张将粮食安全和艾滋病毒/艾滋病计划活动整合起来。迫切需要进行一项严格的纵向研究，以量化影响的影响并确定粮食不安全感会对健康产生负面影响的主要机制，以提高粮食援助计划的有效性和覆盖范围，并指导其与HIV/AIDS计划的整合。拟议的研究组装了一项为期4年的纵向研究，以量化影响的影响并确定将粮食不安全与HIV治疗与HIV治疗与心血管健康联系起来的途径（WIHS），以量化影响的影响并确定将粮食不安全与HIV治疗与心血管健康联系起来的途径，以量化医学，传染病，免疫学，生物统计学和营养专家。。 WIHS是美国1500名艾滋病毒感染妇女和650名未感染但处于危险的妇女的持续前瞻性研究。我们计划利用在WIHS中收集的详细艾滋病毒治疗和心血管风险度量，以实现3个目标。在目标1和2中，我们假设粮食不安全性与较差的艾滋病毒治疗和心血管风险结果有关，这些关系将部分由营养（食物质量/数量，肥胖），心理健康（抑郁症，压力）和行为（治疗不遵守，错过的任命）途径。为了实现目标1和2，我们将添加粮食不安全，饮食质量，社会经济地位，食品和医疗服务之间的竞争要求以及抗逆转录病毒（ARV）头发水平（我们率先作为ARV依从性的一种技术））我们最近在《美国临床营养杂志》上发表的一种新颖的概念模型将指导我们的分析方法。在AIM 3中，我们假设粮食不安全性将与肠道微生物易位（MT），HIV感染的妇女之间的炎症和免疫激活有关，并且这种关联将由饮食，肥胖和较差的HIV控制介导。为了完成AIM 3，我们将为250名ARV治疗的女性的子样本增加肠道MT和免疫激活的措施。我们的工作对于吸引此优先问题的资金至关重要。这项工作的最终目标是开发可持续的解决方案，以应对美国妇女的粮食不安全和艾滋病毒/艾滋病的发病率和死亡率的相交挑战

项目成果

期刊论文数量（2）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

How food insecurity contributes to poor HIV health outcomes: Qualitative evidence from the San Francisco Bay Area.

粮食不安全如何导致艾滋病毒健康状况不佳：来自旧金山湾区的定性证据。

DOI：
10.1016/j.socscimed.2016.09.040
发表时间：
2016
期刊：
Social science & medicine (1982)
影响因子：
0
作者：
Whittle,HenryJ;Palar,Kartika;Seligman,HilaryK;Napoles,Tessa;Frongillo,EdwardA;Weiser,SheriD
通讯作者：
Weiser,SheriD

"The land of the sick and the land of the healthy": Disability, bureaucracy, and stigma among people living with poverty and chronic illness in the United States.