Inadequate access to nutritious food is associated with increased hospitalizations and emergency room visits among HIV-positive individuals, and ensuring that patients have enough to eat may need to be a priority for the doctors and nurses who treat them, UCSF researchers say.
In a paper released Wednesday, the scientists reported that 56 percent of HIV-positive patients who are homeless or living in substandard housing are also food insecure, which is defined as a regular inability to obtain enough healthy food. The researchers looked at 347 HIV patients, all of whom live in San Francisco.
The food-insecure patients were roughly twice as likely to have visited the ER or been hospitalized over a given three-month period, compared with patients who had enough to eat, the researchers found. Food insecurity was more likely than homelessness, drug abuse or depression - or just about any measurable problem associated with poverty - to lead to trips to the hospital.
Earlier studies, both in the United States and abroad, have found that food insecurity also is associated with missed doctors' appointments, less suppression of the HIV virus and greater risk of death.
It's not shocking that inaccessibility to food would be tied to poorer health, said Dr. Sheri Weiser, a study author. But she was surprised at how strong the correlation was between not having enough to eat and needing to use health care resources like hospitals and emergency rooms.
"Food insecurity is a negative factor above and beyond other markers of poverty," said Weiser, an assistant professor of medicine in the UCSF HIV/AIDS Division at San Francisco General Hospital. "It is impacting basically every health outcome you could imagine."
The good news is that simply helping patients get food - an idea that seems less daunting than, for example, discovering the antiretroviral drugs used to treat HIV infections, study authors said - could have profound impacts on their health overall.
"If we can do the really hard things, why can't we figure out a way to make sure people get food?" said Dr. Margot Kushel, also a study author and an associate professor in the UCSF Division of Internal Medicine at San Francisco General Hospital. "I feel like, if we can give antiretroviral medications, why shouldn't we also be able to write a prescription for food?"
Kushel and other researchers pointed out that the study, along with earlier reports, doesn't conclusively prove that a lack of food causes poor health in HIV-positive patients.
The study authors found that food insecurity was a factor in poor health even when controlling for other possible risk factors like homelessness or drug abuse. But there still may be something about patients who aren't eating enough that makes them more prone to health problems - meaning, it's not the lack of food that's hurting them, but something related.
On to the next step
If a lack of adequate food is to blame for poor health, researchers will want to determine why that is. It could be as simple as missing key vitamins in their diet, or more complicated, like skipping medications that must be taken with a meal.
The authors, along with their peers in HIV research and treatment, said the evidence is strong enough that more research would be useful. The next step may be studying whether, when actually given more food to eat, food-insecure patients have better health outcomes.
"This study to me is really exciting because it raises an issue that many of us in San Francisco don't consider when we're taking care of our patients, which is their access to food," said Dr. Edward Machtinger, director of the Women's HIV Program at UCSF who wasn't involved in the study but has looked at the effects of trauma and post-traumatic stress in HIV patients.
"Whether it's preventing intimate partner violence or getting access to food, ignoring those factors limits our ability to have profound impacts on patients' lives," Machtinger said. "If we are trying to help our patients be healthy and powerful and independent, doing so requires more than simply giving them the medicine."
Of note, the authors said, was that only a fifth of participants in the UCSF study took advantage of federal food assistance programs over the course of a year, which means that there's probably room for improvement in either helping patients sign up for the programs or lowering the standards of who can receive aid. About 72 percent of participants received some form of food aid, including federal assistance or food from churches, clinics, food banks or other sources.
San Francisco resident Joey Massey, 43, was diagnosed with HIV four years ago and has since struggled financially, taking graphic design jobs when he's able. He often has a hard time getting enough to eat, even when he takes advantage of the resources available to him. He lost about 50 pounds after his diagnosis and struggles to avoid further weight loss.
"Every day is about consuming as many calories as I can, any way I can," Massey said. "Nausea is a big issue for me, so certain foods are problematic, and things like cereal or yogurt, simple things that would help, are prohibitively expensive.
"It's totally affected my health. I don't feel like I'm able to bounce back as much from stressful situations, from sicknesses," he said. "It's just stressful to wake up and not know how you're going to take care of yourself that day."
Erin Allday is a San Francisco Chronicle staff writer. E-mail: firstname.lastname@example.org