A clinical trial has revealed that medically-tailored meals and groceries, combined with nutritional education, significantly reduce hospitalizations and enhance mental and physical health in people with HIV. However, the intervention did not improve unsuppressed viral load, according to a study published in the Journal of Infectious Diseases.
The “Changing Health through Food Support for HIV Study” (CHEFS-HIV), led by Dr. Kartika Palar of the University of California San Francisco (UCSF), in partnership with Project Open Hand, a non-profit nutrition agency in the San Francisco Bay area, investigated the impact of an intensive medically-tailored food support intervention compared to standard food services. The primary aim was to reduce viral non-suppression among participants. Secondary outcomes included food security, depression symptoms, adherence to antiretroviral therapy, hospitalizations, and frequency of condomless sex.
Food insecurity among people with HIV in high-income countries is linked to poor diets, mental health issues, risky sexual behavior, lower adherence to antiretroviral therapy, lower CD4 cell counts, higher viral loads, and increased mortality. Both food insecurity and HIV disproportionately affect low-income and ethnic minority groups. Previous pilot studies indicated improvements in food security, depression symptoms, and antiretroviral adherence with the “Food is medicine” approach, necessitating a larger, controlled study to validate these findings.
The CHEFS-HIV Study, conducted between 2016 and 2017, included 191 HIV-positive clients of Project Open Hand. Eligible participants were at least eighteen years old, English or Spanish speakers, able to store and reheat perishable food, and had household incomes below 200% of the US federal poverty level.
Ninety-three participants received the “Food is medicine” intervention for six months, which included:
Medically-tailored meals and groceries: Equivalent to three meals a day, these were designed to meet daily energy requirements (1965-2359 calories/day), varying weekly, low in refined sugars and saturated fats, and rich in fresh fruits, vegetables, lean proteins, healthy fats, and whole grains.
Nutritional education: Included an initial and final individual nutritional counseling session, an assessment call at three months, and three two-hour small group classes on HIV, nutrition, portion sizes, food labels, goal setting, and cooking demonstrations.
The control group of 98 participants received groceries or prepared meals sufficient for one or two meals a day and met briefly with dietitians every six months, without additional nutritional education.
At the study’s outset, participants were predominantly men over fifty, from ethnic minority backgrounds, with education levels above high school. Many reported recent illicit drug use and mental health diagnoses, with a median HIV diagnosis duration of twenty-two years.
Baseline measures showed that 36% had an unsuppressed viral load, and the mean quality of life score was 52.4. Food insecurity affected 63%, 46% exhibited depression symptoms, 22% missed more than one in ten antiretroviral doses, 8% had been hospitalized in the past three months, and 61% had engaged in condomless sex.
After six months, 168 participants (88%) remained in the study. While rates of unsuppressed viral load decreased in both arms, no significant differences were observed between groups. Quality of life scores also showed no significant differences.
However, the “Food is medicine” group experienced a 77% reduction in the risk of severe food insecurity and a 68% reduction in severe depression symptoms compared to the control group.
This group also showed lower rates of poor antiretroviral therapy adherence and condomless sex. Notably, hospitalization rates dropped from 11% to 5% in the intervention group, while rising from 6% to 11% in the control group, indicating an 89% lower risk of hospitalization for the intervention group.
Dr. Palar and colleagues conclude that “Food is medicine” programs can significantly improve physical and mental health outcomes for people living with HIV, also positively impacting sexual behavior by addressing food insecurity-related risks.
They emphasize the link between food insecurity and increased emergency department use, hospitalization, and death, influenced by social factors like homelessness and drug use.
In a commentary accompanying the study, Dr. Seth Berkowitz of Johns Hopkins University highlights the significance of reduced hospitalizations as an indicator of improved health, beyond economic considerations. He praises the CHEFS-HIV study but urges a broader perspective on addressing social injustices that underpin food insecurity, advocating for reform in social institutions to more equitably distribute power and resources in the US.
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