Unmet Basic Needs Predict Health Status in HIV-Infected Patients

Access to food and shelter, rather than viral load count, is a better predictor of overall health among homeless HIV-infected men, according to a recent study.

Though HIV medication access and adherence are often cited as the biggest factors affecting the health of HIV-infected patients, a new study shows that basic subsistence needs are the strongest predictor of overall health status in certain subgroups of patients.

Researchers followed a group of 288 HIV-infected impoverished men over a period of 6 years in San Francisco, California. Participants had an average of 349 CD4 T-cells at the beginning of the study, just under the number at which patients should start antiretroviral medications, according to treatment guidelines in the City and County of San Francisco. The participants were recruited from homeless shelters, free food programs, and single-room occupancy hotels. Twenty percent of the subjects had reported being homeless recently, and more than one-third reported symptoms of chronic illness related to their HIV diagnoses.

Elise Riley, PhD, associate professor in the UCSF HIV/AIDS division at San Francisco General Hospital and Trauma Center and the study’s principal investigator, noted that only a fifth of those who had access to antiretroviral therapies were actually on the medications. She argued that the inability to meet basic subsistence needs, not viral load count, is the best predictor of health status among the men studied.

“The study shows that a simple focus on providing medications will neither effectively treat nor end HIV in inner cities,” Dr. Riley emphasized. “A person’s ability to get needed care and take medications becomes less of a priority when they don’t have food or a place to sleep.”

Dr. Riley and her colleagues based their work on an analysis by the Centers for Disease Control and Prevention (CDC) in 2010 that showed that poverty is the single most important demographic factor associated with HIV infection among inner-city heterosexuals. The CDC’s report included more than 9000 heterosexual adults (aged 18-50 years) in high-poverty areas of 23 cities who participated in the 2006-2007 heterosexual cycle of the CDC's National HIV Behavioral Surveillance System.

The study investigators stressed that homelessness itself is more expensive to society than the cost of housing, as many unstably housed individuals end up in the emergency department or incarcerated.

“Our study suggests that the social barriers inherent in poverty are also likely to continue fueling the American HIV epidemic, which may further add to societal costs,” noted Dr. Riley. “While a combination of behavioral, biomedical and structural interventions is expected to provide the most effective approach to HIV prevention and HIV treatment, advances in HIV medicine will not be fully realized by unstably housed persons until opportunity and choice limited by social and structural barriers are overcome.”