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Co-infections and Concurrent Diseases (CCD)

CTN 264: Investigating access to food for people living with HIV-HCV co-infection

Prospective investigation of the relationship between food insecurity and health and behavioural outcomes in HIV-HCV co-Infection: Clues for prevention interventions. A food security & HIV-HCV sub-study of the Canadian Co-Infection Cohort (CTN 222)

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Food insecurity (FI) exists “whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain” (e.g., without resorting to emergency food supplies, scavenging, stealing, and other strategies). FI is associated with poorer health outcomes (sub-optimal treatment adherence) for people living with HIV. Chronic hepatitis C (HCV) infection in combination with HIV may further contribute to FI-related health and treatment complications.

CTN 264 is exploring the risk factors of food insecurity and consequences of being food insecure in people living with HIV-HCV co-infection. To date, the study investigators have estimated the prevalence and severity of food insecurity within this population and identified potential risk factors for food insecurity in this context. They are also in the process of investigating how food insecurity impacts specific HIV-related clinical outcomes (e.g., CD4 cell counts and HIV viral load suppression). Cohen J

Study population/design

CTN 264 is a sub-study of the Canadian Co-infection Cohort (CTN 222), a national cohort that tracks over 1500 Canadian participants who live with HIV-HCV. The food security sub-study recruited participants from CTN 222. Using a measurement tool created by Health Canada, participants were asked to complete a questionnaire to measure their food security status. Various social, economic, behavioral, and clinical variables are being used to identify risk factors for FI and explore outcomes associated with being food insecure over time.


Preliminary analyses of these data revealed that 59% of participants (312 of 525) were food insecure at their first study visit. Recent injection drug use (in the past 6 months) was significantly associated with food insecurity and approximately one third of study participants had recently injected drugs. The largest effect on food insecurity was observed for trading food to obtain tobacco, personal/household items, or drugs. The recent occurrence of depressive symptoms was also significantly associated with FI and roughly one half of participants experienced such symptoms.


To date, CTN 264 has helped identify potential targets for intervention and future research areas that may help reduce FI in HIV-HCV co-infected populations. As further analyses are completed, our understanding of the relationship between FI  and HIV-HCV co-infection will continue to grow.

Additional Information

Principal Investigators

Dr. Joseph Cox
McGill University
Tel: 514.528.2400.3630

Dr. Anne-Marie Hamelin
McGill University
Tel: 514.398.3231


McLinden T, Moodie EEM, Hamelin A-M, Harper S, Rossi C, Walmsley SL, Rourke SB, Cooper C, Klein MB, Cox J. Methadone treatment, severe food insecurity, and HIV-HCV co-infection: A propensity score matching analysis. Drug Alcohol Depend. 2018 Feb 20 epub ahead of print.

Aibibula W, Cox J, Hamelin A-M, Moodie EEM, Naimi AI, McLinden T, Klein MB, Brassard P. Food insecurity may lead to incomplete HIV viral suppression and less immune reconstitution among HIV/hepatitis C virus-coinfected people. HIV Med. 2018 Feb;19(2):123-31

Aibibula W, Cox J, Hamelin A-M, Moodie EEM, Anema A, Klein MB, Brassard P; Canadian Co-infection Cohort Investigators. Association between depressive symptoms, CD4 count and HIV viral suppression among HIV-HCV co-infected people. AIDS Care. January 2018 epub ahead of print.

Aibibula W, Cox J, Hamelin A-M, Moodie EEM, Naimi AI, McLinden T, Klein MB, Brassard P; Canadian Co-infection Cohort Investigators. Impact of food insecurity on depressive symptoms among HIV-HCV co-infected people. AIDS Behav. 2017 Dec;21(12):3464-72.

McLinden T, Moodie EEM, Hamelin AM, Harper S, Walmsley SL, Paradis G, Aibibula W, Klein MB, Cox J. Injection Drug Use, Unemployment, and Severe Food Insecurity Among HIV-HCV Co-Infected Individuals: A Mediation Analysis. AIDS Behav. 2017 Dec;21(12):3496-05.

Cox J, Hamelin A-M, McLinden T, Moodie EEM, Anema A, Rollet-Kurhajec KC, Paradis G, Rourke SB, Walmsley SL, Klein MB, Canadian Co-infection Cohort Investigators. Food insecurity in HIV-hepatitis C virus co-infected individuals in Canada: the importance of co-morbidities. AIDS Behav. 2017 Mar(21):792-802.

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