ORIGINAL PAPER Association Between Food Insecurity and HIV Viral Suppression: A Systematic Review and Meta-Analysis Wusiman Aibibula 1 • Joseph Cox 1,2 • Anne-Marie Hamelin 1 • Taylor McLinden 1 • Marina B. Klein 1,3 • Paul Brassard 1,3,4,5 Ó Springer Science+Business Media New York 2016 Abstract Although an increasing number of HIV infected people are accessing antiretroviral treatment, many do not achieve complete HIV viral suppression and remain at risk for AIDS and capable of HIV transmission. Food insecurity has been identified as a potential risk factor for poor virologic response, but the association between these fac- tors has been inconsistently documented in the literature. We systematically searched five electronic databases and bibliographies of relevant studies through April 2015 and retrieved 11 studies that met our inclusion criteria, of which nine studies were conducted in North America and the remaining two studies were in Brazil and Uganda respectively. Meta-analyzed results indicated that experi- encing food insecurity resulted in 29% lower odds of achieving complete HIV viral suppression (OR = 0.71, 95% CI 0.61–0.82) and this significant inverse association was consistently found regardless of study design, exposure measurement, and confounder adjustment methods. These findings suggest that food insecurity is a potential risk factor for incomplete HIV viral suppression in people liv- ing with HIV. Keywords Food insecurity Á HIV Á Viral suppression Á Meta-analysis Introduction HIV infection continues to be a major global public health issue. It was estimated in 2015 that nearly 37 million people globally were living with HIV [1]. Due to devel- opments in HIV treatment programs, nearly half of HIV infected people are accessing antiretroviral treatment (ART) [1]. Since there is no cure for HIV infection, complete HIV viral suppression is a measure of treatment success and it is the primary goal of ART. However, recent studies have found that only about 75% of those who were receiving ART achieved complete HIV viral suppression [2–4] and this percentage declined with longer treatment duration [2]. Since HIV viral load is strongly associated with both vertical and horizontal transmission of HIV [5, 6], those who have incomplete HIV viral suppression remain capable of forward transmission. Poor treatment adherence and drug resistance are known risk factors for incomplete HIV viral suppression. Recently, food insecurity has been identified as a potential risk factor for poor virologic responses among people liv- ing with HIV [7, 8]. Food insecurity, defined as having ‘‘limited or uncertain access to nutritionally adequate and safe foods or limited or uncertain availability to acquire such foods in socially acceptable ways’’ [9], can be ascertained using validated scales [10–12]. Although statistics about the prevalence of food insecurity among HIV infected people is limited, several studies in North & Paul Brassard paul.brassard@mcgill.ca 1 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada 2 Public Health Department, CIUSSS du Centre-Est-de-l ‘Ile- de-Montre ´al, Montre ´al, QC, Canada 3 Department of Medicine, McGill University, Montreal, QC, Canada 4 Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada 5 Centre for Clinical Epidemiology, Jewish General Hospital, 3755 Cote Sainte-Catherine, Pavilion H 424.1, Montreal, QC H3T 1E2, Canada 123 AIDS Behav DOI 10.1007/s10461-016-1605-5