Researchers said that could be because taking HIV medication or accessing early treatment may not be a priority for people who don't know where their next meal is coming from.

So-called food insecurity may also point to other underlying problems in people with HIV, such as poverty, mental illness and addiction.

"Food insecurity is a significant problem, but when you have a chronic disease, it only exacerbates things," said Seth Kalichman, a psychologist who has studied adherence to HIV treatment and food access at the University of Connecticut in Storrs.

Kalichman, who wasn't involved in the new report, said the combination of hunger and HIV - which hampers the immune system - makes people especially susceptible to other diseases.

The Centers for Disease Control and Prevention estimate that at the end of 2008, close to 1.2 million teens and adults were living with an HIV infection in the United States.

For the new research, Dr. Sheri Weiser of the University of California, San Francisco and her colleagues regularly interviewed 347 people with HIV who were homeless or living in shelters or low-income, temporary housing.

At the study's start, about one-quarter of them had visited an emergency room in the past three months and 11 percent had recently been admitted to a hospital. One-third of the participants reported severe food insecurity and more than half had at least some trouble consistently getting food.

Over the next two years, the researchers found people who were very anxious or uncertain about their food supply or without access to nutritious options were twice as likely to be hospitalized as those who didn't report any food insecurity.

They were also 70 percent more likely to visit an ER, Weiser's team reported in the Journal of General Internal Medicine.

Part of that could be the result of poorer disease control and more HIV-related symptoms, researchers said.

"They're trying to find food on a daily basis - it really can significantly impact their medication adherence," Kalichman told Reuters Health.

"The struggle to find food supersedes remembering to take your medications."

There's also a strong link between mental illness and food insecurity, Weiser said, in addition to the general health problems that come with not getting adequate nutrition.

"No matter what, it's clear that there needs to be better integration of food services and health services," she told Reuters Health.

For example, clinics that treat low-income people need to have social workers available to connect patients to food and housing resources, she added.

Kalichman said more research needs to be done on other strategies to link hungry, food-insecure people, with or without HIV, to reliable food sources such as nutrition assistance programs.

And the researchers emphasized the need to continue to put funding into such food programs for the sick and poor.

"Access to food, hunger and nutrition are central to our efforts to improve the health of people living with HIV-AIDS," Dr. David Bangsberg from Harvard Medical School in Boston, who also worked on the new study, told Reuters Health.

"Cutting food sources is penny-wise kind of foolish when the cost of treating somebody with advanced AIDS is orders of magnitude more expensive than the cost or providing adequate nutrition," he said.

SOURCE: bit.ly/OgtukT Journal of General Internal Medicine, online August 18, 2012.

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