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The European Journal of Public Health Advance Access published online on August 26, 2005
The European Journal of Public Health, doi:10.1093/eurpub/cki153
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© The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Received October 14, 2004
Accepted June 7, 2005

Article

Employment loss following HIV infection in the era of highly active antiretroviral therapies

Rosemary Dray-Spira 1*, Anne Persoz 2, Faroudy Boufassa 2, Alice Gueguen 1, France Lert 1, Thierry Allegre 3, Cécile Goujard 4, Laurence Meyer 2, and The Primo Cohort Study Group{dagger}

1 INSERM U687-IFR69, Hôpital National de Saint-Maurice, Saint-Maurice, France
2 INSERM U569-Service d'Epidémiologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
3 Service d'Hématologie, Centre Hospitalier du pays d'Aix, Aix-en-Provence, France
4 Service de Médecine Interne, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France

* To whom correspondence should be addressed.
Rosemary Dray-Spira, E-mail: Rosemary.Dray-Spira{at}st-maurice.inserm.fr


  Abstract

Background: Employment is a major factor in maintaining living conditions of patients with chronic diseases. This study aimed to quantify the frequency and to identify the determinants of employment loss during the first years of HIV disease in the era of highly active antiretroviral therapies (HAART). Methods: The French PRIMO multicentre prospective cohort of 319 patients enrolled during primary HIV-1 infection between 1996 and 2002. Employment loss was defined as moving from employment to inactivity between two visits. Characteristics associated with employment loss were assessed using generalized estimating equations. Results: During a median follow-up time of 2.5 years, 56 employment losses occurred among 51 patients (18.0%). In multivariate analysis, female gender (adjusted odds ratio 3.1; 95% confidence interval 1.1-8.5), non-permanent job (3.8; 1.5-9.3) and poor accommodation (4.2; 1.6-11.2) constituted independent risk factors for employment loss; subjects with a high occupational position had a decreased risk of job loss. Moreover, an updated HIV viral load above 10 000 copies/ml either persistent (2.4; 1.1-5.0) or incident (3.7; 1.0-13.9) and hospitalization in the preceding 6 months (3.9; 1.6-9.7) constituted independent risk factors for employment loss, as tended to be a baseline CD4 cell count <350/mm3 (1.9; 0.9-4.3) and chronic comorbidity (1.8; 0.9-3.6). Conclusions: In the HAART era, employment loss is frequent from the first months of HIV infection. Employment loss occurs especially in women and in patients with adverse socioeconomic conditions, severe HIV infection and/or comorbidity. Social interventions should seek to prevent HIV-infected patients from leaving their job from the earliest times of the disease.

Keywords: employment; HIV infection; prospective study; socioeconomic factors.
{dagger} See Appendix.
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