Unemployment as a risk factor of AIDS and death for HIV-infected patients in the era of HAART
- Lise Cuzin (cuzin.l{at}chu-toulouse.fr)
- Geetanjali Datta (gdatta{at}hsph.harvard.edu)
- Harvard School of Public Health, Department of Epidemiology and Center for Society and Health, United States
- Lisa Berkman (lberkman{at}hsph.harvard.edu)
Abstract
Objectives: To assess the association between social situation and disease progression among patients diagnosed with HIV infection since the advent HAART, taking late testing into account.
Methods: Prospective cohort study of adults diagnosed with HIV since 1996 in six large HIV reference centers in France. Associations between social situation and death, disease progression, and treatment initiation were assessed using Cox regression model. Analysis were restricted to 5302 patients (77.9% of the sample) for whom the status at HIV diagnosis (late or non late) was known.
Results: One hundred and thirty-four persons (2.5%) died and 400 presented with a new ADE (7.5%). In mutivariate analysis, probabilities of death and disease progression were higher for non-working patients (Hazard Ratio (HR): 3.75, 95% CI: 2.11-6.66 and HR: 1.59, 95% CI: 1.17-2.15, for death and disease progression respectively), as for late testers (HR: 9.18, 95% CI: 4.32-19.48 for death) and lower for treated patients (HR: 0.18, 95% CI: 0.08-0.41 and HR: 0.29, 95% CI: 0.20-0.42, for death and disease progression respectively). The probability of receiving antiretroviral treatment was not associated with employment status but was higher for late testers, for those living in a stable relationship and lower for those diagnosed after 2000.
Conclusion: Among patients diagnosed for HIV infection in the HAART era, poor social situation is an independent risk factor of mortality and morbidity, and is not explained by delayed access to diagnosis or treatment.
