Impact of HIV disease severity on the risk of work cessation in France in 2004-2008: results from the ANRS-COPANA cohort
Background: Employment is a major factor in maintaining income and
living conditions among persons with chronic diseases. Severity of HIV
infection has been shown to be a predictor of work cessation earlier in the
HAART era. Our objective was to measure the impact of HIV disease severity on
the risk of work cessation in the most recent years, as the context of HIV management
has changed.
Methods: We used data from the French multicenter ANRS-COPANA
cohort of 800 recently diagnosed (< 1year)
HIV-1-infected adults, naïve of antiretroviral treatment at baseline in
2004-2008.
Detailed information on employment, living conditions
and clinical/biological data were collected prospectively. Work cessation was
defined as moving from employment to unemployment/inactivity before legal age
for retirement (60years). The impact of indicators of HIV disease severity (i.e.,
clinical stage and CD4 cell count) on the risk of work cessation was estimated
using Cox models accounting for socio-demographic and occupational
characteristics, living conditions, health behaviours, comorbidities and hospitalizations.
Results: A total of 321 participants were of working age and employed
at baseline (median age at enrolment 36.6years; 20.2% women; 28.6% migrants).
Of them, 34 (10.6%) stopped working before 60years: 29 became unemployed and 5
inactive. In multivariate analysis, the risk of work cessation was higher among
participants aged>50years, those self-employed or with a temporary position,
and participants living single, but not among those with
clinical/biological indicators of HIV disease severity. Having experienced ≥1 hospitalization
was associated with an increased risk of work cessation in the following year (Hazard
Ratio 2.9, 95%CI [1.1-7.8]); though, causes of these hospitalizations were not
HIV-related. HIV disclosure was associated with a decreased risk of work
cessation (0.4 [0.2-0.9]).
Conclusions: Our results do not support the existence of a deleterious
effect of HIV disease severity on the risk of work cessation in the most recent
period in France.
R. Dray-Spira1, M. Le Den1, C. Legeai2, F. Boufassa2, O. Bouchaud3, J.-P. Viard4, C. Goujard5, L. Meyer2,5, ANRS-COPANA Cohort Study Group
1INSERM, U1018/CESP - Equipe Determinants Professionels et Sociaux de la Sante, Villejuif, France, 2INSERM, U1018/CESP - Equipe Epidemiologie du VIH et des IST, Le Kremlin Bicetre, France, 3Hopital Avicenne, Bobigny, France, 4Hopital Hotel-Dieu, Paris, France, 5Hopital de Bicetre, Le Kremlin Bicetre, France