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