Employment loss following HIV infection in the era of highly active antiretroviral therapies
Employment loss following HIV infection in the era of highly active antiretroviral therapies
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DOI：
10.1093/eurpub/cki153
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发表时间：
2006-02-01
影响因子：
4.4
通讯作者：
Meyer, L
中科院分区：
文献类型：
--
作者：
Dray-Spira, R;Persoz, A;Meyer, L
背景：就业是维持慢性病患者生活条件的主要因素。这项研究的目的是量化在高效抗逆转录病毒疗法(HAART)时代艾滋病毒疾病第一年期间失业的频率和确定决定因素。方法：法国Primo多中心前瞻性队列研究，研究对象为1996年至2002年间首次感染HIV-1期间登记的319名患者。失业被定义为在两次访问之间从有工作转移到不活动。使用广义估计方程评估了与就业损失相关的特征。结果：中位随访时间为2.5年，51例患者中有56人失业(18.0%)。在多因素分析中，女性(调整后优势比3.1；95%可信区间1.1-8.5)、非固定工作(3.8；1.5-9.3)和住宿条件差(4.2；1.6-11.2)是失业的独立危险因素；职业岗位越高，失业风险越低。此外，新的艾滋病毒病毒载量超过10 000拷贝/毫升，无论是永久性的(2.4；1.1-5.0)还是偶发的(3.7；1.0-13.9)，以及之前6个月的住院(3.9；1.6-9.7)是失业的独立危险因素，往往是基线CD4细胞计数和350/mm(3)(1.9；0.9-4.3)和慢性共病(1.8；0.9-3.6)。结论：在HAART时代，从感染艾滋病毒的头几个月开始就经常失去工作。失业尤其发生在妇女和患有不利社会经济条件、严重艾滋病毒感染和/或共病的患者中。社会干预应设法防止艾滋病毒感染者在疾病最早的时候就离开工作岗位。
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/mm(3) (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.