title: Employment loss following HIV infection in the era of highly active antiretroviral therapies.
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/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.
authors.affiliation: INSERM U687-IFR69, Hôpital National de Saint-Maurice, Saint-Maurice, France. Rosemary.Dray-Spira@st-maurice.inserm.fr
authors.forename: Rosemary
authors.initials: R
authors.lastname: Dray-Spira
authors.forename: Anne
authors.initials: A
authors.lastname: Persoz
authors.forename: Faroudy
authors.initials: F
authors.lastname: Boufassa
authors.forename: Alice
authors.initials: A
authors.lastname: Gueguen
authors.forename: France
authors.initials: F
authors.lastname: Lert
authors.forename: Thierry
authors.initials: T
authors.lastname: Allegre
authors.forename: Cécile
authors.initials: C
authors.lastname: Goujard
authors.forename: Laurence
authors.initials: L
authors.lastname: Meyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D004651:Employment; D005260:Female; D005602:France; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012959:Socioeconomic Factors