Unemployment as a risk factor for AIDS and death for HIV-infected patients in the era of highly active antiretroviral therapy

Objectives: To assess the association between social situation and disease progression among patients diagnosed with HIV infection since the advent of highly active antiretroviral therapy (HAART), taking late testing into account. Methods: Prospective cohort study of adults diagnosed with HIV since 1996 in six large HIV reference centres in France. Associations between social situation and death, disease progression and treatment initiation were assessed using Cox regression model. Analysis was restricted to 5302 patients (77.9% of the sample) for whom the status at HIV diagnosis (late or not late) was known. Results: 134 people (2.5%) died and 400 presented with a new AIDS defining event (7.5%). In multivariate analysis, probabilities of death (HR 3.75, 95% CI 2.11 to 6.66) and disease progression (HR 1.59, 95% CI 1.17 to 2.15) were higher for non-working patients and for late testers (HR 9.18, 95% CI 4.32 to 19.48 for death) and lower for treated patients (HR 0.18, 95% CI 0.08 to 0.41 for death and HR 0.29, 95% CI 0.20 to 0.42 for disease progression). 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.