Challenges remain for HIV-infected individuals re-entering workplace

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The likelihood of HIV-infected individuals receiving combination ART to engage in full- or part-time employment after 1 year of treatment significantly increased during the last 20 years, but hurdles remain for their reintegration into the workforce, according to study data.

“Benefits of employment include economic well-being, decreased symptoms of depression and improved social support,” Healio reports that Dr Luigia Elzi, from the division of infectious diseases and hospital epidemiology at the University Hospital Basel, Switzerland, and colleagues wrote. “However, barriers to workforce re-entry have been reported for HIV-infected individuals, side effects of [combination ART (cART)], and discrimination.”

Elzi and colleagues used the June 2014 database extract of the Swiss HIV Cohort study (SHCS), in which HIV-infected individuals aged 18 years or older were tracked in the outpatient clinics of seven Swiss hospitals and associated smaller hospitals and physicians’ practices.

Aiming to investigate patients’ ability to work after receiving cART, the study looked at 5,800 ART-naive HIV-infected adults aged younger than 60 years who participated in the SHCS, started treatment from 1998 through 2012, and for whom data on their ability to work were available.

Of 947 patients unable to work at baseline, 46.3% were able to work either full time (n = 310) or part time (n = 129) after 1 year of cART, and that ability was sustained after 5 years of treatment, the researchers found. Predictors of a patient recovering their full ability to work included non-white ethnicity (OR = 2.04; 95% CI, 1.2-3.44), higher level of education (OR = 4.03; 95% CI, 2.47-7.48) and a CD4 cell count of at least 500 cells/mcL at 1 year (OR = 2.53; 95% CI 1.27-5.04). Other predictors were HIV RNA of less than 50 copies/mL at 1 year (OR = 2.06; 95% CI, 1.2-3.54) and starting cART later in the study (OR = 2.11; 95% CI, 1.3-3.44).
According to the researchers, older age (OR = 0.55; 95% CI, 0.42-0.72) and psychiatric disorders (OR = 0.24; 95% CI, 0.13-0.47) were both associated with reduced odds of being able to work.

Recovering the full ability to work after 1 year of treatment increased from 24%, during 1998 to 2001, to 41.2% for 2009 to 2012 (P = .001). However, employment rates did not increase, and employment rates of adults with HIV infection living in high-income countries remained lower than those of the general population, a discrepancy indicating barriers to reintegration, including concerns over a patient’s future health, possible loss of benefits, outdated job skills, side effects of cART, and discrimination, the researchers reported.

The ability of the participants to work was “mainly dependent on achieving viral suppression and beneficial psychosocial factors as well as on the absence of specific comorbidities,” Elzi and colleagues wrote.

They acknowledged limitations in the study, including the reliance on physicians to judge an individual’s ability to work, though they noted that previously available literature was based only on the employment rates of HIV-infected adults. However, they also noted the large study population, the inclusion of a high proportion of women, and the study’s reflection of “real-life scenarios” for HIV-infected individuals, including IV drug use, advanced HIV clinical stage, and patients with comorbidities.

“Our study reflects a better prognosis for individuals with HIV infection who are treated with cART,” Elzi and colleagues wrote. “Further studies will have to address whether specific measures, such as offer of modified work (work accommodation) to sick workers, training of supervisors and communication between employer and health care providers, might support reintegration and increase employment rates of treated HIV-infected persons.”

Background. Limited data exist on HIV-infected individuals’ ability to work after receiving combination antiretroviral therapy (cART). We aimed to investigate predictors of regaining full ability to work at 1 year after starting cART.
Methods. Antiretroviral-naïve HIV-infected individuals <60 years who started cART from January 1998 through December 2012 within the framework of the Swiss HIV Cohort Study (SHCS) were analyzed. Inability to work was defined as a medical judgment of the patient’s ability to work as 0%.
Results. Of 5,800 subjects, 4,382 (75.6%) were fully able to work, 471 (8.1%) able to work part-time, and 947 (16.3%) unable to work at baseline. Of the 947 patients unable to work, 439 (46.3%) were able to work either full-time or part-time at 1 year of treatment. Predictors of recovering full ability to work were non-white ethnicity (odds ratios [OR] 2.06, 95% CI 1.20-3.54), higher education (OR 4.03, 95% CI 2.47-7.48), and achieving HIV-RNA <50 copies/ml (OR 1.83, 95% CI 1.20-2.80). Older age (OR 0.55, 95% CI 0.42-0.72, per 10 years older) and psychiatric disorders (OR 0.24, 95% CI 0.13-0.47) were associated with lower odds of ability to work. Recovering full ability to work at 1 year increased from 24.0% in 1998-2001 to 41.2% in 2009-2012, but the employment rates did not increase.
Conclusions. Regaining full ability to work depends primarily on achieving viral suppression, absence of psychiatric co-morbidity, and favourable psychosocial factors. The discrepancy between patients’ ability to work and employment rates indicates barriers to re-integration of HIV-infected persons.

Full Healio report
Open Forum Infectious Diseases abstract

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