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Lack of Employment and the Absence of a Stable Partnership Are Independent
Risk Factors for Hospitalization or Death among HIV Patients on
HAART
In
the HAART era, in economically-advanced western nations, HIV infection
has become a condition in which non-specific morbidity has
played an increasing role in the overall morbidity
and mortality of people with chronic
HIV disease. The health status of HIV patients increasingly
is influenced by factors such as adherence, co-morbidity,
and level of social support.
Despite
the effectiveness of anti-HIV therapy, HIV patients are at considerable
risk for hospitalization, which French researchers recently have
determined is significantly impacted by the patients’ socio-economic
situation. Their study results, published in the current issue of
JAIDS (October 1, 2005), demonstrates that socio-economic
factors, such as not having a stable relationship and lack of a
permanent job, are risk factors for hospitalization or death much earlier
in the course of HIV infection than would be expected.
“In
France, write the study authors, “access to care for HIV infection
is universal. In the HAART era, HIV infection has been mostly managed
through outpatient clinics, and inpatient admissions have been limited
to the most serious cases. Thus, the indicator constituted by all-cause
hospitalization or death is likely to represent a valid marker of
HIV-infected patients' global health deterioration.”
The
aim of this study was to estimate the independent association between
socio-economic situation and the risk of all-cause hospitalization
or death during the course of HIV in the HAART era.
Patients in the French PRIMO multicenter
prospective cohort of 319 individuals were enrolled during primary
HIV-1 infection between 1996 and 2002. Associations between social
characteristics (ie, employment status, stable partnership) and
the risk of hospitalization or death were assessed using generalized
estimating equations.
Results
During a median follow-up of 2.5 years,
109 hospitalizations among 84 patients (26.3%) and 3 deaths occurred.
Even after adjustment for classic determinants
of HIV-infected patients' health status, social characteristics
were independently associated with the risk of hospitalization or
death, with a significantly increased risk for patients with temporary
employment compared with those with stable employment and for patients
without a stable partnership compared with those with a stable partnership.
The authors conclude, “In the era of
HAART, adverse social conditions constitute independent risk factors
of hospitalization or death during the course of HIV disease.”
Discussion
Overall,
greater than 25 percent of the study participants were hospitalized
at least once during a median follow-up period of 2.5 years,. This
rate seems unusually high in a population of young, recently HIV-infected,
non hepatitis C coinfected, HAART-treated patients. “The persisting
high risk of inpatient admission in the HAART era reported among
ethnic minorities and injection drug users
therefore also seems to occur among more socially privileged patients,”
note the authors.
At
21.3 percent, the number of hospital admissions determined by mental
disorders was also high. The result indicating that
the risk of hospitalization or death is higher during the first
year of follow-up compared with the later period was unexpected.
“As suggested by sociologic studies, the biographical disruption
consecutive to a diagnosis of chronic illness may lead to a period
of increased social and health vulnerability,” according to the
researchers.
“In
conclusion,” write the authors, “in the era of HAART, the risk of
hospitalization is high from the first months of HIV disease. Early
psychologic support should seek to prevent a portion of these hospitalizations
occurring at the early stages of the disease.”
“Adverse
social conditions, namely, temporary employment and the absence
of a stable partnership, constitute independent risk factors of
poor health status as defined by all-cause hospitalization or death
among HIV-infected patients.”
“Further
studies with more detailed data on patients' living conditions should
provide a better understanding of the mechanisms of such social
health inequalities in this specific context.”
10/05/05
Reference
R
Dray-Spira and others (for the the PRIMO Cohort Study Group). Temporary Employment, Absence of Stable
Partnership, and Risk of Hospitalization or Death during the Course
of HIV Infection. Journal of Acquired Immune Deficiency
Syndromes 40(2):190-197, October 1, 2005.
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