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Silva MR, de Lima Bento J, de Aguiar Oliveira M, Fochat RC, Leite ICG, da Cruz Pereira GM. Cluster-Based Multinomial Logistic Regression Model for Health-Related Quality of Life Among People Living with HIV in Brazil. AIDS Behav 2024; 28:285-299. [PMID: 38087154 DOI: 10.1007/s10461-023-04220-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/30/2023]
Abstract
Improvement in treatment options has increased the survival of people living with HIV (PLHIV). Thus, we evaluated the factors associated with better health-related quality of life (HRQoL) among PLHIV in Brazil. This was a cross-sectional study carried out among 349 PLHIV. Data were collected using an interview-based questionnaire, and HRQoL was assessed by the Brazilian version of the WHOQOL HIV BREF instrument. We used non-hierarchical cluster analysis (K-means) to compile the WHOQOL HIV BREF's overall and domain scores into a unique more multidimensional measure for HRQoL consisting of three clusters: poor, fair and good; associations with clusters of better HRQoL were assessed using multinomial logistic regression models. The mean and median overall HRQoL scores were 15.13 (SD = 3.39) and 16, respectively. The reliability and validity of the Brazilian version of the WHOQOL HIV BREF instrument was confirmed among PLHIV in a non-metropolitan, medium-sized municipality of Brazil, which reaffirmed the cross-cultural validity of this instrument. The factors male sex; heterosexual and asexual orientations; higher individual income; undetectable viral load; absence of any comorbidity and presence of an infectious or a chronic comorbidity, with mental illness as the reference; and never having consumed illegal substances were independently associated with good HRQoL. Thus, the compilation of the WHOQOL HIV BREF's overall and domain scores into a unique multidimensional measure for HRQoL, which this study proposed for the first time, may facilitate more robust interpretations and models of predictors. These differentials could simplify HRQoL as an indicator of health and wellbeing to be routinely used as a key outcome in the clinical management of patients and in the global monitoring of health system responses to HIV.
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Affiliation(s)
- Marcio Roberto Silva
- Postgraduate Program in Collective Health, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-330, Brazil.
- Embrapa Dairy Cattle, Brazilian Agricultural Research Company, Av. Eugênio do Nascimento, 610 - Aeroporto, Juiz de Fora, Minas Gerais, 36038-330, Brazil.
| | - Joseane de Lima Bento
- Postgraduate Program in Collective Health, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-330, Brazil
| | - Marina de Aguiar Oliveira
- Postgraduate Program in Collective Health, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-330, Brazil
- Doctor João Penido Regional Hospital, Hospital Foundation of the State of Minas Gerais, Juiz de Fora, Minas Gerais, 36048-000, Brazil
| | - Romário Costa Fochat
- Postgraduate Program in Collective Health, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-330, Brazil
- Faculty of Pharmacy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-900, Brazil
| | - Isabel Cristina Gonçalves Leite
- Postgraduate Program in Collective Health, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-330, Brazil
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Rodríguez-Sánchez B, Peña-Longobardo LM, Oliva-Moreno J. The employment situation of people living with HIV: a closer look at the effects of the 2008 economic crisis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:485-497. [PMID: 34477995 DOI: 10.1007/s10198-021-01372-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
This study aims to assess the determinants of employment probabilities among people living with Human Immunodeficiency Virus (HIV) during a 15-year period (2001-2016) in Spain, focusing on the possible effects of occurrences such as the 2008 economic crisis. The probability of people living with HIV having a job was evaluated by applying several multivariate probit regression models. Differences between the employment status of people living with HIV and that of the general population were evaluated by applying genetic matching regression models. With respect to the former evaluation, for people living with HIV, the period before the crisis (2001-2007) was associated with a probability of being employed that was 2.43 percentage points (p.p.) higher than during the crisis, and the period after the crisis (2014-2016) with a probability that was 7.58 p.p. lower than during the crisis. Greater effects were also observed among males, the probability of being in employment before the economic crisis being higher (by 2.26 p.p.) and lower after the crisis (- 3.41 p.p.) than among women, and among those infected through drug use (6.18 p.p. and - 7.34 p.p. before and after the crisis, respectively), than among those infected through sex. When analysing the differences with respect to the general population, people living with HIV reported lower probabilities of being employed: by - 18 p.p. before the crisis, by - 15 p.p. during the crisis (years 2008-2013) and by - 10 p.p. after the crisis, implying a convergence in the prospects of employment with the passage of the years. Those differences were greater for people of basic educational level (- 23 to - 16 p.p.), a weaker immune system (- 34 p.p. to - 21 p.p.) and those infected through the use of drugs (- 31 p.p. to - 26 p.p.). Although the results suggest that the economic crisis had a greater effect on the employment prospects of people living with HIV, and that effect is still felt by that group, our findings also point towards a convergence of their employment prospects with those of the general population, over the 15-year period assessed. An analysis of the employment situation of people living with HIV might have helped when designing job-seeking methods and policies on the working environment, especially through the 15-year period considered, when the economic crisis had a greater effect on the job market.
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Affiliation(s)
- Beatriz Rodríguez-Sánchez
- Faculty of Communication and Humanities, University Camilo José Cela, Urb. Villafranca del Castillo, Calle Castillo de Alarcón, 49Villanueva de la Cañada, 28692, Madrid, Spain.
| | - Luz María Peña-Longobardo
- Faculty of Law and Social Sciences, Economic Analysis and Finances Department, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
| | - Juan Oliva-Moreno
- Faculty of Law and Social Sciences, Economic Analysis and Finances Department, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
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McElhiney MC, Rabkin JG, Wainberg ML, Finkel MR, Scodes J. Comparison of counseling methods to promote employment for HIV+ ADULTS. Work 2021; 69:981-995. [PMID: 34219692 DOI: 10.3233/wor-213529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite improved health and during a strong job market (pre-COVID-19), a substantial proportion of HIV+ adults remained unemployed. This study sought to provide time-limited counseling to promote employment goals. OBJECTIVE To determine whether behavioral activation (BA) or supportive counseling (SC), would be more effective in promoting vocational goals (full or part-time, paid or volunteer). METHODS The study included two groups: those with clinically significant fatigue, who were first treated with armodafinil. Once their fatigue diminished, they were enrolled in the counseling program. Those without fatigue were enrolled directly. Both BA and SC interventions were manualized, consisting of eight individual sessions plus a follow-up. RESULTS 116 participants entered counseling, including 87 assigned to BA and 29 to SC. Of these, 79 completed counseling or found a job by session eight. By follow-up, 51%of BA versus 41%of SC participants had found jobs, a non-significant difference either clinically or statistically. CONCLUSIONS Multiple issues contributed to difficulty in employment, including gaps in resumes, loss of contact with former colleagues, and uncertainty about career direction. Ongoing barriers included substance use, housing instability, ambivalence about forfeiting government benefits, as well as inadequately treated depression. Success in employment for about half of participants is, in this context, a reasonable outcome.
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Affiliation(s)
- Martin C McElhiney
- Department of Mood, Anxiety, Eating and Related Disorders New York State Psychiatric Institute New York, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA
| | - Judith G Rabkin
- Department of Mood, Anxiety, Eating and Related Disorders New York State Psychiatric Institute New York, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA
| | - Milton L Wainberg
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA.,Department of Translational Epidemiology New York State Psychiatric Institute New York, NY, USA
| | - Madeline R Finkel
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA
| | - Jennifer Scodes
- Department of Mental Health Data Science New York State Psychiatric Institute New York, NY, USA
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Carlander C, Wagner P, Yilmaz A, Sparén P, Svedhem V. Employment by HIV status, mode of HIV transmission and migrant status: a nation-wide population-based study. AIDS 2021; 35:115-123. [PMID: 33048876 DOI: 10.1097/qad.0000000000002724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare employment in people by HIV status, mode of HIV transmission and migrant status. DESIGN Nation-wide population-based register data from 1996 to 2016. METHODS All people born between 1940 and 2000 (n = 8587 629) were identified from the Swedish Total Population Register and linked to the Swedish National HIV Register (n = 9492) and Longitudinal Integration Database for Health Insurance and Labour Market Studies. Adjusted prevalence ratios (adjPR) of employment were calculated using Poisson regression. Trends in employment were illustrated in scatterplots with overlaid prediction plots. RESULTS People with HIV were less likely employed than HIV-negative but with decreasing difference over time [adjPR 0.57, 95% confidence interval (CI) 0.54-0.60 in 1996, adjPR 0.84, 95% CI 0.83-0.86 in 2016]. Female migrants with HIV had the highest increase of employment over time and were more likely employed than HIV-negative female migrants by end of follow-up (adjPR 1.12, 95% CI 1.08-1.16). Swedish-born with present/former intravenous drug use had the lowest employment rates. Individuals with undetectable HIV-RNA viral levels showed higher employment rates (adjPR 1.29, 95% CI 1.20-1.38) compared with those with detectable viral levels. CONCLUSION Employment in people living with HIV (PLWH) increased over time but remained lower than for HIV-negative people. HIV was not associated with lower employment in migrants by end of follow-up, indicating that HIV is not a barrier for employment among migrants in Sweden. The heterogeneity of PLWH needs to be taken into account in interventions, and future studies, focusing on access to the labour market in PLWH.
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Affiliation(s)
- Christina Carlander
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm
- Centre for Clinical Research, County of Västmanland, Uppsala University, Västerås
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
| | - Philippe Wagner
- Centre for Clinical Research, County of Västmanland, Uppsala University, Västerås
| | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
| | - Veronica Svedhem
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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Ware D, Rueda S, Plankey M, Surkan P, Okafor CN, Teplin L, Friedman MR. The longitudinal impact of employment, retirement and disability status on depressive symptoms among men living with HIV in the Multicenter AIDS Cohort Study. PLoS One 2020; 15:e0239291. [PMID: 33007781 PMCID: PMC7532049 DOI: 10.1371/journal.pone.0239291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/02/2020] [Indexed: 01/21/2023] Open
Abstract
Many persons living with HIV (PLWH) either reduced their employment capacity or stopped work completely due to disease progression. With the advent of effective antiretroviral therapy, some PLWH were able to return to the workforce and many are now transitioning into retirement. We examined the histories of employment, retirement and disability status on depression among 1,497 Participants living with HIV from 1997 to 2015 in the Multicenter AIDS Cohort Study. Data were collected on depressive symptoms, employment, retirement, disability status as well as HIV-related and sociodemographic characteristics. Employment, retirement and disability status were lagged 2 years to assess whether the risk of depression at a given observation were temporally predicted by each respective status, adjusting for prior depressive symptoms and covariates. Being employed (aOR: 0.76; 95% CI: 0.71-0.82) had lower odds of depression risk two years later compared to those unemployed. There were higher odds of depression risk associated with disability (aOR: 1.43; 95% CI: 1.32-1.54) versus those not on disability. Retirement status was not associated with the risk of depressive symptoms. These findings could help inform policies and employment programs to facilitate the return to work for PLWH who are willing and able to work.
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Affiliation(s)
- Deanna Ware
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, United States of America
| | - Sergio Rueda
- Department of Psychiatry, Institute of Medical Science, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Michael Plankey
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, United States of America
| | - Pamela Surkan
- Johns Hopkins Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland, United States of America
| | - Chukwuemeka N. Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, United States of America
| | - Linda Teplin
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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McElhiney MC, Rabkin JG, Daughters SB, Timperlake EC, Wainberg ML. Returning to work after fatigue treatment and counseling in HIV/AIDS. Work 2020; 64:843-852. [PMID: 31815724 DOI: 10.3233/wor-193046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Employment rates for people with HIV/AIDS are low, compared to the general population. One widespread barrier is fatigue, accompanied by daytime sleepiness and a lack of stamina. Previous pharmacological studies have demonstrated improvement of fatigue-related symptoms without affecting work-related goal attainmentOBJECTIVE:In this pilot study, we sought to determine whether a pharmacologic-behavioral two-phase combined approach could facilitate returning to work. METHODS HIV+ participants with fatigue were treated with armodafinil. If energy improved, 8 sessions of biweekly manualized Behavioral Activation (BA) counseling were added to medication maintenance. Outcome was assessed on a 3-point scale along with clinician and self-ratings. RESULTS Of the 46 participants enrolled in BA, 15 (33%) did not complete all 8 sessions: 6 got jobs so they no longer needed counseling; 4 did not like BA, and 5 dropped out for reasons such as moving away or substance use relapse. Of the 46, 29 (63%) attained their vocational goal and showed significant changes on self-report scales. CONCLUSIONS Our integrated treatment including armodafinil plus BA counseling significantly increased the success of achieving work-related goals. The two-phase medication plus counseling program was well-tolerated by participants and the manualized BA counseling was readily applied by counselors without advanced mental health training, making the method potentially feasible in community settings.
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Affiliation(s)
- Martin C McElhiney
- Department of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Judith G Rabkin
- Department of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Milton L Wainberg
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.,Department of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
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Kusejko K, Marzel A, Nguyen H, Chaudron SE, Bachmann N, Weber R, Bruggmann P, Roth JA, Bernasconi E, Calmy A, Cavassini M, Bregenzer A, Böni J, Yerly S, Klimkait T, Perreau M, Walti LN, Günthard HF, Kouyos RD. Differences in social and mental well-being of long-term survivors among people who inject drugs and other participants in the Swiss HIV Cohort Study: 1980-2018. Antivir Ther 2020; 25:43-54. [PMID: 32235037 DOI: 10.3851/imp3347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND People living with HIV who were diagnosed before highly active antiretroviral therapy became available in 1996 and who survived at least 15 years after HIV diagnosis, termed long-term survivors (LTS), form a particularly vulnerable population. We study social, clinical and mental factors of LTS in the Swiss HIV Cohort Study, with a particular focus on people who inject drugs (PWID). METHODS We quantified differences between PWID LTS, and men who have sex with men (MSM) and heterosexual (HET) LTS. Using phylogenetic methods, we distinguished between heterosexual LTS who most likely shared a social network with PWID at the time of infection, termed clusteredHET, and those who did not, termed HET not clustered (HETnc). The analysis was performed using data collected at least 15 years post diagnosis. RESULTS Overall, 1,663 of 5,686 (29.2%) PWID were LTS. We found significant differences between PWID LTS and MSM/HETnc LTS regarding self-reported depression (59.4% versus 43.3%; odds ratio [OR]=1.8; P<0.001), incarceration (30.6% versus 7.0%; OR=6.9; P<0.001) and full work ability (25.4% versus 59.0%; OR=0.27; P<0.001). ClusteredHET were less vulnerable with respect to these variables than PWID LTS but more at risk compared with MSM/HETnc LTS, indicating that clusteredHET are closer to PWID with regard to social and mental aspects compared with all MSM/HETnc. CONCLUSIONS Even more than 15 years post HIV diagnosis, special care for HIV-positive PWID is needed, with emphasis on mental health and social integration of PWID LTS.
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Affiliation(s)
- Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Alex Marzel
- Department of Teaching, Research and Development, Schulthess Clinic, Zurich, Switzerland
| | - Huyen Nguyen
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Sandra E Chaudron
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Nadine Bachmann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Jan A Roth
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Alexandra Calmy
- Laboratory of Virology and Division of Infectious Diseases, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrea Bregenzer
- Division of Infectious Diseases, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Jürg Böni
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Sabine Yerly
- Laboratory of Virology and Division of Infectious Diseases, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Thomas Klimkait
- Molecular Virology, Department of Biomedicine-Petersplatz, University of Basel, Basel, Switzerland
| | - Matthieu Perreau
- Division of Immunology and Allergy, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Laura N Walti
- Clinic for Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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8
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Ghoneim FM, Raouf MM, Elshaer NS, Abdelhamid SM, Noor Eldeen RA. Study of Patterns and Markers of Human Immune Deficiency Virus -1 (HIV-1) Progression and Unemployment Rate among Patients from Alexandria, Egypt. Pol J Microbiol 2019; 66:519-527. [PMID: 29319511 DOI: 10.5604/01.3001.0010.7044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Middle East and North Africa (MENA) new HIV cases show the highest increase among all regions in the world. Even though Egypt has a low prevalence among the general population (< 0.02%), a national HIV epidemic occurs in certain population risk groups. The current study was conducted to asses clinical and immunological disease progression; following up viral load (VL) and detecting delta-32 CCR5 genotype polymorphism in selected cases, determining unemployment rate and identify predictors of employment for HIV-cases. A cross sectional design was adopted. HIV infected cases attending Alexandria Fever Hospital (AFH) for one year. Interview questionnaire and four CD+4 counts were done for all patients, HIV VL and delta-32 CCR5 polymorphism were done for selected cases. Sexual transmission and drug abuse are the most important risk factors. Infectious comorbidity increases the rate of HIV progression. CD4+ count at the end of the study; CD+4 (4), count was significantly higher than all other CD4+ readings among the whole cohort and among the treated group. Also, VL at the end of the study; VL(2), was significantly higher than VL(1) among the untreated group. Unemployment rate was 40%. Male gender and obtaining vocational training were significant predictors of employment. It can be concluded that having a family member living with HIV and drug abusers are high risk groups for HIV acquisition. Factors responsible for progression of HIV should be further investigated. Antiretroviral therapy is very effective in checking HIV replication rate, delaying the progression of HIV, reconstituting the immune response and should be available for all cases detected.
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Affiliation(s)
- Faika M Ghoneim
- Microbiology Department, Faculty of Medicine, Alexandria University, Egypt
| | - May M Raouf
- Microbiology Department, Faculty of Medicine, Alexandria University, Egypt
| | - Noha S Elshaer
- Community Medicine Department, Faculty of Medicine, Alexandria University, Egypt
| | - Sarah M Abdelhamid
- Microbiology Department, Faculty of Pharmacy, Damanhour University, Egypt
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Kordovski VM, Woods SP, Verduzco M, Beltran J. The effects of aging and HIV disease on employment status and functioning. Rehabil Psychol 2018; 62:591-599. [PMID: 29265874 DOI: 10.1037/rep0000175] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE As the prevalence of older adults living with HIV disease increases, questions are emerging regarding the extent to which older age amplifies the adverse effects of HIV on employment status and functioning. This cross-sectional study sought to (1) investigate the combined effects of HIV and older age on employment status, (2) identify clinicodemographic correlates of employment status among older HIV+ persons, and (3) examine the combined effects of HIV and age on workplace performance among employed participants. METHOD The sample was 358 HIV+ (163 older, 195 younger) and 193 HIV- (94 older, 99 younger) adults, who completed a comprehensive neurocognitive research assessment that included measures of employment status and current workplace functioning. RESULTS We observed main effects of HIV and age on employment status, but no interaction. The older HIV+ sample demonstrated particularly high rates of disability, rather than elective retirement or unemployment. Among older HIV+ adults significant predictors of employment status included age, global neurocognitive functioning, combination antiretroviral therapy status, age at HIV infection, and hepatitis C coinfection. Finally, self-reported work functioning of older HIV+ adults differed only from the younger HIV- group. CONCLUSION Findings suggest that older age and HIV disease have additive adverse effects on employment status, but not work functioning, and that employment status is associated with both neurocognitive and medical risk factors among older HIV+ adults. Further longitudinal research is needed to elucidate specific disease and demographic characteristics that may operate as protective factors for retaining gainful employment among older HIV+ adults. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Jessica Beltran
- Department of Psychiatry, University of California, San Diego
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10
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Johs NA, Wu K, Tassiopoulos K, Koletar SL, Kalayjian RC, Ellis RJ, Taiwo B, Palella FJ, Erlandson KM. Disability Among Middle-Aged and Older Persons With Human Immunodeficiency Virus Infection. Clin Infect Dis 2018; 65:83-91. [PMID: 28369402 DOI: 10.1093/cid/cix253] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/17/2017] [Indexed: 01/03/2023] Open
Abstract
Background Older human immunodeficiency virus (HIV)-infected adults may experience higher rates of frailty and disability than the general population. Improved understanding of the prevalence, risk factors, and types of impairment can better inform providers and the healthcare system. Methods HIV-infected participants within the AIDS Clinical Trials Group A5322 HAILO study self-reported disability by the Lawton-Brody Instrumental Activities of Daily Living (IADL) Questionnaire. Frailty was measured by 4-m walk time, grip strength, self-reported weight loss, exhaustion, and low activity. Logistic regression models identified characteristics associated with any IADL impairment. Agreement between IADL impairment and frailty was assessed using the weighted kappa statistic. Results Of 1015 participants, the median age was 51 years, 15% were aged ≥60 years, 19% were female, 29% black, and 20% Hispanic. At least 1 IADL impairment was reported in 18% of participants, most commonly with housekeeping (48%) and transportation (36%) and least commonly with medication management (5%). In multivariable models, greater disability was significantly associated with neurocognitive impairment, lower education, Medicare/Medicaid insurance (vs private/other coverage), smoking, and low physical activity. Although a greater proportion of frail participants had IADL impairment (52%) compared to non-frail (11%) persons, agreement was poor (weighted kappa <0.18, 95% confidence interval, 0.13, 0.23). Conclusion IADL disability occurs frequently among middle-aged and older HIV-infected adults on effective antiretroviral therapy. Potentially modifiable risk factors (smoking, physical activity) provide targets for interventions to maintain independent living. Systematic recognition of persons at greater risk for disability can facilitate connection to resources that may help preserve independence.
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Affiliation(s)
- Nikolas A Johs
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora
| | - Kunling Wu
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Susan L Koletar
- Department of Internal Medicine, Ohio State University, Columbus
| | - Robert C Kalayjian
- Department of Medicine, MetroHealth and Louis Stokes Cleveland Veterans Administration Medical Center, Ohio
| | - Ronald J Ellis
- Department of Neurosciences, University of California-San Diego
| | - Babafemi Taiwo
- Department of Medicine,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Frank J Palella
- Department of Medicine,Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Peña Longobardo LM, Oliva-Moreno J. Differences in labour participation between people living with HIV and the general population: Results from Spain along the business cycle. PLoS One 2018; 13:e0195735. [PMID: 29684076 PMCID: PMC5912724 DOI: 10.1371/journal.pone.0195735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 03/28/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV/AIDS (Human immunodeficiency virus/Acquired immune deficiency syndrome) not only has a strong impact on the health of the worldwide population but also affects the labour status of HIV-positive people. The primary aim of this paper is to compare the labour participation of people living with HIV (PlwHIV) with the labour participation of the general population along the last business cycle in Spain. METHOD The data used are from the Hospital Survey on HIV-AIDS, with a total sample size of 4,651 PlwHIV and the Labour Force Survey from 2001 to 2010, with a total sample size of 660,674 individuals as general population. Propensity Score Matching method was used to analyse the differences between the labour participation of PlwHIV and the general population. Additionally, several specific models categorised into different subgroups (gender, education, source of infection and level of defences) were also performed. RESULTS We identified a convergence in labour participation across the period in the two populations considered: PlwHIV was 23% less likely to have a job than the general population during 2001-2002 and 14% less likely during 2009-2010. This convergence is mainly explained by two facts: first, the positive evolution of people infected by sex; second, the change in the PlwHIV population composition with a decreasing weight of people infected by drug use throughout the decade. Thereby, at the end of period, there was no statistical difference in the employment rate between PlwHIV infected through sex and the general population but there was strongly difference in PlwHIV infected through drugs. CONCLUSION Inmunological status, source of infection and level of education play a relevant role among the PlwHIV population when comparing their labour participation with the general population. In spite of this positive result, the likelihood of being employed in HIV-positive people continues to be different from that of non-carriers. Our study shows that institutional features of labour markets are relevant and should be considered in comparison between countries.
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Affiliation(s)
- Luz María Peña Longobardo
- Department of Economic Analysis and Finance, Faculty of Law and Social Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Juan Oliva-Moreno
- Department of Economic Analysis and Finance, Faculty of Law and Social Sciences, University of Castilla-La Mancha, Toledo, Spain
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Burch LS, Smith CJ, Anderson J, Sherr L, Rodger AJ, O'Connell R, Geretti AM, Gilson R, Fisher M, Elford J, Jones M, Collins S, Azad Y, Phillips AN, Speakman A, Johnson MA, Lampe FC. Socioeconomic status and treatment outcomes for individuals with HIV on antiretroviral treatment in the UK: cross-sectional and longitudinal analyses. LANCET PUBLIC HEALTH 2016; 1:e26-e36. [PMID: 28299369 PMCID: PMC5341147 DOI: 10.1016/s2468-2667(16)30002-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Few studies have assessed the effect of socioeconomic status on HIV treatment outcomes in settings with universal access to health care. Here we aimed to investigate the association of socioeconomic factors with antiretroviral therapy (ART) non-adherence, virological non-suppression, and virological rebound, in HIV-positive people on ART in the UK. Methods We used data from the Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) questionnaire study, which recruited participants aged 18 years or older with HIV from eight HIV outpatient clinics in the UK between Feb 1, 2011, and Dec 31, 2012. Participants self-completed a confidential questionnaire on sociodemographic, health, and lifestyle issues. In participants on ART, we assessed associations of financial hardship, employment, housing, and education with: self-reported ART non-adherence at the time of the questionnaire; virological non-suppression (viral load >50 copies per mL) at the time of questionnaire in those who started ART at least 6 months ago (cross-sectional analysis); and subsequent virological rebound (viral load >200 copies per mL) in those with initial viral load of 50 copies per mL or lower (longitudinal analysis). Findings Of the 3258 people who completed the questionnaire, 2771 (85%) reported being on ART at the time of the questionnaire, and 2704 with complete data were included. 873 (32%) of 2704 participants reported non-adherence to ART and 219 (9%) of 2405 had virological non-suppression in cross-sectional analysis. Each of the four measures of lower socioeconomic status was strongly associated with non-adherence to ART, and with virological non-suppression (prevalence ratios [PR] adjusted for gender/sexual orientation, age, and ethnic origin: greatest financial hardship vs none 2·4, 95% CI 1·6–3·4; non-employment 2·0, 1·5–2·6; unstable housing vs homeowner 3·0, 1·9–4·6; non-university education 1·6, 1·2–2·2). 139 (8%) of 1740 individuals had subsequent virological rebound (rate=3·6/100 person-years). Low socioeconomic status was predictive of longitudinal rebound risk (adjusted hazard ratio [HR] for greatest financial hardship vs none 2·3, 95% CI 1·4–3·9; non-employment 3·0, 2·1–4·2; unstable housing vs homeowner 3·3, 1·8–6·1; non-university education 1·6, 1·1–2·3). Interpretation Socioeconomic disadvantage was strongly associated with poorer HIV treatment outcomes in this setting with universal health care. Adherence interventions and increased social support for those most at risk should be considered. Funding National Institute for Health Research.
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Affiliation(s)
- Lisa S Burch
- Research Department of Infection and Population Health, University College London, London, UK
| | - Colette J Smith
- Research Department of Infection and Population Health, University College London, London, UK
| | - Jane Anderson
- Centre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Lorraine Sherr
- Research Department of Infection and Population Health, University College London, London, UK
| | - Alison J Rodger
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Anna-Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Richard Gilson
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Jonathan Elford
- School of Health Sciences, City, University of London, London, UK
| | - Martin Jones
- East Sussex Healthcare NHS Trust, Eastbourne, UK
| | | | | | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew Speakman
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Fiona C Lampe
- Research Department of Infection and Population Health, University College London, London, UK
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Neigh GN. Neurobiology of HIV-associated neuropsychiatric and neurocognitive disorders. Neurobiol Dis 2016; 92:113-5. [PMID: 27180942 DOI: 10.1016/j.nbd.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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