Background: 

With HIV now considered a chronic disease, economic burden for people living with HIV (LWH) may threaten long-term disease outcomes. We studied associations between economic burden (employment, income, insurance, and financial difficulty) and HIV status for gay, bisexual, and other men who have sex with men (GBMSM) and how economic burden relates to disease progression.

Setting: 

We analyzed data collected every 6 months through 2015 from GBMSM LWH and GBMSM living without HIV from 2 waves (2001–2003 cohort and 2010+ new recruit cohort) of the Multicenter AIDS Cohort Study.

Methods: 

Using generalized estimating equations, we first assessed the association between HIV status (exposure) and economic burden indicators since the last study visit (outcomes) of employment (working/student/retired versus not currently working), personal annual income of ≥$10,000, insurance (public/private versus none), and financial difficulty meeting basic expenses. Then among people LWH, we assessed the relationships between economic burden indicators (exposures), risk of progressive immune suppression (CD4 ≤500 cells/uL), and progression to AIDS (CD4 ≤200; outcomes).

Results: 

Of 1721 participants, 59.5% were LWH (n = 1024). GBMSM LWH were 12% less likely to be employed, 16% more likely to have health insurance, and 9% more likely to experience financial difficulty than GBMSM living without HIV. Among GBMSM LWH, employment was associated with a 6% and 32% lower likelihood of immune suppression or progression to AIDS, respectively, and the income was associated with a 15% lower likelihood of progression to AIDS.

Conclusions: 

Interventions that stabilize employment, income, and offer insurance support may enrich GBMSM LWH's ability to prevent disease progression.

中文翻译：

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在多中心艾滋病队列研究中，男同性恋、双性恋和其他与艾滋病毒携带者或未感染艾滋病毒的男性发生性关系的男性的经济负担

背景： 

由于HIV现在被认为是一种慢性疾病，HIV 感染者( LWH) 的经济负担可能会威胁到长期的疾病结局。我们研究了同性恋、双性恋和其他男男性行为者 (GBMSM) 的经济负担（就业、收入、保险和经济困难）与HIV 感染状况之间的关联，以及经济负担与疾病进展的关系。

环境： 

我们分析了截至 2015 年每 6 个月从多中心 AIDS 队列研究的 2 波（2001-2003 年队列和 2010 年以上新招募队列）的GBMSM LWH 和未感染 HIV的 GBMSM 收集的数据。

方法： 

使用广义估计方程，我们首先评估了自上次研究访问（结果）就业（工作/学生/退休与当前不工作）、个人年收入≥10,000美元、保险（公共/私人与无），以及满足基本开支的财务困难。然后，在 LWH 人群中，我们评估了经济负担指标（暴露）、进行性免疫抑制风险（CD4 ≤500 个细胞/uL）和进展为 AIDS（CD4 ≤200；结果）之间的关系。

结果： 

在 1721 名参与者中，59.5% 为 LWH（n = 1024）。与未感染 HIV的 GBMSM 相比，GBMSM LWH 的就业可能性降低了 12%，拥有健康保险的可能性增加了 16% ，遇到经济困难的可能性增加了 9% 。在 GBMSM LWH 中，就业与免疫抑制或进展为 AIDS 的可能性分别降低 6% 和 32%相关，收入与进展为 AIDS 的可能性降低 15% 相关。

结论： 

稳定就业、收入和提供保险支持的干预措施可能会增强 GBMSM LWH 预防疾病进展的能力。