The economic benefits of high CD4 counts among people living with HIV/AIDS in Zambia

Background: The economic effects of poor immunologic recovery among HIV-infected patients receiving antiretroviral therapy (ART) in sub-Saharan Africa are not well understood. We examined the relationship between the CD4 counts of patients on long-term ARTand employment outcomes in HIV-affected households in Lusaka, Zambia. Methods: Administrative data and a household survey captured information on the clinical records, demographics and employment outcomes of the ART-treated adults and their adult family members (n = 311). Multivariable regression analyses were used to assess relationships between CD4 counts of ART-treated adults and household employment outcomes. Results: Patients with a CD4 count of at least 350 cells/μl were 22 percentage points more likely to be engaged in the labor force (P < 0.05) and worked ∼6 more days per month (P < 0.05) and 9 more hours per week (P = 0.05) compared with patients with a CD4 count <350 cells/μl. Non-patient adults in the HIV-affected household had significantly higher labor participation if the patient's CD4 count was ≥500 compared with <500 cells/μl (P < 0.05), but this was not significant for a CD4 ≥350 versus <350. Conclusion: These findings suggest that interventions to improve or maintain robust immune recovery during ART may confer economic benefits for both HIV-infected individuals and HIV-affected households.