HIV people with high CD4 counts could work more hours per week

In a first-of-its-kind health campaign in Uganda, researchers from the University of North Carolina at Chapel Hill show that adults with HIV who had less severe infections could work more hours per week, and their children were more likely to be enrolled in school.

The finding, led by Harsha Thirumurthy, Ph.D., a health economist at UNC's Gillings School of Global Public Health, not only could mean greater earning potential for people with HIV, but also a better economic outlook for entire regions-results that underscore the potential value of testing for HIV widely and starting treatment early.

Thirumurthy and colleagues conducted a community health campaign in which 3,000 adults in a rural region of Uganda were tested for HIV. For those who were infected with the virus, Thirumurthy and his team looked at specialized immune cells that the virus co-opts and uses to replicate. They found that people with HIV who had high levels of these cells, called CD4 cells, could work nearly one week more per month and 30 percent more hours per day than those with low CD4 counts. Furthermore, their children had school enrollment rates that were 15 percent higher than the children of people with low CD4 counts.

"When one member of the family is ill, that member works fewer hours in a given week," said Thirumurthy, who presented the results at the XIX International AIDS Conference in Washington, D.C., last week. "As a result of that lost labor, other members of the family may have to pitch in and help, which often means that children in the household between the ages of 12 and 18 will be called upon to spend more time at home and miss out on school."

For these children, missing school during these critical years could, in turn, reduce their earning potential in the future.

The community-based finding-part of a larger study called the Sustainable East Africa Research in Community Health (SEARCH) Collaboration led by researchers from Makerere University and the University of California, San Francisco-builds upon a comprehensive public health strategy known as 'test and treat,' an approach that involves universal testing, linkage to care and early treatment. SEARCH aims to demonstrate that this same approach could be used effectively in the poorest parts of sub-Saharan Africa, where 60 percent of all the people infected with HIV worldwide reside.

"Mounting evidence shows that early HIV treatment keeps people healthier and reduces the spread of HIV within the community," said Thirumurthy. "This study offers the hope that early treatment will also forestall any negative economic impacts that reduced CD4 counts may have on employment and education, thereby enabling people in HIV-affected communities to live healthy and productive lives."