Trabalho, sono e bem-estar associados à evolução clínica de pessoas vivendo com HIV

Abstract

Introduction: With the advent of antiretroviral therapy (ART), HIV infection has assumed characteristics of a chronic disease. However, despite advances achieved, people living with HIV (PLWHIV) have high prevalences of sleep and psychiatric disorders, which directly interfere with the reconstitution of the immune system. The environment and work organization can also influence the clinical evolution of workers living with HIV, once that work is considered a social determinant of health conditions. Objective: To evaluate the association between work, sleep and subjective well-being aspects with the clinical evolution of PLWHIV in clinical follow-up by the Specialized Care Service (SCC) in the city of Santos (SP). Methods: A cross-sectional epidemiological study was performed with 115 workers living with HIV, including 97 day workers and 18 night workers. The instrument for data collection was applied as an interview at the SCC. Biochemical indicators (viral load quantification, CD4 T lymphocyte count and CD4/CD8 ratio) were obtained through the CD4/CD8 and Viral Load Testing System (Siscel). Generalized linear models (GLM) with LSD post-hoc were performed to compare the means of the clinical evolution indicators according to the aspects of work, sleep and subjective well-being. The following adjustment variables were used: gender, age, time of HIV diagnosis, time of ART, use of efavirenz (whose adverse effects may be confused with symptoms of depression), use of psychoactive substances (sleep medications and illicit drugs), mild emotional disturbance and severe emotional disturbance. Significance level of 5% was adopted in all tests. Results: The sample had mean age of 43 years (SD=10.3 years) and was composed mainly of male subjects (54.8% sex and 49.6% gender, respectively), single (71.3%) and complete secondary education (51.3%). The majority was under an informal work regime (53.5%) and classified as having good work capacity (57%). On working days, there was a higher prevalence of poor sleep quality (52.2%). There was a high prevalence of insomnia symptoms (78.6%) and 37.4% of the sample were classified with low level of subjective well-being. The median time of diagnosis was nine years (AIQ = 4-17 years) and median time of ART was seven years (AIQ = 1-12 years). The majority had undetectable viral load (75.9%), CD4 T lymphocyte count ¿200 cells/mm³ (89.4%) and CD4/CD8 ratio <1 (71.7%). There was a significant association between subjective well-being and viral load (p<0.01), as well as CD4 T lymphocyte counts with need for recovery after work (GLM p=0.04, post-hoc p=0.02) and CD4/CD8 ratio with need for recovery after work (GLM p=0.04, post-hoc p=0.03). There was a borderline association between CD4 T lymphocyte count and work shift (p = 0.05). Conclusion: Low levels of subjective well-being seem to be associated with increased viral load. Furthermore, night workers have lower CD4/CD8 ratio, while those with higher fatigue have higher CD4 count. However, work capacity, sleep quality and insomnia symptoms do not influence the indicators of the clinical evolution of PLWHIV.