Impact of HIV diagnosis on job separation in Japanese employed men: a retrospective matched cohort study using an administrative claims database

People living with HIV (PLWH) have been reported to have higher unemployment rates than the general population. However, most previous studies were cross-sectional and lacked appropriate controls. To assess the impact of HIV diagnosis on job separation, we conducted a retrospective matched cohort study using a Japanese claims database of employed men. We conducted a retrospective matched cohort study of newly diagnosed male PLWH and non-PLWH controls using a Japanese administrative claims database mainly covering employees of larger enterprises. PLWH were matched 1:5 with controls based on age, dependent family status, psychiatric history, cancer history, and insurance enrollment month/year. The primary outcome was job separation within three years from diagnosis. For subgroup analyses, PLWH were stratified by prescriptions for Pneumocystis jirovecii pneumonia (PJP) prophylaxis or treatment as a proxy for CD4 count < 200 cells/µL. A total of 1,031 newly diagnosed male PLWH and 5,155 matched controls were included. Overall, the PLWH group had a higher risk of job separation than the control group (three-year incidence: 36.8% vs. 31.4%; HR 1.17, 95% CI: 1.05–1.31, p = 0.005). However, the higher CD4 count group (n = 776) showed no significant difference from their controls (37.7% vs. 34.3%; HR 1.07, 95% CI: 0.94–1.21, p = 0.30). In contrast, the lower CD4 count group (n = 255) had a significantly higher risk (33.6% vs. 22.5%; HR 1.69, 95% CI: 1.34–2.14, p < 0.001). An HIV diagnosis was associated with increased job separation risk overall. However, using background-matched controls, the higher CD4 count group showed no increased risk. This suggests that HIV diagnosis itself may not increase the risk of job separation among individuals diagnosed at an early stage.