OBJECTIVES While the life expectancy of timely antiretrovirally treated HIV infected adults converges to that of the general population, there are still imbalances with regard to the labor market [Worthington et al. (2011); Dray-Spira et al. (2008); Rabkin et al. (2004); Goldman, Bao (2004)]. Previous studies of a French cohort find that unemployment of HIV patients is significantly related to health related factors such as the number of CD4 cells [Dray-Spira et al. (2007); Dray-Spira et al. (2005)].Based on data of a German cohort we aim to analyze drivers of unemployment of HIV infected individuals receiving antiretroviral therapy in specialized centers in Germany.  METHODS We prospectively surveyed 656 HIV patients in the age of 18-60 over two years and collected data on potential factors that influence the propensity of unemployment (e.g. age, educational background, and disease related factors). By means of a logistic regression we identify significant determinants of unemployment.  RESULTS The unemployment rate within our sample is 29.9% which is much higher than the overall German unemployment rate of 6.6%. A poor level of education, concomitant mental diseases, and most of all advanced stage of HIV disease significantly determine the likelihood of being unemployed. Even controlling for other determinants of unemployment, moving from CDC stage A to CDC stage C increases the probability of unemployment by 180%.   CONCLUSIONS We confirm the results of earlier studies that health related factors among HIV patients significantly affects the probability of being unemployed. Specifically, the stage of HIV disease seems to be a good predictor of unemployment. From a health economic point of view, earlier start of antiretroviral treatment and deceleration of disease progression is not only beneficial for the patient but also for the economy as a whole.