Rabkin J G, Ferrando S J, Lin S H, Sewell M, McElhiney M
Department of Psychiatry, Weill College of Medicine, Cornell University, Ithaca, NY, USA.
Psychosom Med. 2000 May-Jun;62(3):413-22. doi: 10.1097/00006842-200005000-00015.
The objectives of this study were to evaluate the psychological consequences of combination antiretroviral treatment in terms of mood, hope, and life satisfaction in men with symptomatic human immunodeficiency virus (HIV) infection or acquired immune deficiency syndrome and to compare those whose health improved with those whose health did not improve.
One hundred seventy-three HIV+ gay or bisexual men with symptomatic HIV illness (40% nonwhite) were evaluated semiannually in a university-affiliated research program between July 1995 and December 1997. The primary outcome measures were the Structured Clinical Interview for DSM-IV, Beck Depression Inventory, Endicott Quality of Life Enjoyment and Satisfaction Questionnaire, and Beck Hopelessness Scale.
Psychological distress in this sample was mild to moderate at baseline. During the first 2 years that highly active antiretroviral therapy became widely available, we observed a statistically significant but clinically modest reduction in distress in the sample as a whole, with significant covariates of CD4 cell count, HIV symptoms, and social support in a mixed-effects model. Rates of clinical depression declined. However, this generalized mental health improvement was not related to individual medical improvement of markers of HIV illness progression; those classified as improved were no more likely than those who remained unimproved to report greater declines in measures of distress and hopelessness. Number of self-reported physical symptoms were directly related to distress levels.
A cohort effect was observed, with overall psychological improvement. Physical symptoms were more strongly related to psychological distress than were laboratory markers. Consequently, those whose CD4 cell count and HIV RNA viral load reflected successful treatment were no more likely than others to be relieved of the psychological burdens of illness.
本研究的目的是评估联合抗逆转录病毒治疗对有症状的人类免疫缺陷病毒（HIV）感染或获得性免疫缺陷综合征男性患者在情绪、希望和生活满意度方面的心理影响，并比较健康状况改善者与未改善者的情况。
1995年7月至1997年12月期间，在一个大学附属研究项目中，对173名有症状的HIV阳性同性恋或双性恋男性（40%为非白人）进行了半年一次的评估。主要结局指标包括《精神疾病诊断与统计手册》第四版结构化临床访谈、贝克抑郁量表、恩迪科特生活质量享受与满意度问卷以及贝克绝望量表。
该样本在基线时的心理困扰为轻度至中度。在高效抗逆转录病毒治疗广泛应用的头两年，我们观察到整个样本的困扰在统计学上有显著但临床上适度的降低，在混合效应模型中，CD4细胞计数、HIV症状和社会支持是显著的协变量。临床抑郁症的发生率下降。然而，这种普遍的心理健康改善与HIV疾病进展标志物的个体医学改善无关；被归类为改善的患者在困扰和绝望测量指标上的下降幅度并不比未改善的患者更大。自我报告的身体症状数量与困扰程度直接相关。
观察到一种队列效应，整体心理状况有所改善。身体症状比实验室指标与心理困扰的关系更强。因此，CD4细胞计数和HIV RNA病毒载量反映治疗成功的患者并不比其他人更有可能减轻疾病的心理负担。
