Mijch A, Burgess P, Judd F, Grech P, Komiti A, Hoy J, Lloyd J H, Gibbie T, Street A
Victorian HIV Psychiatry Consortium, Melbourne, Australia.
HIV Med. 2006 May;7(4):205-12. doi: 10.1111/j.1468-1293.2006.00359.x.
The aims of the study were to describe the prevalence and associations of mental health disorder (MHD) among a cohort of HIV-infected patients attending the Victorian HIV/AIDS Service between 1984 and 2000, and to examine whether antiretroviral therapy use or mortality was influenced by MHD (defined as a record of service provision by psychiatric services on the Victorian Psychiatric Case Register). It was hypothesized that HIV-positive individuals with MHD would have poorer treatment outcomes, reduced responses to highly active antiretroviral therapy (HAART) and increased mortality compared with those without MHD.
This is a retrospective cohort of 2981 individuals (73% of the Victorian population diagnosed with HIV infection) captured on an HIV database which was electronically matched with the public Victorian Psychiatric Case Register (VPCR) (accounting for 95% of public system psychiatry service provision). The prevalence, dates and recorded specifics of mental health disorders at the time of the electronic match on 1 June 2000 are described. The association with recorded MHD, gender, age, AIDS illness, HIV exposure category, duration and type of antiviral therapy, treatment era (prior to 1986, post-1987 and pre-HAART, and post-HAART) on hospitalization and mortality at 1 September 2001 was assessed.
Five hundred and twenty-five individuals (17.6% of the Victorian HIV-positive population) were recorded with MHD, most frequently coded as attributable to substance dependence/abuse or affective disorder. MHD was diagnosed prior to HIV in 33% and, of those diagnosed after HIV, 93.8% were recorded more than 1 year after the HIV diagnosis. Schizophrenia was recorded in 6% of the population with MHD. Hospitalizations for both psychiatric and nonpsychiatric illness were more frequent in those with MHD (relative risk 5.4; 95% confidence interval 3.7, 8.2). The total number of antiretrovirals used (median 6.4 agents vs 5.5 agents) was greater in those with MHD. When adjusted for antiretroviral treatment era, HIV exposure category, CD4 cell count and antiretroviral therapy, survival was not affected by MHD.
MHD is frequent in this population with HIV infection and is associated with increased healthcare utilization but not with reduced survival.
本研究旨在描述1984年至2000年间在维多利亚州艾滋病毒/艾滋病服务机构就诊的一组艾滋病毒感染患者中精神健康障碍（MHD）的患病率及其相关性，并研究MHD（定义为维多利亚州精神科病例登记册上的精神科服务提供记录）是否会影响抗逆转录病毒治疗的使用或死亡率。研究假设，与没有MHD的艾滋病毒阳性个体相比，患有MHD的个体治疗效果更差，对高效抗逆转录病毒疗法（HAART）的反应降低，死亡率增加。
这是一个回顾性队列研究，纳入了2981名个体（占维多利亚州诊断为艾滋病毒感染人群的73%），这些个体的数据记录在一个艾滋病毒数据库中，并与维多利亚州公共精神科病例登记册（VPCR）进行电子匹配（占公共系统精神科服务提供量的95%）。描述了2000年6月1日电子匹配时精神健康障碍的患病率、日期和记录的详细信息。评估了记录的MHD与性别、年龄、艾滋病疾病、艾滋病毒暴露类别、抗病毒治疗的持续时间和类型、治疗时代（1986年之前、1987年之后和HAART之前以及HAART之后）与2001年9月1日住院率和死亡率之间的关联。
525名个体（占维多利亚州艾滋病毒阳性人群的17.6%）被记录患有MHD，最常见的编码归因于物质依赖/滥用或情感障碍。33%的MHD在艾滋病毒感染之前被诊断出来，在艾滋病毒感染之后被诊断出的患者中，93.8%是在艾滋病毒诊断后1年以上被记录的。患有MHD的人群中6%被记录患有精神分裂症。患有MHD的患者因精神疾病和非精神疾病住院的频率更高（相对风险5.4；95%置信区间3.7，8.2）。患有MHD的患者使用的抗逆转录病毒药物总数更多（中位数为6.4种药物，而无MHD者为5.5种药物）。在调整了抗逆转录病毒治疗时代、艾滋病毒暴露类别、CD4细胞计数和抗逆转录病毒治疗后，MHD对生存没有影响。
在这组艾滋病毒感染人群中，MHD很常见，并且与医疗保健利用率增加相关，但与生存率降低无关。
