开始接受抗逆转录病毒治疗时的抑郁症状对HIV临床进展和死亡率的影响：对临床实践的启示

The effect of depressive symptoms at ART initiation on HIV clinical progression and mortality: implications in clinical practice.

作者信息

Villes Virginie, Spire Bruno, Lewden Charlotte, Perronne Christian, Besnier Jean-Marc, Garré Michel, Chêne Geneviève, Leport Catherine, Carrieri Maria Patrizia, Le Moings Vincent

机构信息

INSERM U379, Marseilles, France.

出版信息

Antivir Ther. 2007;12(7):1067-74.

PMID:18018765

Abstract

BACKGROUND

Depression is common in HIV-infected patients receiving antiretroviral therapy. However, longitudinal studies addressing the role that depression might play in HIV clinical progression and mortality remain rare. This is especially true for those studies that also consider the possible confounding influence of patient's adherence to treatment.

METHODS

The ANRS CO-8 APROCO-COPILOTE cohort study enrolled 1,281 individuals at the initiation of a protease-inhibitor-containing regimen between 1997 and 1999. Adherence, depressive symptoms and other psychosocial factors were measured using self-administered questionnaires. Predictors of progression to AIDS or death were studied using Cox models.

RESULTS

Out of 1,028 individuals eligible for the present analysis, 92 individuals either died or had an AIDS-defining event during a median follow up of 54 months. At baseline, 377 individuals (41%) reported depressive symptoms and 124 (12%) reported non-adherence at month 4. Depressive symptoms at baseline were associated with progression (hazard ratio [HR] 2.1; P = 0.001). Despite the association between depressive symptoms and nonadherence, depressive symptoms remained a predictor of clinical progression (adjusted HR [aHR] [95% confidence interval (CI)] 1.6 [1.0-2.5]) after adjustment for several factors: initial non-adherence (aHR [95% CI] 2.0 [1.1-3.6]), having a steady partner (aHR [95% CI] 0.5 [0.3-0.7]), older age (aHR [95% CI] 1.40 [1.12-1.74] per 10-year increment), HIV clinical stage C (aHR [95% CI] 2.5 [1.6-4.0]), plasma HIV RNA > or = 100,000 copies/ml (aHR [95% CI] 1.7 [1.1-2.87]) and more than 8 years since HIV diagnosis (aHR [95% CI] 1.8 [1.1-2.8]).

CONCLUSION

Depressive symptoms and non-adherence are independent predictors of HIV clinical progression and mortality. Screening and appropriate treatment of depressive symptoms at antiretroviral treatment initiation should be included in the standard care of HIV-infected patients.

摘要

背景

抑郁症在接受抗逆转录病毒治疗的HIV感染患者中很常见。然而，针对抑郁症在HIV临床进展和死亡率中可能发挥的作用的纵向研究仍然很少。对于那些还考虑患者治疗依从性可能产生的混杂影响的研究来说尤其如此。

方法

ANRS CO-8 APROCO-COPILOTE队列研究在1997年至1999年期间纳入了1281名开始含蛋白酶抑制剂方案治疗的个体。使用自我管理问卷测量依从性、抑郁症状和其他社会心理因素。使用Cox模型研究进展至艾滋病或死亡的预测因素。

结果

在1028名符合本分析条件的个体中，92人在中位随访54个月期间死亡或发生了艾滋病定义事件。基线时，377人（41%）报告有抑郁症状，124人（12%）在第4个月报告不依从。基线时的抑郁症状与进展相关（风险比[HR]2.1；P = 0.001）。尽管抑郁症状与不依从之间存在关联，但在对以下几个因素进行调整后，抑郁症状仍然是临床进展的预测因素（调整后HR[aHR][95%置信区间(CI)]1.6[1.0 - 2.5]）：初始不依从（aHR[95%CI]2.0[1.1 - 3.6]）、有固定伴侣（aHR[95%CI]0.5[0.3 - 0.7]）、年龄较大（每增加10岁aHR[95%CI]1.40[1.12 - 1.74]）、HIV临床分期C（aHR[95%CI]2.5[1.6 - 4.0]）、血浆HIV RNA>或=100,000拷贝/ml（aHR[95%CI]1.7[1.1 - 2.87]）以及HIV诊断后超过8年（aHR[95%CI]1.8[1.1 - 2.8]）。