Chander Geetanjali, Himelhoch Seth, Fleishman John A, Hellinger James, Gaist Paul, Moore Richard D, Gebo Kelly A
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
AIDS Care. 2009 May;21(5):655-63. doi: 10.1080/09540120802459762.
Mental illness (MI) and illicit drug use (DU) frequently co-occur. We sought to determine the individual and combined effects of MI and DU on highly active antiretroviral therapy (HAART) receipt and HIV-RNA suppression among individuals engaged in HIV care. Using 2004 data from the HIV Research Network (HIVRN), we performed a cross-sectional study of HIV-infected patients followed at seven primary care sites. Outcomes of interest were HAART receipt and virological suppression, defined as an HIV-RNA <400 copies/ml. Independent variables of interest were: (1) MI/DU; (2) DU only; (3) MI only; and (4) Neither. We used chi-squared analysis for comparison of categorical variables, and logistic regression to adjust for age, race, sex, frequency of outpatient visits, years in clinical care, CD4 nadir, and study site. During 2004, 10,284 individuals in the HIVRN were either on HAART or HAART eligible defined as a CD4 cell count < or =350. Nearly half had neither MI nor DU (41%), 22% MI only, 15% DU only, and 22% both MI and DU. In multivariate analysis, co-occurring MI/DU was associated with the lowest odds of HAART receipt (Adjusted Odds Ratio: 0.63 (95% CI: (0.55-0.72]), followed by those with DU only (0.75(0.63-0.87)), compared to those with neither. Among those on HAART, concurrent MI/DU (0.66 (0.58-0.75)), DU only (0.77 (0.67-0.88)), were also associated with a decreased odds of HIV-RNA suppression compared to those with neither. MI only was not associated with a statistically significant decrease in HAART receipt (0.93(0.81-1.07)) or viral suppression (0.93 (0.82-1.05)) compared to those with neither. Post-estimation testing revealed a significant difference between those with MI/DU and DU only, and MI/DU and MI only. Co-occurring MI and DU is associated with lower HAART receipt and viral suppression compared to individuals with either MI or DU or neither. Integrating HIV, substance abuse, and mental healthcare may improve outcomes in this population.
精神疾病（MI）与非法药物使用（DU）经常同时出现。我们试图确定MI和DU对接受高效抗逆转录病毒治疗（HAART）以及参与HIV护理的个体中HIV-RNA抑制的个体影响和综合影响。利用来自HIV研究网络（HIVRN）的2004年数据，我们对在七个初级保健地点接受随访的HIV感染患者进行了一项横断面研究。感兴趣的结果是HAART的接受情况和病毒学抑制，定义为HIV-RNA<400拷贝/毫升。感兴趣的自变量为：（1）MI/DU；（2）仅DU；（3）仅MI；以及（4）两者皆无。我们使用卡方分析来比较分类变量，并使用逻辑回归来调整年龄、种族、性别、门诊就诊频率、临床护理年限、CD4最低点和研究地点。在2004年期间，HIVRN中的10284名个体要么正在接受HAART治疗，要么符合HAART治疗条件，即CD4细胞计数<或=350。近一半的人既没有MI也没有DU（41%），22%的人仅有MI，15%的人仅有DU，22%的人同时患有MI和DU。在多变量分析中，同时存在MI/DU与接受HAART的最低几率相关（调整后的优势比：0.63（95%置信区间：[0.55 - 0.72]），其次是仅有DU的人（0.75（0.63 - 0.87）），与两者皆无的人相比。在接受HAART治疗的人群中，同时存在MI/DU（0.66（0.58 - 0.75））、仅有DU（0.77（0.67 - 0.88））与HIV-RNA抑制几率降低也相关，与两者皆无的人相比。与两者皆无的人相比，仅MI与HAART接受率（0.93（0.81 - 1.07））或病毒抑制（0.93（0.82 - 1.05））的统计学显著降低无关。估计后检验显示，患有MI/DU的人与仅有DU的人之间以及MI/DU与仅MI的人之间存在显著差异。与患有MI或DU或两者皆无的个体相比，同时存在MI和DU与较低的HAART接受率和病毒抑制相关。整合HIV、药物滥用和精神卫生保健可能会改善该人群的治疗结果。
