在接受抗逆转录病毒治疗的合并结核分枝杆菌/人类免疫缺陷病毒（TB/HIV）感染和无结核的 HIV 患者中，常见精神障碍是否会随时间推移而减少？

Do common mental disorders decline over time in TB/HIV co-infected and HIV patients without TB who are on antiretroviral treatment?

机构信息

Department of Epidemiology, Jimma University, Jimma, Ethiopia.

出版信息

BMC Psychiatry. 2013 Jun 27;13:174. doi: 10.1186/1471-244X-13-174.

DOI:10.1186/1471-244X-13-174

PMID:23802647

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3702441/

Abstract

BACKGROUND

The relationship between TB/HIV co-infection and common mental disorders (CMD) is not well investigated. A follow up study was conducted to assess the change in CMD over a 6-months period and its predictors among TB/HIV co-infected and HIV patients without TB in Ethiopia.

METHODS

A longitudinal study was conducted in 2009. A total of 465 HIV/AIDS patients without TB and 124 TB/HIV co-infected patients from four antiretroviral treatment (ART) centers in Ethiopia were recruited to assess CMD and quality of life (QoL). CMD and QoL were assessed at baseline and at six month using the Kessler-10 scale and the short Amharic version of the World Health Organization Quality of Life Instrument for HIV clients (WHOQOL HIV-Bref) respectively. Multivariate analysis was conducted using generalized estimating equations (GEE) using STATA to assess change in CMD and its predictors.

RESULTS

At the 6 month, 540 (97 TB/HIV co-infected and 455 HIV/AIDS patients without TB) patients completed the follow up and 8.6% (21% among TB/HIV co-infected and 2.2% among HIV patients without TB) lost to follow-up.At baseline, 54.4% of TB/HIV co-infected patients had mild to severe mental disorder compared to 41.2% among HIV patients without TB. At the six month follow up, 18.1% of TB/HIV co-infected patients had mild to severe mental disorder compared to 21.8% among HIV patients without TB. The decline of the prevalence of any form of metal disorder was 36.3% among TB/HIV co-infected patients compared to 19.4% among HIV patients without TB (P<0.001).QoL was strongly associated with CMD in TB/HIV co-infected patients and HIV patients without TB (β = -0.04, P<0.001) after controlling the effect of several confounding variables such as sex, income, WHO disease stage, duration on ART, CD4 lymphocyte count, adherence to ART and social support.

CONCLUSION

The prevalence of CMD has significantly reduced particularly among TB/HIV co-infected patients over a 6 months period. Poor QoL is the major independent predictors of CMD. We recommend integration of mental health services in TB/HIV programs. Training of health care providers at TB/HIV clinics could help to screen and treat CMD among TB/HIV co-infected patients.

摘要

背景

结核病/艾滋病病毒合并感染与常见精神障碍（CMD）之间的关系尚未得到充分研究。本研究旨在评估在埃塞俄比亚，结核病/艾滋病病毒合并感染患者和未感染结核病的艾滋病病毒患者在六个月内 CMD 的变化及其预测因素。

方法

这是一项 2009 年开展的纵向研究。研究共纳入了来自埃塞俄比亚四家抗逆转录病毒治疗（ART）中心的 465 名艾滋病病毒/艾滋病患者（未合并结核病）和 124 名结核病/艾滋病病毒合并感染患者，以评估 CMD 和生活质量（QoL）。采用 Kessler-10 量表和世界卫生组织艾滋病毒感染者生活质量量表的短阿姆哈拉语版本（WHOQOL HIV-Bref）分别在基线和六个月时评估 CMD 和 QoL。使用 STATA 中的广义估计方程（GEE）进行多变量分析，以评估 CMD 的变化及其预测因素。

结果

在六个月时，共有 540 名（97 名结核病/艾滋病病毒合并感染患者和 455 名艾滋病病毒患者）患者完成了随访，8.6%（结核病/艾滋病病毒合并感染患者中为 21%，艾滋病病毒患者中为 2.2%）失访。基线时，结核病/艾滋病病毒合并感染患者中有 54.4%存在轻至重度精神障碍，而未合并结核病的艾滋病病毒患者中这一比例为 41.2%。在六个月随访时，结核病/艾滋病病毒合并感染患者中有 18.1%存在轻至重度精神障碍，而未合并结核病的艾滋病病毒患者中这一比例为 21.8%。结核病/艾滋病病毒合并感染患者中各种形式的金属障碍患病率下降了 36.3%，而未合并结核病的艾滋病病毒患者中这一比例为 19.4%（P<0.001）。在控制了性别、收入、世界卫生组织疾病分期、ART 持续时间、CD4 淋巴细胞计数、ART 依从性和社会支持等多种混杂因素的影响后，QoL 与结核病/艾滋病病毒合并感染患者和未合并结核病的艾滋病病毒患者的 CMD 显著相关（β=-0.04，P<0.001）。