Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.
Lancet HIV. 2015 Aug;2(8):e344-50. doi: 10.1016/S2352-3018(15)00089-2. Epub 2015 Jul 2.
Associations between HIV and schizophrenia in people with and without substance use disorders and the effect on timeliness of HIV diagnosis, antiretroviral therapy (ART), and treatment outcomes are poorly understood. We aimed to assess the association between HIV and schizophrenia and the effect on HIV treatment outcomes in people with and without substance use disorders.
We did a population-based cohort study with data from nationwide registries in Denmark to investigate the risk of schizophrenia after a diagnosis of HIV and the risk of HIV after a diagnosis of schizophrenia, accounting for substance misuse, timeliness of HIV diagnosis, and treatment success in relation to schizophrenia. We selected the cohort from people born in Denmark between Jan 1, 1955, and Dec 31, 1995, who we followed up from their 16th birthday or Jan 1, 1995 (whichever occurred last) until their death, emigration from Denmark, onset of schizophrenia, or Dec 31, 2011 (whichever came first). We estimated incidence rate ratios (IRRs) with Poisson and Cox regression, with adjustment for calendar period, and age and its interaction with sex.
We identified 2,786,286 individuals, of whom we included 2,646,154 people in analyses of risk of schizophrenia diagnosis and 2,658,662 people in analyses of risk of HIV diagnosis. In 35,353,633 person-years of follow up, HIV was associated with an increased risk of schizophrenia (IRR 4·09, 95% CI 2·73-5·83) and acute psychosis (7·15, 4·45-10·8); the IRR was highest within the first year of HIV diagnosis for both disorders (8·24, 2·95-17·7 and 12·7, 3·15-32·9, respectively). Schizophrenia was not associated with an increased risk of HIV in individuals without substance misuse disorders (IRR 1·42, 95% CI 0·81-2·27). The risk of schizophrenia in individuals with HIV decreased after ART (IRR 0·53, 0·32-0·87). The risk of acute psychosis did not differ between HIV-infected individuals receiving antiretroviral regimens with and without efavirenz (IRR 0·70, 95% CI 0·32-1·54). We recorded no differences in CD4 cell counts, time to ART, or viral suppression between individuals with schizophrenia with HIV and those without schizophrenia when substance use was taken into account. Between 1999 and 2011, the mortality rate ratio comparing HIV-infected individuals with schizophrenia with HIV-negative individuals without schizophrenia was 25·8 (95% CI 18·8-34·3).
Our findings emphasise the need for interventions to prevent HIV in people with schizophrenia, especially for those with substance use disorders, and for accessible mental health services for individuals with HIV.
Stanley Medical Research Institute, Lundbeck Foundation, Preben and Anna Simonsen Fund, Novo Nordisk Foundation, The Danish AIDS Foundation, and the Augustinus Foundation.
在有和没有物质使用障碍的人群中，艾滋病毒与精神分裂症之间的关联，以及对艾滋病毒诊断及时性、抗逆转录病毒治疗（ART）和治疗结果的影响，人们对此知之甚少。我们旨在评估有和没有物质使用障碍的人群中艾滋病毒与精神分裂症之间的关联，以及对艾滋病毒治疗结果的影响。
我们进行了一项基于人群的队列研究，该研究的数据来自丹麦全国性登记处，旨在调查艾滋病毒诊断后的精神分裂症风险，以及精神分裂症诊断后的艾滋病毒风险，并考虑了物质滥用、艾滋病毒诊断及时性以及与精神分裂症相关的治疗效果。我们从 1955 年 1 月 1 日至 1995 年 12 月 31 日期间在丹麦出生的人群中选择了队列，从他们 16 岁生日或 1995 年 1 月 1 日（以最后一个为准）开始，对他们进行随访，直到他们死亡、移民出丹麦、出现精神分裂症或 2011 年 12 月 31 日（以最早发生的为准）。我们使用泊松和 Cox 回归估计发病率比率（IRR），并进行了调整，以考虑日历时间、年龄及其与性别的交互作用。
我们确定了 2786286 人，其中 2646154 人纳入了精神分裂症诊断风险分析，2658662 人纳入了艾滋病毒诊断风险分析。在 35353633 人年的随访中，艾滋病毒与精神分裂症（IRR 4.09，95%CI 2.73-5.83）和急性精神病（7.15，4.45-10.8）的风险增加相关；在艾滋病毒诊断的第一年，这两种疾病的 IRR 最高（分别为 8.24，2.95-17.7 和 12.7，3.15-32.9）。在没有物质使用障碍的个体中，精神分裂症与艾滋病毒感染风险增加无关（IRR 1.42，95%CI 0.81-2.27）。在接受抗逆转录病毒治疗后，艾滋病毒感染者患精神分裂症的风险降低（IRR 0.53，0.32-0.87）。接受含有依非韦伦和不含有依非韦伦的抗逆转录病毒方案的艾滋病毒感染者发生急性精神病的风险没有差异（IRR 0.70，95%CI 0.32-1.54）。当考虑物质使用时，我们没有发现艾滋病毒感染者与未感染艾滋病毒的精神分裂症患者之间的 CD4 细胞计数、ART 时间或病毒抑制率有差异。在 1999 年至 2011 年期间，艾滋病毒合并精神分裂症患者与未感染艾滋病毒的无精神分裂症患者的死亡率比为 25.8（95%CI 18.8-34.3）。
我们的研究结果强调了需要采取干预措施来预防有精神分裂症的人群感染艾滋病毒，特别是对有物质使用障碍的人群，以及为有艾滋病毒感染的人群提供可及的精神卫生服务。
斯坦利医学研究所、Lundbeck 基金会、Preben 和 Anna Simonsen 基金、诺和诺德基金会、丹麦艾滋病基金会和 Augustinus 基金会。
