Velloza Jennifer, Celum Connie, Haberer Jessica E, Ngure Kenneth, Irungu Elizabeth, Mugo Nelly, Baeten Jared M, Heffron Renee
Department of Global Health, University of Washington, Seattle, WA, USA.
Department of Epidemiology, University of Washington, Seattle, WA, USA.
AIDS Behav. 2017 Aug;21(8):2509-2518. doi: 10.1007/s10461-017-1829-z.
Depression is a known barrier for antiretroviral therapy (ART) adherence, but less is understood about its effects on ART initiation. We followed 1013 HIV-infected individuals participating in the Partners Demonstration Project, an open-label study of integrated pre-exposure prophylaxis (PrEP) and ART delivery for HIV serodiscordant couples in Kenya and Uganda. Associations between depression, measured annually with the Hopkins Symptoms Checklist-Depression (HSCL-D), and ART initiation were assessed with Cox proportional hazards regression. At enrollment, 162 participants (16.0%) reported symptoms consistent with probable depression, defined by a HSCL-D mean score >1.75, and this proportion decreased during study follow-up (6.7 and 3.6% at 12- and 24-months, respectively; p value < 0.001). Greater depressive symptom severity was associated with a greater likelihood of ART initiation overall (adjusted hazard ratio [aHR] 1.32, 95% CI 1.01-1.73) and among participants with CD4 count ≤ 350 cells/µl (aHR 1.30, 95% CI 1.01-1.67). Depression decreased 6 months after ART initiation (adjusted odds ratio [aOR] 0.34, 95% CI 0.23-0.51). Among East African HIV-infected persons in HIV serodiscordant couples, depression was not a barrier to ART initiation. ART initiation was associated with improved depressive symptoms in this setting.
抑郁症是抗逆转录病毒疗法（ART）依从性的一个已知障碍，但人们对其对ART启动的影响了解较少。我们对参与伙伴示范项目的1013名艾滋病毒感染者进行了跟踪，该项目是一项针对肯尼亚和乌干达艾滋病毒血清学不一致夫妇的综合暴露前预防（PrEP）和ART提供的开放标签研究。使用考克斯比例风险回归评估每年用霍普金斯症状清单-抑郁量表（HSCL-D）测量的抑郁症与ART启动之间的关联。在入组时，162名参与者（16.0%）报告有符合可能抑郁症的症状，定义为HSCL-D平均得分>1.75，这一比例在研究随访期间有所下降（12个月和24个月时分别为6.7%和3.6%；p值<0.001）。总体而言，抑郁症状越严重，启动ART的可能性越大（调整后风险比[aHR]为1.32，95%置信区间为1.01-1.73），在CD4细胞计数≤350个/微升的参与者中也是如此（aHR为1.30，95%置信区间为1.01-1.67）。在启动ART 6个月后，抑郁症状有所减轻（调整后优势比[aOR]为0.34，95%置信区间为0.23-0.51）。在东非艾滋病毒血清学不一致夫妇中的艾滋病毒感染者中，抑郁症不是ART启动的障碍。在这种情况下，启动ART与抑郁症状改善有关。
