aDepartment of Epidemiology, University of North Carolina, Chapel Hill, North Carolina bDepartment of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee cDepartment of Epidemiology and Medicine, University of Florida dDepartment of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida eDepartment of Health Policy and Management, Indiana University, Indianapolis, Indiana fDepartment of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA.
AIDS. 2017 Nov 28;31(18):2515-2524. doi: 10.1097/QAD.0000000000001618.
Depression is highly prevalent among people living with HIV/AIDS (PLWHA) and has deleterious effects on HIV clinical outcomes. We examined changes in depression symptoms, viral suppression, and CD4 T cells/μl among PLWHA diagnosed with depression who initiated antidepressant treatment during routine care, and compared the effectiveness of dual-action and single-action antidepressants for improving those outcomes.
Comparative effectiveness study of new user dual-action or single-action antidepressant treatment episodes occurring from 2004 to 2014 obtained from the Center for AIDS Research Network of Integrated Clinical Systems.
We identified new user treatment episodes with no antidepressant use in the preceding 90 days. We completed intent-to-treat and per protocol evaluations for the main analysis. Primary outcomes, were viral suppression (HIV viral load <200 copies/ml) and CD4 T cells/μl. In a secondary analysis, we used the Patient Health Questionnaire-9 (PHQ-9) to evaluate changes in depression symptoms and remission (PHQ <5). Generalized estimating equations with inverse probability of treatment weights were fitted to estimate treatment effects.
In weighted intent-to-treat analyses, the probability of viral suppression increased 16% after initiating antidepressants [95% confidence interval = (1.12, 1.20)]. We observed an increase of 39 CD4T cells/μl after initiating antidepressants (30, 48). Both the frequency of remission from depression and PHQ-9 scores improved after antidepressant initiation. Comparative effectiveness estimates were null in all models.
Initiating antidepressant treatment was associated with improvements in depression, viral suppression, and CD4 T cells/μl, highlighting the health benefits of treating depression in PLWHA. Dual and single-action antidepressants had comparable effectiveness.
抑郁症在艾滋病毒/艾滋病感染者（PLWHA）中普遍存在，对艾滋病毒临床结局有不良影响。我们研究了在常规护理中开始抗抑郁治疗的抑郁症确诊的 PLWHA 中抑郁症状、病毒抑制和 CD4 T 细胞/μl 的变化，并比较了双重作用和单一作用抗抑郁药改善这些结局的效果。
来自艾滋病研究网络综合临床系统中心的 2004 年至 2014 年期间新用户双重作用或单一作用抗抑郁治疗发作的比较效果研究。
我们确定了在之前 90 天内没有使用抗抑郁药物的新用户治疗发作。我们对主要分析完成了意向治疗和方案治疗评估。主要结局是病毒抑制（艾滋病毒病毒载量<200 拷贝/ml）和 CD4 T 细胞/μl。在二次分析中，我们使用患者健康问卷-9（PHQ-9）评估抑郁症状和缓解（PHQ<5）的变化。使用逆概率治疗加权的广义估计方程拟合来估计治疗效果。
在加权意向治疗分析中，开始抗抑郁药治疗后，病毒抑制的可能性增加了 16%[95%置信区间（1.12，1.20）]。我们观察到开始抗抑郁药治疗后 CD4T 细胞/μl 增加了 39[30，48]。抗抑郁药治疗开始后，抑郁缓解的频率和 PHQ-9 评分均有所改善。所有模型中的比较效果估计均为零。
开始抗抑郁治疗与改善抑郁、病毒抑制和 CD4 T 细胞/μl 相关，突出了治疗 PLWHA 抑郁症的健康益处。双重和单一作用抗抑郁药具有相当的效果。
