Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill.
Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health.
Clin Infect Dis. 2018 Oct 30;67(10):1575-1581. doi: 10.1093/cid/ciy264.
Research linking depression to mortality among people living with human immunodeficiency virus (PLWH) has largely focused on binary "always vs never" characterizations of depression. However, depression is chronic and is likely to have cumulative effects on mortality over time. Quantifying depression as a cumulative exposure may provide a better indication of the clinical benefit of enhanced depression treatment protocols delivered in HIV care settings.
Women living with HIV (WLWH), naive to antiretroviral therapy, from the Women's Interagency HIV Study were followed from their first visit in or after 1998 for up to 10 semiannual visits (5 years). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. An area-under-the-curve approach was used to translate CES-D scores into a time-updated measure of cumulative days with depression (CDWD). We estimated the effect of CDWD on all-cause mortality using marginal structural Cox proportional hazards models.
Overall, 818 women contributed 3292 woman-years over a median of 4.8 years of follow-up, during which the median (interquartile range) CDWD was 366 (97-853). Ninety-four women died during follow-up (2.9 deaths/100 woman-years). A dose-response relationship was observed between CDWD and mortality. Each additional 365 days spent with depression increased mortality risk by 72% (hazard ratio, 1.72; 95% confidence interval, 1.34-2.20).
In this sample of WLWH, increased CDWD elevated mortality rates in a dose-response fashion. More frequent monitoring and enhanced depression treatment protocols designed to reduce CDWD may interrupt the accumulation of mortality risk among WLWH.
将抑郁与艾滋病毒感染者（PLWH）的死亡率联系起来的研究主要集中在抑郁的二元“总是与从不”特征上。然而，抑郁是慢性的，随着时间的推移，它很可能对死亡率产生累积影响。将抑郁量化为累积暴露，可能更能说明在艾滋病毒护理环境中实施强化抑郁治疗方案的临床获益。
来自妇女艾滋病联合研究（Women's Interagency HIV Study）的、未经抗逆转录病毒治疗的艾滋病毒女性患者（WLWH），从 1998 年或之后的首次就诊开始，进行了长达 10 次半年度就诊（5 年）的随访。使用中心流行病学研究抑郁量表（Center for Epidemiologic Studies Depression Scale）评估抑郁症状。采用曲线下面积方法，将 CES-D 评分转换为累积抑郁天数（CDWD）的时间更新测量值。我们使用边缘结构 Cox 比例风险模型估计 CDWD 对全因死亡率的影响。
总体而言，818 名女性在中位 4.8 年的随访中提供了 3292 名女性年，中位（四分位距）CDWD 为 366（97-853）。94 名女性在随访期间死亡（2.9 例/100 名女性年）。CDWD 与死亡率之间存在剂量反应关系。每多 365 天抑郁，死亡率风险增加 72%（危险比，1.72；95%置信区间，1.34-2.20）。
在这个 WLWH 样本中，CDWD 的增加以剂量反应的方式提高了死亡率。更频繁的监测和旨在降低 CDWD 的强化抑郁治疗方案可能会中断 WLWH 中死亡率风险的累积。
