Ebuenyi Ikenna, Taylor Chris, O'Flynn David, Matthew Prina A, Passchier Ruth, Mayston Rosie
a Athena Institute for Research on Innovation and Communication in Health and Life Sciences , Vrije Universiteit Amsterdam , Netherlands.
b Department of Sexual Health and HIV , King's College Hospital London UK.
AIDS Care. 2018 Dec;30(12):1586-1594. doi: 10.1080/09540121.2018.1510110. Epub 2018 Aug 16.
Our aim was to review the evidence related to the impact of co-morbid severe mental illness SMI (schizophrenia, schizoaffective and bipolar disorder) and HIV upon mental health, physical health and social outcomes. We carried out a systematic review of scientific evidence, searching online databases (MEDLINE, PsychInfo, EMBASE, Global Health and Scopus) for studies between 1983 and 2017 using search terms for SMI and HIV. Studies were included if they compared health or social outcomes between people living with co-morbid SMI and HIV and people living with either: a) HIV only; or b) SMI only. Outcomes of interest were: mortality, health service use, HIV/SMI-related, co-morbidities, and social outcomes. We identified 20 studies which met our inclusion criteria. Although studies were generally high quality, there was heterogeneity in both selection of outcomes and choice of measure. It was therefore difficult to draw strong conclusions regarding the impact of co-morbid SMI and HIV across any outcome. We found little evidence that co-morbid SMI and HIV were associated with lower levels of treatment, care or poorer clinical outcomes compared to people living with SMI or HIV alone. However, mortality appeared to be higher among the co-morbid group in three out of four analyses identified. Physical and mental co-morbidities and social outcomes were rarely measured. Limited data mean that the impact of co-morbid SMI and HIV is uncertain. In order to develop evidence-based guidelines, there is an urgent need for further research. This may be realized by exploring opportunities for using data from existing cohort studies, routinely collected data and data linkage to investigate important questions relating to this neglected but potentially important area.
我们的目的是回顾与共病严重精神疾病（SMI，即精神分裂症、分裂情感性障碍和双相情感障碍）和艾滋病毒对心理健康、身体健康及社会结局的影响相关的证据。我们对科学证据进行了系统回顾，在在线数据库（MEDLINE、PsychInfo、EMBASE、Global Health和Scopus）中搜索1983年至2017年期间使用SMI和艾滋病毒搜索词的研究。如果研究比较了共病SMI和艾滋病毒患者与以下两类人群的健康或社会结局，则纳入研究：a）仅感染艾滋病毒的人群；或b）仅患有SMI的人群。感兴趣的结局包括：死亡率、医疗服务使用情况、与艾滋病毒/ SMI相关的合并症以及社会结局。我们确定了20项符合我们纳入标准的研究。尽管这些研究总体质量较高，但在结局选择和测量方法的选择上均存在异质性。因此，很难就共病SMI和艾滋病毒对任何结局的影响得出强有力的结论。我们几乎没有发现证据表明，与仅患有SMI或艾滋病毒的人群相比，共病SMI和艾滋病毒与治疗水平较低、护理较差或临床结局较差有关。然而，在确定的四项分析中有三项显示，共病组的死亡率似乎更高。身体和精神合并症以及社会结局很少被测量。有限的数据意味着共病SMI和艾滋病毒的影响尚不确定。为了制定基于证据的指南，迫切需要进一步的研究。这可以通过探索利用现有队列研究数据、常规收集的数据以及数据链接来调查与这一被忽视但可能很重要的领域相关的重要问题的机会来实现。
