Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E92, Atlanta, GA, 30329, USA.
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
AIDS Behav. 2019 Dec;23(12):3452-3459. doi: 10.1007/s10461-019-02613-6.
Previous research indicates a high burden of depression among adults living with HIV and an association between depression and poor HIV clinical outcomes. National estimates of diagnosed depression, depression treatment status, and association with HIV clinical outcomes are lacking. We used 2009-2014 data from the Medical Monitoring Project to estimate diagnosed depression, antidepressant treatment status, and associations with sustained viral suppression (all viral loads in past year < 200 copies/mL). Data were obtained through interview and medical record abstraction and were weighted to account for unequal selection probabilities and non-response. Of adults receiving HIV medical care in the U.S. and prescribed ART, 27% (95% confidence interval [CI] 25-29%) had diagnosed depression during the surveillance period; the majority (65%) were prescribed antidepressants. The percentage with sustained viral suppression was highest among those without depression (72%, CI 71-73%) and lowest among those with untreated depression (66%, CI 64-69%). Compared to those without depression, those with a depression diagnosis were less likely to achieve sustained viral suppression (aPR 0.95, CI 0.93-0.97); this association held for persons with treated depression compared to no depression (aPR 0.96, CI 0.94-0.99) and untreated depression compared to no depression (aPR 0.92, CI 0.89-0.96). The burden of depression among adults living with HIV in care is high. While in our study depression was only minimally associated with a lower prevalence of sustained viral suppression, diagnosing and treating depression in persons living with HIV remains crucial in order to improve mental health and avoid other poor health outcomes.
先前的研究表明，HIV 感染者群体中成年人患有抑郁症的负担较重，且抑郁症与 HIV 临床转归较差有关。缺乏针对确诊抑郁症、抑郁症治疗状况及其与 HIV 临床转归的关系的全国性评估。我们使用 2009-2014 年医疗监测项目的数据，来评估确诊抑郁症、抗抑郁药物治疗状况，以及与持续病毒抑制的相关性（过去一年所有病毒载量均＜200 拷贝/mL）。数据是通过访谈和病历摘录获得的，并经过加权处理，以考虑到选择概率不均等和无应答的情况。在美国接受 HIV 医疗护理和开具 ART 处方的成年人中，有 27%（95%置信区间 [CI] 25-29%）在监测期间被诊断患有抑郁症；大多数人（65%）开具了抗抑郁药物。在没有抑郁症的患者中，持续病毒抑制的比例最高（72%，CI 71-73%），而未经治疗的抑郁症患者比例最低（66%，CI 64-69%）。与没有抑郁症的患者相比，有抑郁症诊断的患者更不可能实现持续病毒抑制（调整后的比值比 [aPR] 0.95，CI 0.93-0.97）；对于有治疗抑郁症的患者与没有抑郁症的患者（aPR 0.96，CI 0.94-0.99）和未经治疗的抑郁症患者与没有抑郁症的患者（aPR 0.92，CI 0.89-0.96），这一相关性依然存在。在接受护理的 HIV 感染者中，成年人的抑郁症负担沉重。虽然在我们的研究中，抑郁症与持续病毒抑制率降低仅有轻微相关性，但诊断和治疗 HIV 感染者的抑郁症仍然至关重要，这有助于改善心理健康，避免其他不良健康结局。
