抗逆转录病毒治疗对青少年 HIV 感染者抑郁症状、神经认知功能和病毒抑制的 36 个月轨迹研究。
Trajectories of Depressive Symptoms, Neurocognitive Function, and Viral Suppression With Antiretroviral Therapy Among Youth With HIV Over 36 months.
机构信息
Department of Psychiatry, University of California San Diego, La Jolla, CA.
Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina Chapel Hill, Chapel Hill, NC.
出版信息
J Acquir Immune Defic Syndr. 2021 Jun 1;87(2):851-859. doi: 10.1097/QAI.0000000000002653.
BACKGROUND
Depression and neurocognitive impairment are highly prevalent among persons living with HIV and associated with poorer clinical outcomes; however, longitudinal studies of depression-neurocognition relationships in youth living with HIV (YLWH), and the role of antiretroviral therapy (ART), are lacking. This study tested whether (1) depressive symptomatology, across somatic, cognitive, and affective symptom domains, improved with ART and (2) more severe depressive symptoms at baseline were associated with poorer neurocognitive function and poorer HIV suppression.
SETTING
Data were collected from 181 YLWH (18-24 years) who were treatment-naive, a subset of whom (n = 116) initiated ART.
METHODS
Participants were categorized into elevated (DS) or nonelevated (non-DS) depressive symptom groups at entry (Beck Depression Inventory-II ≥14) and followed for 36 months. Neurocognition (5-domain battery) and depressive symptoms were repeatedly assessed. Longitudinal models examined depressive symptomatology, neurocognition, and odds of HIV nonsuppression by group.
RESULTS
Greater improvements in depressive symptoms were observed in the DS group over 36 months [beta = -0.14, (-0.24 to -0.03)], particularly within cognitive and affective domains. Verbal learning performance increased in the DS group [beta = 0.13, (0.01 to 0.24)], whereas psychomotor function improved somewhat in the non-DS group [beta = -0.10, (-0.22 to 0.00)]. Adjusted for ART adherence, odds of HIV nonsuppression did not significantly differ by group [odds ratio = 0.22, (0.04 to 1.23)]; however, greater somatic symptoms at study entry were associated with an increased risk of nonsuppression over time [odds ratio = 2.33 (1.07 to 5.68)].
CONCLUSION
Depressive symptoms were associated with differential neurocognitive trajectories, and somatic depressive symptoms at baseline may predict poorer subsequent HIV suppression. Identifying and treating depressive symptoms at ART initiation may benefit neurocognitive and clinical outcomes in YLWH.
背景
抑郁和神经认知障碍在 HIV 感染者中非常普遍，并且与较差的临床结局相关；然而，针对 HIV 感染者青少年中抑郁与神经认知关系的纵向研究，以及抗逆转录病毒治疗（ART）的作用，还很缺乏。本研究旨在检验以下两个问题：（1）躯体、认知和情感症状领域的抑郁症状是否会随着 ART 而改善；（2）基线时更严重的抑郁症状是否与更差的神经认知功能和更差的 HIV 抑制有关。
地点
数据来自 181 名未经治疗的 HIV 感染者青少年（18-24 岁），其中一部分（n=116）开始接受 ART。
方法
参与者根据贝克抑郁量表二（BDI-II）评分（≥14 分）分为抑郁症状升高（DS）或不升高（非 DS）组，并随访 36 个月。多次评估神经认知（5 域测试）和抑郁症状。纵向模型检验了组间的抑郁症状、神经认知和 HIV 抑制失败的几率。
结果
DS 组在 36 个月内观察到抑郁症状有更大的改善[β=-0.14，（-0.24 至-0.03）]，尤其是在认知和情感领域。DS 组的词语学习表现有所提高[β=0.13，（0.01 至 0.24）]，而非 DS 组的精神运动功能则略有改善[β=-0.10，（-0.22 至 0.00）]。调整 ART 依从性后，组间 HIV 抑制失败的几率无显著差异[比值比=0.22，（0.04 至 1.23）]；然而，研究开始时躯体症状更严重与随时间推移 HIV 抑制失败的风险增加相关[比值比=2.33，（1.07 至 5.68）]。
结论
抑郁症状与不同的神经认知轨迹相关，并且基线时的躯体抑郁症状可能预示着随后 HIV 抑制效果较差。在开始 ART 时识别和治疗抑郁症状可能有益于 HIV 感染者青少年的神经认知和临床结局。
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