美国 HIV 感染军人人群中抑郁与 HIV 治疗结局的相关性。
Association between depression and HIV treatment outcomes in a US military population with HIV infection.
机构信息
Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX, 78234-6200, USA.
Department of Sociology, University of Texas at San Antonio, San Antonio, TX, USA.
出版信息
AIDS Res Ther. 2021 May 12;18(1):29. doi: 10.1186/s12981-021-00350-2.
BACKGROUND
Depression is common among HIV-infected individuals and may contribute to suboptimal adherence to antiretroviral therapy (ART) and subsequent inability to attain viral load (VL) suppression. We evaluated associations between depression, self-reported adherence, and longitudinal HIV treatment outcomes in US Military HIV Natural History Study (NHS) participants with and without depression.
METHODS
Male NHS participants with available ICD-9 data for mental health diagnoses, Center for Epidemiological Studies Depression (CES-D) measures, and self-reported adherence (SRA) were included. ART use was defined as ART initiation between 2006 and 2010, with follow-up through 2015. SRA was defined as taking 95% of ART doses and continuous ART was defined as longitudinal ART use with gaps < 30 days. Continuous VL suppression was defined as maintaining VLs < 200 c/mL on ART. To analyse the association between depression and HIV treatment outcomes, latent class analysis was used to create classes of depression trajectories: low depression (LD), recent onset depression (ROD) and high Depression (HD).
RESULTS
Participants had a mean age of 32 (± 8.3) years at HIV diagnosis, and similar proportions were Caucasian (44.3%) or African American (40.8%). Overall, older participants at HIV diagnosis had greater odds of having 95% self-reported adherence (OR 1.06, 95% CI 1.02-1.12), and African Americans had lower odds (OR 0.41, 95% CI 0.22-0.76) compared to Caucasians (OR 1.49, 95% CI 0.52-4.28). However, there was no difference in SRA by depression trajectory. Participants with HD had an increased odds of taking ART continuously (OR 1.75, 95% CI 0.99-3.09), and those with ROD had significantly higher odds of virologic failure (OR 0.58, 95% CI 0.38-0.91).
CONCLUSIONS
Although there was no observed association between depression and SRA, participants with ROD had lower odds of attaining the HIV treatment goal of VL suppression. Continued efforts to identify and aggressively manage mental health disorders is important to success along the HIV care continuum.
背景
抑郁症在感染 HIV 的人群中很常见，可能导致抗逆转录病毒治疗（ART）的依从性不佳，进而无法实现病毒载量（VL）抑制。我们评估了美国军事 HIV 自然史研究（NHS）参与者中抑郁、自我报告的依从性与纵向 HIV 治疗结局之间的关系，这些参与者有或没有抑郁。
方法
纳入了具有可用 ICD-9 心理健康诊断数据、中心流行病学研究抑郁量表（CES-D）测量值和自我报告的依从性（SRA）的 NHS 男性参与者。ART 的使用定义为 2006 年至 2010 年之间开始 ART，随访至 2015 年。SRA 定义为服用 95%的 ART 剂量，连续 ART 定义为纵向 ART 使用，间隔 < 30 天。连续 VL 抑制定义为在 ART 上保持 VLs < 200 c/mL。为了分析抑郁与 HIV 治疗结局之间的关系，使用潜在类别分析创建了抑郁轨迹的类别：低抑郁（LD）、近期发作抑郁（ROD）和高抑郁（HD）。
结果
参与者在 HIV 诊断时的平均年龄为 32（± 8.3）岁，白人和非裔美国人的比例相似（分别为 44.3%和 40.8%）。总体而言，在 HIV 诊断时年龄较大的参与者更有可能具有 95%的自我报告的依从性（OR 1.06，95%CI 1.02-1.12），而非裔美国人的可能性较低（OR 0.41，95%CI 0.22-0.76）与白人（OR 1.49，95%CI 0.52-4.28）。然而，抑郁轨迹对 SRA 没有影响。HD 患者连续服用 ART 的几率更高（OR 1.75，95%CI 0.99-3.09），ROD 患者病毒学失败的几率显著更高（OR 0.58，95%CI 0.38-0.91）。
结论
尽管没有观察到抑郁与 SRA 之间存在关联，但 ROD 患者达到 HIV 治疗目标 VL 抑制的几率较低。继续努力识别和积极治疗精神障碍对于在 HIV 护理连续体中取得成功非常重要。
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