HIV Unit, Department of Infectious Diseases, Hospital Universitario Reina Sofia - IMIBIC - CIBERINFEC, Córdoba, Spain.
Department of Psychiatry, Hospital Clínic de Barcelona, Barcelona, Spain.
HIV Med. 2022 Oct;23(9):969-977. doi: 10.1111/hiv.13296. Epub 2022 Mar 16.
Despite the importance of neuropsychiatric comorbidities (NPCs) in people with HIV, the degree of physician compliance with recommendations for diagnosis and management is unknown. This study assessed the perceptions, knowledge, skills, and attitudes of physicians regarding the diagnosis and management of NPCs in people with HIV in hospital settings in Spain.
This was a cross-sectional study including non-psychiatrist HIV specialist physicians responsible for antiretroviral therapy (ART) prescription and clinical care of ≥50 people with HIV/month, who completed an online survey of 34 questions.
The 115 physicians who completed the survey (totally) agreed that assessing mental health was relevant (97.4%) and that NPCs were underdiagnosed (76.6%) and were very/fairly sensitized (67.8%). However, they reported receiving little/no training on the detection of NPCs (64.3%). Physicians considered that patients underreported NPCs (53.9%) and that alcohol (94.8%), recreational substances (97.4%), and tobacco consumption (95.6%) were (very) relevant. Physicians agreed that NPCs were difficult to identify (52.2%) and that few tools were available (53.0%) and failed to use questionnaires (79.1%) and follow guidelines (77.4%) for the detection of NPCs. The main reasons precluding appropriate diagnosis and evaluation were lack of proactive attitudes and specific training and limited visit time. Upon detection of NPCs, physicians referred patients to the in-house psychiatry/psychology centre (61.7%), adjusted ART to minimize interactions (96.5%), and managed NPCs in conjunction with mental health professionals (71.3%).
Physicians in hospital settings in Spain were aware of the relevance of NPC diagnosis and their underdiagnosis. However, they still failed to routinely evaluate NPCs, follow guideline recommendations, and use questionnaires, highlighting opportunities for improved NPC detection and management in people with HIV.
尽管神经精神合并症（NPCs）在 HIV 感染者中很重要，但医生对 NPCs 的诊断和管理建议的遵从程度尚不清楚。本研究评估了西班牙医院环境中 HIV 专科医生对 NPCs 的诊断和管理的看法、知识、技能和态度。
这是一项横断面研究，纳入了负责抗逆转录病毒治疗（ART）处方和≥50 名 HIV 感染者/月的临床护理的非精神科 HIV 专家医生，他们完成了一项包含 34 个问题的在线调查。
完成调查的 115 名医生（共计）一致认为评估心理健康很重要（97.4%），认为 NPCs 诊断不足（76.6%），并且非常/相当敏感（67.8%）。然而，他们报告说很少/没有接受过 NPC 检测方面的培训（64.3%）。医生认为患者很少报告 NPCs（53.9%），并且酒精（94.8%）、娱乐性物质（97.4%）和烟草消费（95.6%）非常/相当相关。医生认为 NPCs 难以识别（52.2%），并且很少有工具（53.0%）可用，无法使用问卷（79.1%）和遵循指南（77.4%）来检测 NPCs。妨碍适当诊断和评估的主要原因是缺乏主动态度和特定的培训以及有限的就诊时间。一旦发现 NPCs，医生会将患者转介到内部精神病学/心理学中心（61.7%），调整 ART 以尽量减少相互作用（96.5%），并与心理健康专业人员共同管理 NPCs（71.3%）。
西班牙医院环境中的医生意识到 NPC 诊断的相关性及其诊断不足。然而，他们仍然没有常规评估 NPCs，遵循指南建议，也没有使用问卷，这突显了在 HIV 感染者中提高 NPC 检测和管理的机会。
