Zhang Wenhui, Wang Yi, Li Er, Yan Dingyan, Yu Jianhua, Zhu Mingli, Shi Jinchuan, Zheng Liping
Department of Nursing, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Department of Infection, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Infect Drug Resist. 2023 Aug 2;16:5007-5019. doi: 10.2147/IDR.S419308. eCollection 2023.
Neuropsychiatric adverse events (NPAEs) occur frequently in people living with human immunodeficiency virus (PLWH) receiving antiretroviral therapy (ART). This study aimed to assess the dynamic trends and risk factors of NPAEs among PLWH in Hangzhou taking efavirenz (EFV)- or dolutegravir (DTG)- or elvitegravir (EVG)-based regimens.
A total of 287 ART-naive PLWH were included in this study, EFV (400mg)- (n = 122), EFV (600mg)- (n = 37), DTG- (n = 73), EVG-based (n = 47) and other ART regimens (n = 8) as the initial ART regimen were administered for 12 months. All data were collected at five time points within a 12-month follow-up. The Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale were used to evaluate sleep disorders and anxiety and depression symptoms, respectively. The dynamic trends and potential risk factors of NPAEs were investigated using a generalized linear mixed model.
Mean age was 29.4 (SD: 7.5) years with 97.2% males. After 12 months of ART, the prevalence of sleep disorders and anxiety decreased significantly, although only a slight improvement was observed for depression. In addition, there was a significant positive correlation between sleep disorders, anxiety, and depression. The risk factors for NPAEs differed slightly depending on the choice of ART regimen, but the seven factors most commonly associated with NPAEs were age, sex, marital status, education level, smoking status, body mass index, and WHO clinical stage. Treatment-induced changes in CD4-positive T-cell count and virological suppression did not depend on the particular choice of ART regimen.
The prevalence of sleep disorders and anxiety changed significantly over time on ART and the risks of these disorders were associated with seven common clinical and demographic factors.
接受抗逆转录病毒治疗（ART）的人类免疫缺陷病毒感染者（PLWH）中神经精神不良事件（NPAEs）频繁发生。本研究旨在评估杭州市接受基于依非韦伦（EFV）、多替拉韦（DTG）或埃替拉韦（EVG）方案治疗的PLWH中NPAEs的动态趋势及危险因素。
本研究共纳入287例初治PLWH，分别给予EFV（400mg）（n = 122）、EFV（600mg）（n = 37）、DTG（n = 73）、基于EVG方案（n = 47）以及其他ART方案（n = 8）作为初始ART方案，治疗12个月。在12个月的随访期内于5个时间点收集所有数据。匹兹堡睡眠质量指数和医院焦虑抑郁量表分别用于评估睡眠障碍以及焦虑和抑郁症状。使用广义线性混合模型研究NPAEs的动态趋势及潜在危险因素。
平均年龄为29.4（标准差：7.5）岁，男性占97.2%。ART治疗12个月后，睡眠障碍和焦虑的患病率显著下降，尽管抑郁仅略有改善。此外，睡眠障碍、焦虑和抑郁之间存在显著正相关。NPAEs的危险因素因ART方案的选择略有不同，但与NPAEs最常相关的七个因素为年龄、性别、婚姻状况、教育水平、吸烟状况、体重指数和世界卫生组织临床分期。治疗引起的CD4阳性T细胞计数变化和病毒学抑制并不取决于ART方案的具体选择。
ART治疗过程中睡眠障碍和焦虑的患病率随时间显著变化，这些障碍的风险与七个常见的临床和人口统计学因素相关。
