Di Gennaro Francesco, Papagni Roberta, Segala Francesco Vladimiro, Pellegrino Carmen, Panico Gianfranco Giorgio, Frallonardo Luisa, Diella Lucia, Belati Alessandra, Santoro Carmen Rita, Brindicci Gaetano, Balena Flavia, Bavaro Davide Fiore, Montalbò Domenico, Guido Giacomo, Calluso Lina, Di Tullio Marilisa, Sgambati Margherita, Fiordelisi Deborah, De Gennaro Nicolò, Saracino Annalisa
Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy.
Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari 'Aldo Moro', Bari, Italy.
BMC Infect Dis. 2024 Apr 22;24(1):423. doi: 10.1186/s12879-024-09315-y.
Mental health (MH) is extremely relevant when referring to people living with a chronic disease, such as people living with HIV (PLWH). In fact - although life expectancy and quality have increased since the advent of antiretroviral therapy (ART) - PLWH carry a high incidence of mental disorders, and this burden has been exacerbated during the COVID-19 pandemic. In this scenario, UNAIDS has set new objectives for 2025, such as the linkage of at least 90% of PLWH to people-centered, context-specific MH services. Aim of this study was to determine the prevalence of MD in PLWH followed at the Clinic of Infectious Diseases of the University of Bari, Italy.
From January 10th to September 10th, 2022, all PLWH patients accessing our outpatient clinic were offered the following standardized tools: HAM-A for anxiety, BDI-II for depression, PC-PTSD-5 for post-traumatic stress disorder, CAGE-AID for alcohol-drug abuse. Factors associated with testing positive to the four MD were explored with a multivariable logistic regression model.
578 out of 1110 HIV-patients agreed to receive MH screening, with 141 (24.4%) people resulting positive to at least one MH disorder. HAM-A was positive in 15.8% (n = 91), BDI-II in 18% (n = 104), PC-PTSD-5 in 5% (n = 29) and CAGE in 6.1% (n = 35). The multivariable logistic regression showed a higher probability of being diagnosed with anxiety, depression and post-traumatic stress disorder for PLWH who reported severe stigma, social isolation, psychological deterioration during the COVID-19 pandemic and for those receiving a dolutegravir (DTG)-based regimen. Moreover, history of drug use (OR 1.13; [95% CE 1.06-4.35]), family stigma (2.42 [1.65-3.94]) and social isolation (2.72 [1.55;4.84]) were found to be associated to higher risk for substance use disorder.
In this study, stigma was a strong predictor for being diagnosed of a MH disorder among PLWH. Also, the possible role of dolutegravir as a risk factor for the onset of MH disorders should be considered in clinical practice, and MH of patients receiving DTG-containing regimens should be constantly monitored.
心理健康（MH）在提及慢性病患者时极为重要，例如艾滋病毒感染者（PLWH）。事实上，尽管自抗逆转录病毒疗法（ART）问世以来，预期寿命和生活质量有所提高，但PLWH患精神障碍的几率很高，且在新冠疫情期间这一负担进一步加重。在此背景下，联合国艾滋病规划署（UNAIDS）为2025年设定了新目标，比如让至少90%的PLWH获得以患者为中心、因地制宜的心理健康服务。本研究旨在确定意大利巴里大学传染病诊所所追踪的PLWH中精神障碍（MD）的患病率。
2022年1月10日至9月10日，所有前来我们门诊就诊的PLWH患者都接受了以下标准化检测工具：用于焦虑症的汉密尔顿焦虑量表（HAM-A）、用于抑郁症的贝克抑郁量表第二版（BDI-II）、用于创伤后应激障碍的创伤后应激障碍检查表平民版（PC-PTSD-5）、用于酒精-药物滥用的CAGE-AID问卷。采用多变量逻辑回归模型探究与这四种精神障碍检测呈阳性相关的因素。
1110名艾滋病毒患者中有578人同意接受心理健康筛查，其中141人（24.4%）至少有一种精神障碍检测呈阳性。HAM-A阳性率为15.8%（n = 91），BDI-II为18%（n = 104），PC-PTSD-5为5%（n = 29），CAGE问卷为6.1%（n = 35）。多变量逻辑回归显示，报告在新冠疫情期间遭受严重耻辱感、社会隔离、心理恶化的PLWH以及接受基于度鲁特韦（DTG）方案治疗的PLWH被诊断为焦虑症、抑郁症和创伤后应激障碍的可能性更高。此外，吸毒史（比值比1.13；[95%置信区间1.06 - 4.35]）、家庭耻辱感（2.42 [1.65 - 3.94]）和社会隔离（2.72 [1.55；4.84]）被发现与物质使用障碍的较高风险相关。
在本研究中，耻辱感是PLWH被诊断患有精神障碍的一个重要预测因素。此外，在临床实践中应考虑度鲁特韦作为精神障碍发病风险因素的可能作用，对于接受含DTG方案治疗的患者的心理健康应持续监测。
