Portilla-Tamarit Irene, Rubio-Aparicio María, Ruiz-Robledillo Nicolás, Ferrer-Cascales Rosario, Albaladejo-Blázquez Natalia, Portilla Joaquín
Department of Health Psychology, University of Alicante, Alicante, Spain.
Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
Psychol Health Med. 2025 Feb;30(2):341-356. doi: 10.1080/13548506.2024.2407438. Epub 2024 Sep 29.
The relationship between mental disorders other than depression or anxiety, and low adherence to both antiretroviral treatment (ART) and linkage to HIV care are unclear. The aim of our study was to compare the prevalence of mental disorders in people living with HIV (PLHIV) in Spain who present low versus high adherence to ART. We performed a cross-sectional study comparing two groups of PLHIV: 20 PLHIV with low adherence and 80 PLHIV with high adherence to ART. PLHIV who met at least one of the following criteria were included in the low-adherence group: virological failure (HIV-VL > 50 copies/mL in two consecutive blood samples); low attendance to scheduled clinical visits (≥2 missed visits in last year); irregular administration of ART (≥10 forgotten doses in the last month); and interruption of ART for more than 1 week. Inclusion criteria for high adherence were: PLHIV who had been on stable ART for more than 1 year with an HIV-VL below 50 copies/mL and without missed visits over the previous 12 months. The Millon Clinical Multiaxial Inventory was administered to participants. PLHIV with low adherence showed higher scores for all mental disorders compared with those with high adherence. And, in the multivariate binary logistic regression analysis, drug dependence and post-traumatic stress disorder were independently associated with low adherence (Nagelkerke R2 = 0.0686). In conclusion, PLHIV with poorly controlled HIV infection presented important psychological vulnerabilities. Mental health should be checked at the beginning of ART and during follow-up, especially in PLHIV with low adherence or low linkage to the health care system.
抑郁症或焦虑症以外的精神障碍与抗逆转录病毒治疗（ART）依从性低及与HIV治疗衔接之间的关系尚不清楚。我们研究的目的是比较西班牙HIV感染者（PLHIV）中ART依从性低与高的人群中精神障碍的患病率。我们进行了一项横断面研究，比较两组PLHIV：20名ART依从性低的PLHIV和80名ART依从性高的PLHIV。符合以下至少一项标准的PLHIV被纳入低依从性组：病毒学失败（连续两份血样中HIV病毒载量>50拷贝/mL）；未按计划进行临床就诊（去年≥2次漏诊）；ART用药不规律（过去一个月内≥10次漏服剂量）；以及ART中断超过1周。高依从性的纳入标准为：接受稳定ART治疗超过1年且HIV病毒载量低于50拷贝/mL且在过去12个月内无漏诊的PLHIV。对参与者进行了米隆临床多轴问卷测试。与高依从性的PLHIV相比，低依从性的PLHIV在所有精神障碍方面得分更高。并且，在多变量二元逻辑回归分析中，药物依赖和创伤后应激障碍与低依从性独立相关（Nagelkerke R2 = 0.0686）。总之，HIV感染控制不佳的PLHIV存在重要的心理脆弱性。在ART开始时及随访期间应检查心理健康，尤其是在依从性低或与医疗保健系统衔接不佳的PLHIV中。
