Machado Daisy Maria, Duda Stephany N, Célia de Menezes Succi Regina, Kim Ahra, Ranadive Paridhi, Rouzier Vanessa, Crabtree-Ramírez Brenda, Luque Marco T, Mejia Fernando, Rodríguez Fernanda, Pinto Jorge, Wagner Cardoso Sandra, Maruri Fernanda, Shepherd Bryan E, McGowan Catherine C, Person Anna K
Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Open Forum Infect Dis. 2025 Jun 17;12(7):ofaf353. doi: 10.1093/ofid/ofaf353. eCollection 2025 Jul.
Adolescents and young adults with HIV (AYAWH) represent vulnerable populations, with increased risk of virologic failure, loss to follow-up, and death. Depression and substance use in AYAWH can lead to worse outcomes, yet this overlap is not well understood.
This cross-sectional study included adolescents (10-17 years) and young adults (18-24 years) with HIV in the Caribbean, Central and South America network for HIV epidemiology (CCASAnet). Participants were administered surveys to assess for depression, substance use, and antiretroviral therapy (ART) adherence. Risk factors for depression; alcohol, tobacco, and substance use; missing ART doses; viral suppression; and 1-year retention were assessed.
Six hundred twenty-five AYAWH were included. Depression prevelance was 16%. Males (adjusted odds ratio [aOR], 0.26; 95% CI, 0.16-0.44) and younger youth (15-year-olds vs 18-year-olds: aOR, 0.61; 95% CI, 0.40-0.95) were less likely to have depression. Fifty-eight percent reported using alcohol, 28% reported tobacco use, 17% reported cannabis use, and 4% reported cocaine use. Forty-one percent missed 1 or more doses of ART in the past week. Forty percent had detectable viral loads at the time of survey completion. Those who acquired HIV perinatally were more likely to have an unsuppressed viral load (aOR, 2.4; 95% CI, 1.24-4.62; = .009). Only 73% of participants were retained in care following the survey; there was no statistical association between retention and age, sex, education, probable route of HIV acquisition, depression, and needing intervention for substance use.
Substance use and depression were prevalent in AYAWH, as were missed doses of ART and detectable viral loads.
感染艾滋病毒的青少年和青年（AYAWH）是弱势群体，病毒学治疗失败、失访和死亡风险增加。AYAWH中的抑郁和物质使用会导致更糟的结果，但这种重叠情况尚未得到充分了解。
这项横断面研究纳入了加勒比地区、中美洲和南美洲艾滋病毒流行病学网络（CCASAnet）中感染艾滋病毒的青少年（10 - 17岁）和青年（18 - 24岁）。参与者接受了评估抑郁、物质使用和抗逆转录病毒疗法（ART）依从性的调查。评估了抑郁的风险因素；酒精、烟草和物质使用；错过ART剂量；病毒抑制；以及1年的留存率。
共纳入625名AYAWH。抑郁患病率为16%。男性（调整优势比[aOR]，0.26；95%置信区间[CI]，0.16 - 0.44）和较年轻的青少年（15岁与18岁相比：aOR，0.61；95% CI，0.40 - 0.95）患抑郁症的可能性较小。58%的人报告使用过酒精，28%的人报告使用过烟草，17%的人报告使用过大麻，4%的人报告使用过可卡因。41%的人在过去一周内错过1剂或更多剂ART。在调查完成时，40%的人病毒载量可检测到。围产期感染艾滋病毒的人更有可能病毒载量未得到抑制（aOR，2.4；95% CI，1.24 - 4.62；P = 0.009）。调查后只有73%的参与者仍在接受治疗；留存率与年龄、性别、教育程度、可能的艾滋病毒感染途径、抑郁以及物质使用需要干预之间无统计学关联。
物质使用和抑郁在AYAWH中很普遍，错过ART剂量和病毒载量可检测到的情况也很普遍。
