Persistent CSF but not plasma HIV RNA is associated with increased risk of new-onset moderate-to-severe depressive symptoms; a prospective cohort study
Persistent CSF but not plasma HIV RNA is associated with increased risk of new-onset moderate-to-severe depressive symptoms; a prospective cohort study
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DOI：
10.1007/s13365-015-0416-1
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发表时间：
2016-08-01
影响因子：
3.2
通讯作者：
Mcarthur, Justin C.
中科院分区：
文献类型：
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作者：
Hammond, Edward R.;Crum, Rosa M.;Mcarthur, Justin C.
重度抑郁症是人类免疫缺陷病毒（HIV）感染中最常见的神经精神并发症，并与较差的临床结果相关。我们确定脑脊液（CSF） HIV核糖核酸（RNA）在阈值为千分之一/毫升时是否与抑郁症风险增加有关。CNS HIV抗逆转录病毒治疗效果研究（CHARTER）队列是一个美国六个中心的前瞻性队列，每两年随访674名参与者。我们拟合线性混合模型（N = 233）和离散时间生存模型（N = 154； 832个观察值），以评估接受联合抗逆转录病毒治疗（cART）的参与者的贝克抑郁量表（BDI） II评分轨迹和新发中度至重度抑郁症状（BDI千分之一/年/欧元千分之一17）的发生率，这些参与者在研究开始时无抑郁，在2496人月随访期间接受了至少三次脑脊液检查。在任何访问中检测到的CSF HIV RNA（阈值为千分之一/毫升）与随后访问中根据血浆HIV RNA和治疗依从性调整的新发抑郁症增加4.7倍相关；风险比(HR) = 4.76, (95% CI 1.58-14.3)；P = 0.006。在包括年龄、性别、种族、教育程度、血浆HIV RNA、CART持续时间和依从性，以及根据《诊断统计手册》（DSM-IV）标准诊断的终生抑郁的完全调整模型中，如果在先前的研究访问中检测到CSF HIV RNA， 6个月后抑郁（BDI）评分高2.53分（95% CI 0.47-4.60; P = 0.02）。持久性脑脊液而非血浆HIV RNA与新发抑郁症风险增加相关。进一步的研究评估免疫激活和炎症标志物的作用可能会提高我们对这种关联的理解。
Major depressive disorder is the most common neuropsychiatric complication in human immunodeficiency virus (HIV) infections and is associated with worse clinical outcomes. We determined if detectable cerebrospinal fluid (CSF) HIV ribonucleic acid (RNA) at threshold a parts per thousand yen50 copies/ml is associated with increased risk of depression. The CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) cohort is a six-center US-based prospective cohort with bi-annual follow-up of 674 participants. We fit linear mixed models (N = 233) and discrete-time survival models (N = 154; 832 observations) to evaluate trajectories of Beck Depression Inventory (BDI) II scores and the incidence of new-onset moderate-to-severe depressive symptoms (BDI a parts per thousand yenaEuro parts per thousand 17) among participants on combination antiretroviral therapy (cART), who were free of depression at study entry and received a minimum of three CSF examinations over 2496 person-months follow-up. Detectable CSF HIV RNA (threshold a parts per thousand yen50 copies/ml) at any visit was associated with a 4.7-fold increase in new-onset depression at subsequent visits adjusted for plasma HIV RNA and treatment adherence; hazard ratio (HR) = 4.76, (95 % CI 1.58-14.3); P = 0.006. Depression (BDI) scores were 2.53 points higher (95 % CI 0.47-4.60; P = 0.02) over 6 months if CSF HIV RNA was detectable at a prior study visit in fully adjusted models including age, sex, race, education, plasma HIV RNA, duration and adherence of CART, and lifetime depression diagnosis by Diagnostic Statistical Manual (DSM-IV) criteria. Persistent CSF but not plasma HIV RNA is associated with an increased risk for new-onset depression. Further research evaluating the role of immune activation and inflammatory markers may improve our understanding of this association.