Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women - Longitudinal analysis from the HIV epidemiology research study
Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women - Longitudinal analysis from the HIV epidemiology research study
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DOI：
10.1001/jama.285.11.1466
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发表时间：
2001-03-21
影响因子：
120.7
通讯作者：
Moore, J
中科院分区：
文献类型：
--
作者：
Ickovics, JR;Hamburger, ME;Moore, J
抑郁症对感染人类免疫缺陷病毒（艾滋病毒）的妇女发病率和死亡率的影响尚未得到研究，尽管感染艾滋病毒的妇女患抑郁症的比例大大高于男性。目的探讨女性HIV感染者抑郁症状与HIV相关死亡率和CD4淋巴细胞计数下降的关系。HIV流行病学研究是一项从1993年4月至1995年1月进行的前瞻性纵向队列研究，随访至2000年3月。在马里兰州巴尔的摩市设立了四个学术医疗中心；纽约布朗克斯;普罗维登斯,国际扶轮;以及密歇根州的底特律。参与者共765名16至55岁的艾滋病毒血清阳性妇女。主要结果测量：与有限或无抑郁症状、间歇性抑郁症状或慢性抑郁症状的妇女相比，使用流行病学研究中心抑郁量表自我报告测量，艾滋病毒相关死亡率和CD4细胞计数在最多7年内斜率下降。结果在控制临床、治疗和其他因素的多因素分析中，有慢性抑郁症状的女性的死亡率是没有或只有有限抑郁症状的女性的2倍（相对危险度[RR]， 2.0； 95%可信区间[CI]， 1.0-3,8）。在CD4细胞计数小于200 × 10(6)/L的妇女中，慢性抑郁症状患者的艾滋病毒相关死亡率为54% (RR, 4.3; 95% CI, 1.6-11.6)，间歇性抑郁症状患者的艾滋病毒相关死亡率为48% (RR, 3.5; 95% CI, 1.1-10.5)，而有限或无抑郁症状患者的艾滋病毒相关死亡率为21%。在控制模型中的其他变量后，慢性抑郁症状也与CD4细胞计数的显著下降有关，特别是在基线CD4细胞计数小于500 x 10(6)/L和基线病毒载量大于10000拷贝/L的女性中。结论：我们的研究结果表明，在控制临床、药物使用和社会人口学特征的情况下，艾滋病毒感染妇女的抑郁症状与艾滋病毒疾病进展有关。这些结果强调了充分诊断和治疗艾滋病毒感染妇女抑郁症的重要性，需要进一步的研究来确定抑郁症的治疗是否不仅可以提高艾滋病毒感染妇女的心理健康，还可以阻止疾病的进展和死亡率。
Context The impact of depression on morbidity and mortality among women with human immunodeficiency virus (HIV) has not been examined despite the fact that women with HIV have substantially higher rates of depression than their male counterparts.Objective To determine the association of depressive symptoms with HIV-related mortality and decline in CD4 lymphocyte counts among women with HIV.Design The HIV Epidemiologic Research Study, a prospective, longitudinal cohort study conducted from April 1993 through January 1995, with follow-up through March 2000.Setting Four academic medical centers in Baltimore, Md; Bronx, NY; Providence, RI; and Detroit, Mich.Participants A total of 765 HIV-seropositive women aged 16 to 55 years.Main Outcome Measures HIV-related mortality and CD4 cell count slope decline over a maximum of 7 years, compared among women with limited or no depressive symptoms, intermittent depressive symptoms, or chronic depressive symptoms, as measured using the self-report Center for Epidemiologic Studies Depression Scale.Results In multivariate analyses controlling for clinical, treatment, and other factors, women with chronic depressive symptoms were 2 times more likely to die than women with limited or no depressive symptoms (relative risk [RR], 2.0; 95% confidence interval [CI], 1.0-3,8). Among women with CD4 cell counts of less than 200 x 10(6)/L, HIV-related mortality rates were 54% for those with chronic depressive symptoms (RR, 4.3; 95 % CI, 1.6-11.6) and 48% for those with intermittent depressive symptoms (RR, 3.5; 95% CI, 1.1-10.5) compared with 21% for those with limited or no depressive symptoms. Chronic depressive symptoms were also associated with significantly greater decline in CD4 cell counts after controlling for other variables in the model, especially among women with baseline CD4 cell counts of less than 500 x 10(6)/L and baseline viral load greater than 10000 copies/mul.Conclusions Our results indicate that depressive symptoms among women with HIV are associated with HIV disease progression, controlling for clinical, substance use, and sociodemographic characteristics. These results highlight the importance of adequate diagnosis and treatment of depression among women with HIV, Further research is needed to determine if treatment of depression can not only enhance the mental health of women with HIV but also impede disease progression and mortality.