Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients
Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients
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DOI：
10.1097/qai.0b013e318160d53e
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发表时间：
2008-03-01
影响因子：
3.6
通讯作者：
Kovach, Drew Anthony
中科院分区：
文献类型：
--
作者：
Horberg, Michael Alan;Silverberg, Michael Jonah;Kovach, Drew Anthony
目的：确定抑郁症对高效抗逆转录病毒治疗（HAART）依从性和临床措施的影响，并调查选择性5-羟色胺再摄取抑制剂（SSRIs）是否改善了这些措施。设计：回顾性队列研究方法：在2个大型健康维护组织中，我们测量了抑郁症的影响（使用和不使用SSRI）对开始新HAART方案的HIV感染患者的依从性以及病毒和免疫控制变化的影响。HAART坚持，HIV RNA水平，并在CD 4 T细胞计数的变化，通过12 months measured.Results：共3359例患者进行了评估; 42%有抑郁症的诊断，15%使用SSRIs在HAART。未使用SSRI的抑郁症与HAART依从性达到90%的几率显著降低相关（比值比[OR] = 0.81，95%置信区间[CI]：0.70 - 0.98; P = 0.03）。抑郁症与HIV RNA水平< 500拷贝/mL的几率显著降低相关（OR = 0.77，95%CI：0.62至0.95; P = 0.02）。抑郁症患者依从SSRI药物治疗（> 80%依从SSRI），HAART依从性和病毒控制与非抑郁症HIV感染患者HAART相似。抑郁症与非抑郁症的HIV感染者相比，CD 4 T细胞反应在统计学上是相似的;抑郁症患者中，那些符合SSRI有统计学上更大的增加CD 4细胞responses.Conclusions：抑郁症显着aims HAART坚持和HIV病毒控制。合规使用SSRI与改善HIV依从性和实验室参数相关。
Objectives: To determine the impact of depression on highly active antiretroviral therapy (HAART) adherence and clinical measures and investigate if selective serotonin reuptake inhibitors (SSRIs) improve these measures.Design: Retrospective cohort studyMethods: In 2 large health maintenance organizations, we measured the effects of depression (with and without SSRI use) on adherence and changes in viral and immunologic control among HIV-infected patients starting a new HAART regimen. HAART adherence, HIV RNA levels, and changes in CD4 T-cell counts through 12 months were measured.Results: A total of 3359 patients were evaluated; 42% had a depression diagnosis, and 15% used SSRIs during HAART. Depression without SSRI use was associated with significantly decreased odds of achieving 90% adherence to HAART (odds ratio [OR] = 0.81, 95% confidence interval [CI]: 0.70 to 0.98; P = 0.03). Depression was associated with significantly lower odds of an HIV RNA level < 500 copies/mL (OR = 0.77, 95% CI: 0.62 to 0.95; P = 0.02). Depressed patients compliant with SSRI medication (> 80% adherence to SSRI) had HAART adherence and viral control statistically similar to nondepressed HIV-infected patients taking HAART. Comparing depressed with nondepressed HIV-infected patients, CD4 T-cell responses were statistically similar; among depressed patients, those compliant with SSRI had statistically greater increases in CD4 cell responses.Conclusions: Depression significantly worsens HAART adherence and HIV viral control. Compliant SSRI use is associated with improved HIV adherence and laboratory parameters.