Pharmacologic Treatment of Psychiatric Disorders and Time With Unsuppressed HIV Viral Load in a Clinical HIV Cohort.
Pharmacologic Treatment of Psychiatric Disorders and Time With Unsuppressed HIV Viral Load in a Clinical HIV Cohort.
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临床 HIV 队列中精神疾病的药物治疗和 HIV 病毒载量不受抑制的时间。
DOI：
10.1097/qai.0000000000002138
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Castel,AmandaD
中科院分区：
文献类型：
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作者：
Levy,MatthewE;Monroe,AnneK;Horberg,MichaelA;Benator,DebraA;Molock,Sherry;Doshi,RupaliK;PowersHapp,Lindsey;Castel,AmandaD
目的：评估 HIV 感染者 (PLWH) 中情绪、焦虑、压力/创伤相关和精神障碍（无论是治疗还是未治疗）与未抑制 HIV 病毒载量 (VL) 持续时间的关系。 背景：DC 队列，一个 PLWH 观察性临床队列，从 2011 年至 2018 年在华盛顿特区 14 个地点进行随访。方法：在 HIV 感染时接受初级护理的 18 岁以上 PLWH 中在诊所中，我们以及时更新的方式确定参与者是否有情绪、焦虑、压力/创伤相关和/或精神障碍的诊断和药物处方。使用带有广义估计方程的多变量泊松回归来评估精神疾病/治疗与随后天数 VL≥ 200 拷贝/mL 的比例之间的关联。 结果：在 5904 名参与者中（中位年龄 51 岁；70% 男性；82% 黑人），45% 患有 ≥ 1 种精神疾病，其中 38% 患有情绪障碍（50% 接受治疗），18% 患有焦虑或焦虑症与压力/创伤相关的疾病（64% 接受治疗），4% 患有精神障碍（52% 接受治疗）。未经治疗的重度抑郁症（调整后的比率= 1.17；95%置信区间：1.00至1.37）、未经治疗的其他/未明确的抑郁症（1.23；1.01至1.49）、未经治疗的双相情感障碍（1.39；1.15至1.69）和已治疗的双相情感障碍（1.25；1.02至1.49） 1.53)（与无情绪障碍相比）预测 VL≥ 200 拷贝/mL 的时间更长。治疗焦虑症（与未治疗焦虑症相比）预测的时间较短（0.78；0.62 至 0.99）。已治疗的抑郁症（与无情绪障碍相比）和未治疗的焦虑症（与无焦虑症）之间的相关性较弱且不显着。结论：患有抑郁症和双相情感障碍的感染者，特别是未经治疗的感染者，比没有情绪障碍的感染者花费更多的时间在未抑制的VL上。情绪障碍的治疗对于促进持续的病毒抑制可能很重要。
Objective:To evaluate associations of mood, anxiety, stress-/trauma-related, and psychotic disorders, both treated and untreated, with duration of unsuppressed HIV viral load (VL) among persons living with HIV (PLWH).Setting:The DC Cohort, an observational clinical cohort of PLWH followed from 2011 to 2018 at 14 sites in Washington, DC.Methods:Among PLWH≥ 18 years old who received primary care at their HIV clinic, we determined in a time-updated manner whether participants had diagnoses and pharmacologic prescriptions for mood, anxiety, stress-/trauma-related, and/or psychotic disorders. Associations between psychiatric disorders/treatments and the proportion of subsequent days with VL≥ 200 copies/mL were assessed using multivariable Poisson regression with generalized estimating equations.Results:Among 5904 participants (median age 51; 70% men; 82% Black), 45% had≥ 1 psychiatric disorder, including 38% with mood disorders (50% treated), 18% with anxiety or stress-/trauma-related disorders (64% treated), and 4% with psychotic disorders (52% treated). Untreated major depressive disorder (adjusted rate ratio= 1.17; 95% confidence interval: 1.00 to 1.37), untreated other/unspecified depressive disorder (1.23; 1.01 to 1.49), untreated bipolar disorder (1.39; 1.15 to 1.69), and treated bipolar disorder (1.25; 1.02 to 1.53)(vs. no mood disorder) predicted more time with VL≥ 200 copies/mL. Treated anxiety disorders (vs. no anxiety disorder) predicted less time (0.78; 0.62 to 0.99). Associations were weaker and nonsignificant for treated depressive disorders (vs. no mood disorder) and untreated anxiety disorders (vs. no anxiety disorder).Conclusions:PLWH with depressive and bipolar disorders, particularly when untreated, spent more time with unsuppressed VL than PLWH without a mood disorder. Treatment of mood disorders may be important for promoting sustained viral suppression.