Depression at antiretroviral therapy initiation and clinical outcomes among a cohort of Tanzanian women living with HIV.
Depression at antiretroviral therapy initiation and clinical outcomes among a cohort of Tanzanian women living with HIV.
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DOI：
10.1097/qad.0000000000001323
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发表时间：
2017-01-14
期刊：
影响因子：
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通讯作者：
Smith Fawzi MC
中科院分区：
文献类型：
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作者：
Sudfeld CR;Kaaya S;Gunaratna NS;Mugusi F;Fawzi WW;Aboud S;Smith Fawzi MC
这项研究的目的是评估坦桑尼亚艾滋病毒感染妇女在抗逆转录病毒治疗（ART）开始时抑郁与死亡率和临床结局的关系。我们对坦桑尼亚达累斯萨拉姆1，487名开始ART的女性进行了一项前瞻性队列研究。抑郁和焦虑的症状进行了评估，使用坦桑尼亚改编和验证版本的霍普金斯症状自评量表（HSCL-25）。参与者在ART的前两年每月参加一次诊所访问，每四个月评估一次CD 4 T细胞计数。比例风险模型用于评估抑郁症与死亡率和临床结局的关系。在开始抗逆转录病毒治疗的妇女中，57.8%的人普遍存在抑郁症状。在包括社会支持和耻辱在内的多变量调整后，ART启动时的抑郁与死亡风险增加（HR：1.92; 95% CI：1.15-3.20; p=0.01）和严重贫血（血红蛋白<8.5 g/dL）发生率增加（HR：1.59; 95% CI：1.07-2.37; p=0.02）相关。在因果关系的假设下，我们估计研究队列中36.1%（95%CI：13.6-55.1%）的死亡可归因于抑郁症及其后果。抑郁症与CD 4 T细胞重建轨迹或免疫失败风险无显著相关性（p值>0.05）。在我们的研究队列中，消除抑郁症可能会使ART前两年的死亡率降低三分之一。需要进行随机试验和严格的实施研究，以评估在资源有限的情况下综合心理健康干预措施和艾滋病毒治疗方法在个人和人口层面的影响。
The objective of the study was to assess the relationship of depression at antiretroviral therapy (ART) initiation with mortality and clinical outcomes among Tanzanian women living with HIV. We conducted a prospective cohort study of 1,487 women who initiated ART in Dar es Salaam, Tanzania. Symptoms of depression and anxiety were assessed using a Tanzanian adapted and validated version of the Hopkins Symptom Checklist (HSCL-25). Participants attended monthly clinic visits during the first two years of ART and CD4 T-cell counts were assessed every four months. Proportional hazard models were used to assess the relationship of depression with mortality and clinical outcomes. Symptoms consistent with depression were prevalent among 57.8% of women at ART initiation. After multivariate adjustment including social support and stigma, depression at ART initiation was associated with increased risk of mortality (HR: 1.92; 95% CI: 1.15-3.20; p=0.01) and incidence of severe anemia (hemoglobin <8.5 g/dL) (HR: 1.59; 95% CI: 1.07-2.37; p=0.02). Under the assumption of causality, we estimate 36.1% (95% CI: 13.6-55.1%) of deaths among the study cohort were attributable to depression and its consequences. Depression was not significantly associated with trajectory of CD4 T-cell reconstitution or the risk of immunologic failure (p-values >0.05). Elimination of depression may reduce mortality during the first two years of ART by one-third in our study cohort. Randomized trials and rigorous implementation studies are needed to evaluate the individual- and population-level effects of integrated mental health interventions and HIV treatment approaches in resouce-limited settings.