Trajectories of Depressive Symptoms, Neurocognitive Function, and Viral Suppression With Antiretroviral Therapy Among Youth With HIV Over 36 months.
Trajectories of Depressive Symptoms, Neurocognitive Function, and Viral Suppression With Antiretroviral Therapy Among Youth With HIV Over 36 months.
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抑郁症状、神经认知功能和抗逆转录病毒治疗对36个月以上HIV感染青年的病毒抑制的轨迹。
DOI：
10.1097/qai.0000000000002653
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发表时间：
2021-06-01
期刊：
影响因子：
--
通讯作者：
Hong S
中科院分区：
文献类型：
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作者：
Kohn JN;Loop MS;Kim-Chang JJ;Garvie PA;Sleasman JW;Fischer B;Rendina HJ;Woods SP;Nichols SL;Hong S
抑郁症和神经认知障碍在艾滋病毒感染者中非常普遍，并与较差的临床结果相关；然而，青少年HIV感染者（YLWH）抑郁-神经认知关系的纵向研究以及抗逆转录病毒治疗（ART）的作用尚缺乏。本研究测试了(1)抑郁症状学，包括躯体、认知和情感症状领域，是否在抗逆转录病毒治疗后得到改善；(2)基线时更严重的抑郁症状是否与较差的神经认知功能和(3)较差的HIV抑制有关。收集的数据来自181名YLWH（18-24岁）treatment-naïve，其中一部分（n=116）开始接受抗逆转录病毒治疗。参与者在入组时被分为抑郁症状升高（DS）组或非抑郁症状升高（非DS）组（Beck抑郁量表- ii≥14），随访36个月。反复评估神经认知（五域电池）和抑郁症状。纵向模型按组检查抑郁症状、神经认知和HIV不受抑制的几率。在36个月内，DS组观察到抑郁症状有较大改善（β = - 0.14,[- 0.24, - 0.03]），特别是在认知和情感领域。语言学习成绩在DS组有所提高（beta=0.13,[0.01,0.24]），而精神运动功能在非DS组有所改善（beta= - 0.10,[- 0.22,0.00]）。经抗逆转录病毒治疗依从性调整后，各组HIV无抑制的几率无显著差异（优势比=0.22,[0.04,1.23]）；然而，研究开始时躯体症状越严重，随着时间的推移，非抑制风险越高（优势比=2.33[1.07,5.68]）。抑郁症状与不同的神经认知轨迹相关，基线时的躯体抑郁症状可能预示随后较差的HIV抑制。在抗逆转录病毒治疗开始时识别和治疗抑郁症状可能有利于YLWH患者的神经认知和临床结果。
Depression and neurocognitive impairment are highly prevalent among persons living with HIV and associated with poorer clinical outcomes; however, longitudinal studies of depression-neurocognition relationships in youth living with HIV (YLWH), and the role of antiretroviral therapy (ART), are lacking. This study tested whether (1) depressive symptomatology, across somatic, cognitive, and affective symptom domains, improved with ART, and (2) more severe depressive symptoms at baseline were associated with poorer neurocognitive function and (3) poorer HIV suppression. Data were collected from 181 YLWH (18-24 years) who were treatment-naïve, a subset of whom (n=116) initiated ART. Participants were categorized into elevated (DS) or non-elevated (non-DS) depressive symptom groups at entry (Beck Depression Inventory-II ≥14) and followed for 36 months. Neurocognition (five-domain battery) and depressive symptoms were repeatedly assessed. Longitudinal models examined depressive symptomatology, neurocognition, and odds of HIV non-suppression by group. Greater improvements in depressive symptoms were observed in the DS group over 36 months (beta=−0.14, [−0.24,−0.03]), particularly within cognitive and affective domains. Verbal learning performance increased in the DS group (beta=0.13, [0.01,0.24]), whereas psychomotor function improved somewhat in the non-DS group (beta=−0.10, [−0.22,0.00]). Adjusted for ART adherence, odds of HIV non-suppression did not significantly differ by group (odds ratio=0.22, [0.04,1.23]); however, greater somatic symptoms at study entry were associated with increased risk of non-suppression over time (odds ratio=2.33 [1.07,5.68]). Depressive symptoms were associated with differential neurocognitive trajectories, and somatic depressive symptoms at baseline may predict poorer subsequent HIV suppression. Identifying and treating depressive symptoms at ART initiation may benefit neurocognitive and clinical outcomes in YLWH.