The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial.
The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial.
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DOI：
10.1097/qad.0000000000000797
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发表时间：
2015-09-24
期刊：
影响因子：
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通讯作者：
Quinlivan EB
中科院分区：
文献类型：
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作者：
Pence BW;Gaynes BN;Adams JL;Thielman NM;Heine AD;Mugavero MJ;McGuinness T;Raper JL;Willig JH;Shirey KG;Ogle M;Turner EL;Quinlivan EB
抑郁症是艾滋病毒治疗结果的主要障碍。测试将抗抑郁治疗管理决策支持纳入艾滋病毒护理中是否可以提高抗逆转录病毒治疗依从性和抑郁症发病率。伪整群随机试验。美国四家传染病诊所。患有严重抑郁症的艾滋病毒感染成年人。基于测量的护理：抑郁症护理管理者使用系统指标为艾滋病毒初级保健临床医生提供标准化的抗抑郁治疗建议。主要：抗逆转录病毒药物治疗依从性（每月未通知的电话药物数量为 1200 万粒）。主要时间点：6m。次要：抑郁严重程度、抑郁缓解、无抑郁天数，每季度测量 12m。从 2010 年到 2013 年，149 名参与者被随机分配接受干预，155 名参与者被随机分配接受常规护理。参与者大多是男性、非西班牙裔黑人、失业者和病毒抑制者，自我报告的抗逆转录病毒治疗依从性和抑郁严重程度基线较高。在随访过程中，各组之间在抗逆转录病毒治疗依从性或其他艾滋病毒结果方面没有明显差异。 6个月时，干预参与者的抑郁严重程度低于常规治疗（平均差−3.7 [95% CI：−5.6，−1.7]），抑郁缓解的概率较高（风险差13% [1%，25%]），自杀意念较低（RD −18% [−30%，−6%]）。到 12 个月时，两组的心理健康结果相当。干预组参与者在 12 个月内平均多经历了 29 天（95% CI：1-57）天的无抑郁天数。在针对感染艾滋病毒的成年人进行的此类最大型试验中，MBC 并没有改善艾滋病毒结果，可能是因为基线依从性较高，但实现了临床上显着的抑郁症改善并增加了无抑郁天数。 MBC 可能是降低 HIV 患者抑郁症发病率的有效且资源高效的方法。
Depression is a major barrier to HIV treatment outcomes. Test whether antidepressant management decision support integrated into HIV care improves antiretroviral adherence and depression morbidity. Pseudo-cluster randomized trial. Four US infectious diseases clinics. HIV-infected adults with major depressive disorder. Measurement-Based Care: depression care managers used systematic metrics to give HIV primary-care clinicians standardized antidepressant treatment recommendations. Primary: Antiretroviral medication adherence (monthly unannounced telephone-based pill counts for 12m). Primary timepoint: 6m. Secondary: Depressive severity, depression remission, depression-free days, measured quarterly for 12m. From 2010-2013, 149 participants were randomized to intervention and 155 to usual care. Participants were mostly male, Black non-Hispanic, unemployed, and virally suppressed with high baseline self-reported antiretroviral adherence and depressive severity. Over follow-up, no differences between arms in antiretroviral adherence or other HIV outcomes were apparent. At 6 months, depressive severity was lower among intervention participants than usual care (mean difference −3.7 [95% CI: −5.6, −1.7]), probability of depression remission was higher (risk difference 13% [1%, 25%]), and suicidal ideation was lower (RD −18% [−30%, −6%]). By 12 months the arms had comparable mental health outcomes. Intervention arm participants experienced an average of 29 (95% CI: 1-57) more depression-free days over 12 months. In the largest trial of its kind among HIV-infected adults, MBC did not improve HIV outcomes, possibly because of high baseline adherence, but achieved clinically significant depression improvements and increased depression-free days. MBC may be an effective, resource-efficient approach to reducing depression morbidity among HIV patients.