HAART receipt and viral suppression among HIV-infected patients with co-occurring mental illness and illicit drug use.
HAART receipt and viral suppression among HIV-infected patients with co-occurring mental illness and illicit drug use.
复制标题
DOI：
10.1080/09540120802459762
复制
发表时间：
2009-05
期刊：
影响因子：
1.7
通讯作者：
Gebo KA
中科院分区：
文献类型：
--
作者：
Chander G;Himelhoch S;Fleishman JA;Hellinger J;Gaist P;Moore RD;Gebo KA
精神疾病(MI)和非法药物使用(DU)经常同时发生。我们试图确定MI和DU对从事HIV护理的个体接受高效抗逆转录病毒疗法(HAART)和抑制HIV-RNA的单独和联合影响。利用2004年艾滋病毒研究网络(HIVRN)的数据，我们对七个初级保健地点的艾滋病毒感染患者进行了一项横断面研究。感兴趣的结果是接受HAART和病毒学抑制，定义为HIV-RNA；400拷贝/毫升。感兴趣的自变量是：(1)MI/DU；(2)仅DU；(3)仅MI；(4)两者都不是。我们使用卡方分析进行分类变量的比较，并使用Logistic回归对年龄、种族、性别、门诊就诊频率、临床护理年限、CD4值和研究地点进行调整。2004年间，艾滋病病毒感染者中有10,284人参加了HAART或HAART，其定义为CD4细胞计数≤350。近半数患者既无心肌梗死又无DU(41%)，仅MI者占22%，DU者占15%，MI和DU并存者占22%。在多变量分析中，MI/DU并存与接受HAART的几率最低相关(调整后优势比：0.63(95%CI：(0.55-0.72))，其次是仅有DU(0.75(0.63-0.87))，而两者均未发生。在接受HAART的患者中，同时存在MI/DU(0.66(0.58-0.75))和仅存在DU(0.77(0.67-0.88))也与HIV-RNA抑制的几率降低有关。仅MI与HAART接受量(0.93(0.81-1.07))或病毒抑制(0.93(0.82-1.05))相比均无统计学意义的显著下降。后估计检验显示，仅MI/DU和DU与MI/DU和MI之间有显著差异。与MI或DU或两者都不存在的患者相比，同时出现MI和DU的患者的HAART接受率和病毒抑制程度较低。将艾滋病毒、药物滥用和精神卫生保健结合起来可能会改善这一人群的结果。
Mental illness (MI) and illicit drug use (DU) frequently co-occur. We sought to determine the individual and combined effects of MI and DU on highly active antiretroviral therapy (HAART) receipt and HIV-RNA suppression among individuals engaged in HIV care. Using 2004 data from the HIV Research Network (HIVRN), we performed a cross-sectional study of HIV-infected patients followed at seven primary care sites. Outcomes of interest were HAART receipt and virological suppression, defined as an HIV-RNA <400 copies/ml. Independent variables of interest were: (1) MI/DU; (2) DU only; (3) MI only; and (4) Neither. We used chi-squared analysis for comparison of categorical variables, and logistic regression to adjust for age, race, sex, frequency of outpatient visits, years in clinical care, CD4 nadir, and study site. During 2004, 10,284 individuals in the HIVRN were either on HAART or HAART eligible defined as a CD4 cell count ≤350. Nearly half had neither MI nor DU (41%), 22% MI only, 15% DU only, and 22% both MI and DU. In multivariate analysis, co-occurring MI/DU was associated with the lowest odds of HAART receipt (Adjusted Odds Ratio: 0.63 (95% CI: (0.55-0.72]), followed by those with DU only (0.75(0.63-0.87)), compared to those with neither. Among those on HAART, concurrent MI/DU (0.66 (0.58-0.75)), DU only (0.77 (0.67-0.88)), were also associated with a decreased odds of HIV-RNA suppression compared to those with neither. MI only was not associated with a statistically significant decrease in HAART receipt (0.93(0.81-1.07)) or viral suppression (0.93 (0.82-1.05)) compared to those with neither. Post-estimation testing revealed a significant difference between those with MI/DU and DU only, and MI/DU and MI only. Co-occurring MI and DU is associated with lower HAART receipt and viral suppression compared to individuals with either MI or DU or neither. Integrating HIV, substance abuse, and mental healthcare may improve outcomes in this population.
登录
查看更多内容
影响因子：
5.4
作者：
Spire, B;Duran, S;Moatti, JP
通讯作者：
Moatti, JP
影响因子：
17.7
作者：
Watkins, KE;Paddock, SM;Wells, KB
通讯作者：
Wells, KB
影响因子：
7
作者：
Himelhoch, Seth;Chander, Geetanjali;Gebo, Kelly A.
通讯作者：
Gebo, Kelly A.
DOI：
10.1097/00126334-200501010-00017
发表时间：
2005-01-01
影响因子：
3.6
作者：
Gebo, KA;Fleishman, JA;Mathews, WC
通讯作者：
Mathews, WC
影响因子：
5.3
作者：
Buckley, Peter F.
通讯作者：
Buckley, Peter F.