Psychiatric symptoms and antiretroviral nonadherence in US youth with perinatal HIV: a longitudinal study.
Psychiatric symptoms and antiretroviral nonadherence in US youth with perinatal HIV: a longitudinal study.
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DOI：
10.1097/qad.0000000000000697
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发表时间：
2015-06-19
期刊：
影响因子：
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通讯作者：
International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) P1055 Study Team
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文献类型：
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作者：
Kacanek D;Angelidou K;Williams PL;Chernoff M;Gadow KD;Nachman S;International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) P1055 Study Team
在对患有围产期艾滋病毒感染(PHIV)的年轻人的纵向研究中，尚未研究特定精神疾病与依从性的关系。我们在两年多的时间里研究了精神疾病和抗逆转录病毒药物不依从性之间的关系。对美国和波多黎各的294名6-17岁的艾滋病病毒感染者进行了纵向研究。我们每年评估三种不依从性结果：在过去3天内错过了5%的剂量，在过去一个月内错过了一剂，以及未抑制的病毒载量(VL)(>；400拷贝/毫升)。我们使用广义估计方程来拟合非依从性的多变量Logistic模型，并使用多变量Logistic回归来评估入院时的精神状况(ADHD、破坏性行为、抑郁、焦虑)与事件不依从性的相关性。在研究开始时，不坚持的患病率为14%(3天回顾)，32%(过去一个月不坚持)和38%(未抑制的VL)，随着时间的推移保持相似。在入选时，38%的患者符合≥1精神疾病的症状截止标准。在96周，抑郁(调整后的优势比(AOR)=4.14；95%可信区间(CI)：1.11~15.42)或有破坏性行为(AOR=3.36；95%CI：1.02~11.10)的患者在96周观察到更大的3天召回不遵守的几率，但不是在进入时。在48周(AOR=2.46；95%CI：1.27-4.78)和96周(AOR=2.35；95%CI：1.01-5.45)，ADHD患者与非ADHD患者相比，VL未被抑制的几率增加。在232名入境青年中，16%的人报告了事件3天召回不遵守的情况。进入时的破坏性行为状况与事件3天召回不遵守有关(AOR=3.01；95%CI：1.24-7.31)。在艾滋病毒青年中，需要全面的遵守干预措施，在向成人护理过渡的整个过程中处理精神疾病。
The relationship of specific psychiatric conditions to adherence has not been examined in longitudinal studies of youth with perinatal HIV infection (PHIV). We examined associations between psychiatric conditions and ARV non-adherence over two years. Longitudinal study in 294 PHIV youth, 6–17 years old, in the US and Puerto Rico. We annually assessed three non-adherence outcomes: missed >5% of doses in past 3 days, missed a dose within the past month, and unsuppressed viral load (VL) (>400 copies/mL). We fit multivariable logistic models for non-adherence using Generalized Estimating Equations and evaluated associations of psychiatric conditions (ADHD, disruptive behavior, depression, anxiety) at entry with incident non-adherence using multivariable logistic regression. Non-adherence prevalence at study entry was 14% (3-day recall), 32% (past month non-adherence), and 38% (unsuppressed VL), remaining similar over time. At entry, 38% met symptom cutoff criteria for ≥1 psychiatric condition. Greater odds of 3-day recall non-adherence were observed at Week 96 for those with depression (Adjusted Odds Ratio (aOR)=4.14; 95% confidence interval (CI): 1.11–15.42) or disruptive behavior (aOR=3.36; 95% CI: 1.02–11.10) but not at entry. Those with vs. without ADHD had elevated odds of unsuppressed VL at Weeks 48 (aOR=2.46; 95% CI: 1.27–4.78) and 96 (aOR=2.35; 95% CI: 1.01–5.45) but not at entry. Among 232 youth adherent at entry, 16% reported incident 3-day recall non-adherence. Disruptive behavior conditions at entry were associated with incident 3-day recall non-adherence (aOR=3.01; 95% CI: 1.24–7.31). In PHIV youth, comprehensive adherence interventions that address psychiatric conditions throughout the transition to adult care are needed.