PSYCHIATRIC COMORBITY IN PERINATALLY HIV INFECTED CHILDREN AND ADOLESCENTS

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 假设：与未感染艾滋病毒的对照组相比，感染艾滋病毒的儿童和青少年将表现出更高的精神合并症患病率。在艾滋病毒感染者中，精神疾病的发病率会因接受抗逆转录病毒治疗而有所不同。有抑郁症状的受试者或有冲动控制问题的受试者在坚持抗逆转录病毒治疗方面会出现失误。 最近的数据表明，与感染艾滋病毒但未感染的儿童和青少年相比，围产期感染艾滋病毒的儿童和青少年的精神科住院率明显更高(1)。P1055是一项多中心、非治疗的观察性研究，研究艾滋病毒对400名围产期感染艾滋病毒的儿童和青少年(6至12岁至18岁)精神症状的患病率和严重程度的影响，然后选择对照受试者，在按性别和年龄组创建的四个层次内进行频率匹配。所有800名受试者将在进入时以及进入后大约一年(48周)和两年(96周)接受精神症状患病率和严重程度的评估。此外，200-240名艾滋病毒感染者和对照对象(每组100-120人)及其父母/主要照顾者的子组将参加半结构化精神病学访谈，以临床评估基于DSM-IV定义的障碍的暂定精神诊断。 这项研究将探讨儿童和青少年精神症状与艾滋病毒变量(例如抗逆转录病毒治疗的时间和类型、艾滋病毒症状的严重程度、疾病控制中心[CDC]临床和免疫学类别)、对治疗方案的依从性以及环境逆境(例如暴露于创伤、暴力、药物滥用/使用、贫困、主要照顾者的精神健康等)之间的关系。这些变量对儿童和青少年心理健康的影响在衡量多种症状方面预计是非特异性的，尽管根据之前对慢性病儿童和青少年的研究以及我们自己对患有神经疾病的儿童和青少年的研究，最强的影响预计是焦虑、抑郁和ADHD症状的频率和严重程度。还将审查儿童或青少年的人口特征(年龄和性别)、智力功能、父母/主要照顾者的心理健康、家庭稳定性以及是否存在可能的保护因素的直接和间接影响。这项研究将侧重于这些特征，试图了解艾滋病毒感染影响的不同脆弱性或复原力。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Hypothesis: Children and adolescents infected with HIV will exhibit a greater prevalence of psychiatric comorbidity as compared to non-HIV infected controls. Among HIV infected subjects, psychiatric morbidity would be different based on exposure to antiretroviral therapy. Subjects with depression symptomatology or those with impulse control problems will display lapses in adherence to antiretroviral therapy. Recent data suggest that perinatally HIV-infected children and adolescents have significantly higher rates of psychiatric hospitalizations when compared to both HIV-exposed but uninfected children and adolescents (1). P1055 is a multicenter, non-treatment, observational study of the effect of HIV on the prevalence and severity of psychiatric symptoms in 400 perinatally HIV-infected children and adolescents ages 6 to 12 to 18), and then control subjects will be selected to be frequency matched within the four strata created by gender and age group. All 800 subjects will be assessed for the prevalence and severity of psychiatric symptoms at entry and at approximately 1 year (48 weeks) and 2 years (96 weeks) after entry. In addition, a subset of 200-240 HIV-infected subjects and control subjects (100 - 120 in each group) and their parents/primary caregivers will participate in semi-structured psychiatric interviews to clinically evaluate tentative psychiatric diagnoses based on DSM-IV defined disorders. This study will examine the relationship between child and adolescent psychiatric symptoms and HIV variables (e.g., length and type of antiretroviral therapy, severity of HIV symptoms, Center for Disease Control [CDC] clinical and immunological categories), compliance with treatment regimens, and environmental adversities (e.g., exposure to trauma, violence, substance abuse/use, poverty, mental health of primary caregiver, etc.). The influence of these variables on child and adolescent mental health is expected to be nonspecific with regard to measures of multiple symptoms, although the strongest effect, based on prior studies of children and adolescents with chronic illness and our own research on children and adolescents with neurological disorders, is expected to be frequency and severity of anxiety, depression, and ADHD symptoms. The direct and indirect effects of the child or adolescent's demographic characteristics (age and gender), intellectual functioning, parent/primary caregiver mental health, family stability, and the presence of possible protective factors will also be examined. This study will focus on these characteristics in an attempt to understand the differential vulnerability or resilience to the effects of HIV infection.