Jeremy L. Ross, Dhanushi Rupasinghe, Thida Chanyachukul, Brenda Crabtree Ramírez, Gad Murenzi, Edith Kwobah, Fiona Mureithi, Albert Minga, Ivan Marbaniang, Hugo Perazzo, Angela Parcesepe, Suzanne Goodrich, Cleophas Chimbetete, Ephrem Mensah, Fernanda Maruri, Dung Thi Hoai Nguyen, Alvaro López-Iñiguez, Kathryn Lancaster, Helen Byakwaga, Mpho Tlali, Marie K. Plaisy, Smita Nimkar, Rodrigo Moreira, Kathryn Anastos, Aggrey Semeere, Gilles Wandeler, Antoine Jaquet, Annette Sohn, the Sentinel Research Network of the International epidemiology Databases to Evaluate AIDS
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Plaisy, Smita Nimkar, Rodrigo Moreira, Kathryn Anastos, Aggrey Semeere, Gilles Wandeler, Antoine Jaquet, Annette Sohn, the Sentinel Research Network of the International epidemiology Databases to Evaluate AIDS","doi":"10.1002/jia2.26434","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>People with HIV (PWH) are vulnerable to mental health and substance use disorders (MSDs), but the extent to which these are associated with other non-communicable diseases in ageing PWH populations remains poorly documented. We assessed comorbidities associated with symptoms of MSD among PWH ≥40 years in the Sentinel Research Network (SRN) of the International epidemiology Database to Evaluate AIDS (IeDEA).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Baseline data collected between June 2020 and September 2022, from 10 HIV clinics in Asia, Latin America and Africa contributing to the SRN, were analysed. Symptoms of MSDs and comorbidities were assessed using standardized questionnaires, anthropometric and laboratory tests, including weight, height, blood pressure, glucose, lipids, chronic viral hepatitis and liver transient elastography. HIV viral load, CD4 count and additional routine clinical data were accessed from participant interview or medical records. HIV and non-HIV clinical associations of mental illness symptoms and unhealthy substance use were analysed using logistic regression. Mental illness symptoms were defined as moderate-to-severe depressive symptoms (PHQ-9 score >9), moderate-to-severe anxiety symptoms (GAD-7 >9) or probable post-traumatic stress disorder (PCL-5 >32). Unhealthy substance use was defined as ASSIST score >3, or AUDIT ≥7 for women (≥8 for men).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of 2614 participants assessed at baseline study visits, 57% were female, median age was 50 years, median CD4 was 548 cells/mm<sup>3</sup> and 86% had HIV viral load <1000 copies/ml. Overall, 19% had mental illness symptoms, 15% unhealthy substance use, 49% BMI >25 kg/m<sup>2</sup>, 38% hypertension, 15% type 2 diabetes, 35% dyslipidaemia, 34% liver disease and 23% history of tuberculosis. BMI >25 and dyslipidaemia were found in 54% and 40% of those with mental illness symptoms compared to 49% and 34% of those without. Mental illness symptoms were not significantly associated with the clinical factors assessed. Unhealthy substance use was more likely among those with dyslipidaemia (OR 1.55, CI 1.16−2.09, <i>p</i> = 0.003), and less likely in those with BMI >25 (OR 0.48, CI 0.30−0.77, <i>p</i> = 0.009).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Improved integration of MSD and comorbidity services in HIV clinical settings, and further research on the association between MSD and comorbidities, and care integration among older PWH in low-middle-income countries, are required.</p>\n </section>\n </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6000,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26434","citationCount":"0","resultStr":"{\"title\":\"Comorbidities and HIV-related factors associated with mental health symptoms and unhealthy substance use among older adults living with HIV in low- and middle-income countries: a cross-sectional study\",\"authors\":\"Jeremy L. 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引用次数: 0
摘要
艾滋病毒感染者（PWH）容易受到精神健康和物质使用障碍（MSDs）的影响，但在老龄PWH人群中，这些疾病与其他非传染性疾病的关联程度仍然缺乏记录。我们在国际艾滋病流行病学评估数据库（IeDEA）的哨点研究网络（SRN）中评估了PWH≥40岁中与MSD症状相关的合并症。方法分析2020年6月至2022年9月期间从亚洲、拉丁美洲和非洲参与SRN的10家艾滋病毒诊所收集的基线数据。通过标准化问卷调查、人体测量和实验室测试（包括体重、身高、血压、血糖、血脂、慢性病毒性肝炎和肝脏瞬时弹性成像）评估MSDs的症状和合并症。从参与者访谈或医疗记录中获取HIV病毒载量、CD4计数和其他常规临床数据。使用逻辑回归分析了艾滋病毒和非艾滋病毒与精神疾病症状和不健康物质使用的临床关联。精神疾病症状定义为中度至重度抑郁症状（PHQ-9评分>；9）、中度至重度焦虑症状（GAD-7 >9）或可能的创伤后应激障碍（PCL-5 >32）。不健康物质使用的定义为ASSIST评分>；3，或女性AUDIT评分≥7（男性≥8）。结果在基线研究访问时评估的2614名参与者中，57%为女性，中位年龄为50岁，中位CD4为548个细胞/mm3, 86%的HIV病毒载量为1000拷贝/ml。总体而言，19%的人有精神疾病症状，15%的人使用不健康的物质，49%的人体重指数为25kg /m2, 38%的人患有高血压，15%的人患有2型糖尿病，35%的人患有血脂异常，34%的人患有肝病，23%的人有结核病史。BMI指数为25和血脂异常在有精神疾病症状的人群中分别占54%和40%，而在没有精神疾病症状的人群中分别占49%和34%。精神疾病症状与所评估的临床因素无显著相关性。不健康物质使用在血脂异常的人群中更容易发生（OR 1.55, CI 1.16 - 2.09, p = 0.003），而在BMI >；25的人群中较少发生（OR 0.48, CI 0.30 - 0.77, p = 0.009）。结论：需要在艾滋病毒临床环境中改进MSD和合并症服务的整合，并进一步研究MSD和合并症之间的关系，以及中低收入国家老年PWH的护理整合。
Comorbidities and HIV-related factors associated with mental health symptoms and unhealthy substance use among older adults living with HIV in low- and middle-income countries: a cross-sectional study
Introduction
People with HIV (PWH) are vulnerable to mental health and substance use disorders (MSDs), but the extent to which these are associated with other non-communicable diseases in ageing PWH populations remains poorly documented. We assessed comorbidities associated with symptoms of MSD among PWH ≥40 years in the Sentinel Research Network (SRN) of the International epidemiology Database to Evaluate AIDS (IeDEA).
Methods
Baseline data collected between June 2020 and September 2022, from 10 HIV clinics in Asia, Latin America and Africa contributing to the SRN, were analysed. Symptoms of MSDs and comorbidities were assessed using standardized questionnaires, anthropometric and laboratory tests, including weight, height, blood pressure, glucose, lipids, chronic viral hepatitis and liver transient elastography. HIV viral load, CD4 count and additional routine clinical data were accessed from participant interview or medical records. HIV and non-HIV clinical associations of mental illness symptoms and unhealthy substance use were analysed using logistic regression. Mental illness symptoms were defined as moderate-to-severe depressive symptoms (PHQ-9 score >9), moderate-to-severe anxiety symptoms (GAD-7 >9) or probable post-traumatic stress disorder (PCL-5 >32). Unhealthy substance use was defined as ASSIST score >3, or AUDIT ≥7 for women (≥8 for men).
Results
Of 2614 participants assessed at baseline study visits, 57% were female, median age was 50 years, median CD4 was 548 cells/mm3 and 86% had HIV viral load <1000 copies/ml. Overall, 19% had mental illness symptoms, 15% unhealthy substance use, 49% BMI >25 kg/m2, 38% hypertension, 15% type 2 diabetes, 35% dyslipidaemia, 34% liver disease and 23% history of tuberculosis. BMI >25 and dyslipidaemia were found in 54% and 40% of those with mental illness symptoms compared to 49% and 34% of those without. Mental illness symptoms were not significantly associated with the clinical factors assessed. Unhealthy substance use was more likely among those with dyslipidaemia (OR 1.55, CI 1.16−2.09, p = 0.003), and less likely in those with BMI >25 (OR 0.48, CI 0.30−0.77, p = 0.009).
Conclusions
Improved integration of MSD and comorbidity services in HIV clinical settings, and further research on the association between MSD and comorbidities, and care integration among older PWH in low-middle-income countries, are required.
期刊介绍：
The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.
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