Incidence, medical and socio-behavioural predictors of psychiatric events in an 11-year follow-up of HIV-infected patients on antiretroviral therapy.

Camelia Protopopescu (1, 2) , François Raffi (3) , Cécile Brunet-François (3) , Dominique Salmon (4) , Renaud Verdon (5) , Philippe Reboud (6) , Maria Patrizia Carrieri (1, 2) , Catherine Leport (7) , Bruno Spire (1, 2) , Laurent Michel (8) , Christian Michelet (9)

1 AMU - Aix Marseille Université
2 SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
3 Maladies infectieuses et tropicales
4 Service de médecine interne et centre de référence des maladies rares [CHU Cochin]
5 Unité de Maladies Infectieuses et Tropicales [CHU Caen]
6 Epidémiologie et Biostatistique [Bordeaux]
7 U738 / UMR_S738 - Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques
8 UMR_S 669 - Troubles du comportement alimentaire de l'adolescent
9 Irset - Institut de recherche en santé, environnement et travail

BACKGROUND: Psychiatric disorders are relatively common among HIV-infected patients. However, there are few studies about their potential risk factors. This analysis aimed to measure the incidence of severe psychiatric events (PE) among patients receiving combination antiretroviral therapy (cART) of the French APROCO-COPILOTE (ANRS CO8) cohort, and to identify the medical and socio-behavioural correlates of their first episode of depression, suicide or suicide attempt (D/S/SA). METHODS: APROCO-COPILOTE is a cohort of patients started on a protease inhibitor regimen between 1997 and 1999, with prospective medical standardized records and self-administered questionnaires collecting socio-demographic and socio-behavioural data. This analysis included all 11-year follow-up visits for 1,095 patients having completed baseline self-administered questionnaires. A proportional hazard Cox model was used to identify the correlates of a first D/S/SA event. RESULTS: The overall prevalence of severe PE remained low: 50 patients experienced 67 events (incidence rate [95% CI] =1.04 [0.82, 1.32] per 100 person-years). Depression (n=16), suicides (n=5) and suicide attempts (n=14) were the most frequently diagnosed PE (0.54 [0.39, 0.76] per 100 person-years) among 25 patients. Multivariate results showed that unemployment, unstable housing, detectable viral load and smoking more than 20 cigarettes/day were independently associated with D/S/SA. CONCLUSIONS: Although the incidence of severe PE remained relatively low among the patients of APROCO-COPILOTE cohort, this study's results underline a clinically important problem in HIV-infected patients receiving cART. Furthermore, our findings not only emphasize the importance of comprehensive care, especially for socially vulnerable patients, but may also help future studies designed to assess the effectiveness of interventions in reducing the risk of PE during cART.

Mots clés: Immunopathology; Immune deficiency; Infection; Viral disease; Antiretroviral agent; Chemotherapy; Antiviral; Treatment; AIDS; Predictive factor; Epidemiology; Incidence

Domaines: Maladies infectieuses

Camelia Protopopescu, François Raffi, Cécile Brunet-François, Dominique Salmon, Renaud Verdon, et al.. Incidence, medical and socio-behavioural predictors of psychiatric events in an 11-year follow-up of HIV-infected patients on antiretroviral therapy.. Antiviral Therapy, 2012, 17 (6), pp.1079-83. ⟨10.3851/IMP2102⟩. ⟨hal-00875183⟩