Evidence-Based in Clinical Behavioral Infectivology

Transcription

1 LEZIONI DI PSICOINFETTIVOLOGIA Chieti 9-10 Marzo 2018 Evidence-Based in Clinical Behavioral Infectivology Francesco Vadini 1

2 MALATTIA INFETTIVA PER MALATTIA INFETTIVA SI INTENDE UNA PATOLOGIA DOVUTA AL CONTAGIO DELL ORGANISMO UMANO DA PARTE DI MICRORGANISMI: BATTERI VIRUS PARASSITI ECC. 2

3 PSICOINFETTIVOLOGIA Integrazione delle metodologie di intervento psicologico nelle malattie infettive 3

4 AMBITI DI INTERVENTO PERINATAL PSYCHOINFECTIVOLOGY PEDIATRIC PSYCHOINFECTIVOLOGY CHRONIC INFECTIOUS DISEASE PSYCHOINFECTIVOLOGY COUPLE RELATIONSHIP PSYCHOINFECTIVOLOGY 4

5 CHRONIC INFECTIOUS DISEASE PSYCHOINFECTIVOLOGY INFEZIONE CRONICA DA HIV 5

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8 Cumulative survival curve for HIV-infected persons and the general population Based on Lohse N, et al. Ann Intern Med 2007;146:

9 Prevalence of comorbidities increases with age and HIV % Number of Comorbidities per Patient HIV Negative HIV Positive Mean Number of Age-Associated Noncommunicable Comorbidities Number of Participants Schouten J, et al. International AIDS Conference Abstract THAB

10 Interplay of age with morbidity HIV Infection ARV Regimen Aging Risk of comorbidities increases as individuals get older HIV does not cause these illnesses However, HIV and/or ART may increase the risk 10

11 DEPRESSIONE E HIV 11

12 Risk factors for depression Number of years living with HIV Avoidance vs. active coping style Excessive rumination about health-related problems Past history of depression Other psychiatric disorder substance use disorders Personality disorders Low social support Low education Primeau et al Carvalhal et al

13 Clinical relevance of depression for patients with HIV Patients with HIV diagnosed with depression can have Declining CD4+ counts Higher viral loads Slower virological response Carrico AW, et al Horberg MA, et al Pence BW, et al

14 Patients with HIV and depression have lower treatment adherence Depression is negatively correlated with treatment adherence in patients with HIV Adherence decreases as the severity of depression increases Patients are more likely to discontinue treatment Cognitive symptoms of depression may affect adherence Lower treatment adherence in patients with HIV and depression leads to an increased viral load Wagner GJ, et al Carrico AW, et al

15 Disturbi psichiatrici e aderenza alle terapie antiretrovirali (HAART) Disorder Odds Ratio* P Value Generalized anxiety disorder 2.4 ( ).02 Panic disorder 2.0 ( ) <.001 Any psychiatric disorder 1.9 ( ) <.001 Depression 1.7 ( ).001 Multiple disorders (OR per disorder) 1.4 ( ) <.001 Dysthymia 1.3 ( ).17 *Adjusted for sex, race, age, education, employment, insurance, CD4+ cell count nadir, HIV status, ART, having a case manager. Tucker JS, et al. Substance use and mental health correlates of non adherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection. Am J Med. 2003;114:

16 Adherence in patients with HIV and depression Reluctance to prescribe HAART to patients with depression because of concerns about adherence Poor outcomes can exacerbate the symptoms of depression Poorer outcomes in patients with HIV and depression HAART, highly active antiretoviral therapy. Hartzell et al. J Antimicrob Chemother 2008;62:

17 Depressione e aumento di mortalità nelle persone sieropositive Study assessed association of depressive symptoms with HIV-related mortality and decline in CD4+ cell counts in HERS cohort (N = 765) 1.0 HIV-Related Mortality Depression (CES-D) defined as limited, intermittent, or chronic Multivariate analysis: increased RR of mortality in women with chronic depressive symptoms (2.0; 95% CI: ) vs those with limited or no symptoms Mortality in patients with CD4+ < 200 Chronic depression: 54%( RR: 4.3; 95% CI: ) vs limited depression Intermittent depression: 48% (RR: 3.5; 95% CI: ) vs limited depression Limited depression: 21% Cumulative Survival Limited depression Intermittent depression Chronic depression Total Time in Study (Yrs) Ickovics JR, et al. JAMA. 2001;285:

18 Screening for depression Ramasubbu R. et al