依非韦伦更换为洛匹那韦/利托那韦后对AIDS病人睡眠障碍 焦虑 抑郁影响的初步研究

Preliminary study on the impact ofefavirenz switching to lopinavir/ritonavir on sleep disorders,anxiety and depression in patients with AIDS

目的探讨依非韦伦(EFV)更换为洛匹那韦/利托那韦(LPV/r)后,对艾滋病(AIDS)病人睡眠障碍、焦虑和抑郁症状(SAD症状)的影响情况。方法共62例AIDS病人,用统一的调查问卷收集社会人口学资料和用药情况,用匹兹堡睡眠质量指数量表(PSQI)、医院焦虑抑郁情绪测量表(HAD量表),调查病人SAD症状的变化情况。结果 62例中,男性占98.39%,平均年龄(32.84±8.54)岁,大专及以上文化占72.58%,同性性传播占75.81%,更换抗病毒治疗方案的前三位原因依次为中枢神经系统症状(70.97%)、皮疹(9.68%)、一线治疗失败(8.06%)。62例AIDS病人基线平均PSQI值为(8.19±3.90)分,医院焦虑抑郁情绪测量表焦虑评分(HAD-A)为(6.32±4.52)分,抑郁评分(HAD-D)为(6.40±4.91)分。换用LPV/r 3个月后分别为(6.56±2.97)分、(5.27±3.58)分和(5.58±4.76)分(P值分别为0.000、0.029和0.081)。基线时PSQI、HAD-A和HAD-D评分>7分的病人分别占48.39%、38.71%和43.55%,换药3个月分别为35.48%、27.42%和32.26%(P值分别为0.001、0.002和0.000)。结论经治AIDS病人中,含EFV抗病毒治疗方案存在神经精神相关不良反应,即不同程度的睡眠障碍及焦虑、抑郁症状,是导致更换治疗方案的主要原因。治疗方案更换为LPV/r的组合后,病人SAD症状较前明显改善。

Objective To investigate the impact of efavirenz（EFV） switching to lopinavir/ritonavir（LPV/r） on sleep disorders, anxiety and depression in patients with AIDS. Methods HIV/AIDS patients were enrolled who were switched from EFV to LPV/r in Beijing You＇an hospital, from January to July 2015. Changes of sleep disorder, anxiety and depression （SAD） symptoms were evaluated with Pittsburgh sleep quality index （PSQI）, hospital anxiety and depression （HAD） and general information questionnaire scale. Results There were 62 valid questionnaires with predominantly males （n=61, 98.39%）, and mean age of （32.84 ± 8.54） years, education level of col- lege and above accounting for 72.58%. The main mode of transmission was homosexual （75.81%）. The top three reasons for change of antiretroviral regimens were central nervous system symptoms （70.97% ）, rash （9.68 %） and first-line treatment failure （8.06%）. Baseline mean PSQI value, HAD-A and HAD-D were （8.19 ± 3.90）, （6.32± 4.52） and （6.40 ±4.91）, respectively, and after 3 months of treatment with I.PV/r, they were （6.56 ±2.97）, （5.27 ±3.58） and （5.58±4.76）, respectively （P value 0. 000, 0. 029 and 0. 081）. The proportion of pa- tients with scores greater than 7 points in PSQI, HAD-A and HAD-D at baseline were 48.39%, 38.71% and 43.55%, respectively, and after 3 months of treatment with LPV/r, they were 35.48%, 27. 42% and 32.26%, respectively （P value 0. 001, 0. 002 and less than 0. 000）. Conclusion The main reasons for regimen switching of 62 AIDS patients are neuropsychiatric side effects related to antiretroviral regimens containing EFV. They have differ ent levels of anxiety, sleep disorders and depressive symptoms, and the symptoms have been improved significantly after regimen switching to LPV/r.