| ObjectiveTo study the occurrence of central nervous system toxic side effects in HIV/AIDS patients on antiretroviral therapy in Kunming,and to compare whether there are differences in anxiety,depression,sleep disturbance,PRO and quality of survival among patients on different antiretroviral drug regimens,in order to provide a basis for further optimization of the antiretroviral treatment regimen for AIDS.MethodsA cross-sectional survey was used to select patients with HIV/AIDS attending the inpatient department and antiretroviral clinic of the Third People’s Hospital of Kunming from December 2021 to March 2022 as the study population,and to collect patients’ clinical data,general sociodemographic information,and complete questionnaires,including the Chinese version of the World Health Organization Quality of Survival Scale for AIDS patients,the Hospital Anxiety and Depression Inventory,the Pittsburgh Sleep index scale and patient self-report.The data were entered using EXCEL,and the data collected were organized and statistically analyzed using SPSS 20.0 software.Descriptive statistical analysis was performed for basic information,and the χ2 test was used for single factors of anxiety,depression,and sleep disorders,and dichotomous unconditional logistic regression was used for multiple factors to analyze the influencing factors;ANOVA or t-test was used for group comparisons of survival quality scores: LSD was chosen for two-by-two comparisons between multiple groups;and single-and multifactor logistic regression analyses were used for patient self-reporting.Results1.Demographics and epidemiology: the mean age of 1200 subjects was(42.26±11.97),52.9% were predominantly male,46.7% were married,72.1% had secondary school education or less,63.6% were urban residents,80.3% were Han Chinese,90.9% were sexually transmitted,88.75% had been on treatment for more than 3 months,CD4+ T-cell counts ≥ The number of patients with CD4+ T-cell count ≥ 500 was 46.3%,the viral load was below the detection limit was 88.4%,and 46.4% of patients received efavirenz-containing antiviral regimen.2.Central nervous system toxic side effects such as anxiety depression and sleep disorders: anxiety detection rate was 24.9%,depression detection rate was 30.5%,sleep disorders detection rate was 39.1%,combined anxiety and depression detection rate was20.6%,and the detection rate of anxiety,depression and sleep disorders occurring simultaneously was 11%.Risk factors for anxiety symptoms were viral load above the detection limit and use of non-nucleoside reverse transcriptase inhibitors,and protective factors were being male,having a stable job,and having a short treatment period of less than 3 months(P<0.05).Risk factors for depressive symptoms were viral load above the detection limit,use of non-nucleoside reverse transcriptase inhibitors,and protective factors were being male and having a stable job(P<0.05).Risk factors for sleep disorder symptoms were mainly the use of non-nucleoside reverse transcriptase inhibitors and having a stable job as a protective factor(P<0.05).3.Patient self-report(PRO): the results of univariate analysis showed that patients using integrase inhibitors self-reported memory problems(OR=0.40,95% CI: 0.179 to1.891),difficulty sleeping(OR=0.337,95% CI: 0.192 to 1.593,)and hair loss symptoms(OR=0.313,95% CI: 0.124 to 1.787,)were lower,(P<0.05);multifactorial analysis showed that patients on integrase inhibitors self-reported higher rates of diarrhea/constipation(OR=1.794,95% CI: 0.931 to 3.459),loss of appetite(OR=2.101,95% CI:0.823 to(OR=0.531,95% CI:0.270-1.044)and difficulty sleeping(OR=0.356,95% CI:0.206-1.615)were reported at a higher rate than in patients on other regimens(P<0.05).4.Survival quality analysis: The survival quality scores of HIV/AIDS patients in Kunming area after using HIV antiretroviral therapy(67.90±10.31)were higher than most reports in China,with scores in the psychological domain(15.76±2.91),social domain(13.34±2.64),environmental domain(12.91±2.07),and physical domain(12.60±1.67).Gender,work,place of residence,route of infection,viral load,duration of treatment,type of medication,and blood lipids were the predictors of high quality of survival.The results of multiple stepwise linear regression analysis showed that men,those with stable jobs,treatment duration under 3 months,integrase inhibitor regimen,normal triglyceride count,urban residents,viral load under the detection limit level,and MSM transmission had high total survival quality scores;men,urban residents,MSM transmission,viral load under the detection limit level,treatment duration under 3 months,taking drugs containing integrase inhibitors The physical domain scores were high for men,urban residents,men who have sex with men,viral load at or below the detection limit,duration of treatment at or below 3 months,taking an integrase inhibitor,and psychological domain scores for stable workers;men,smoking habit,urban residents,viral load at or below the detection limit,men who have sex with men,duration of treatment at or below3 months,taking an integrase inhibitor,and social domain scores for stable workers.The social domain scores were higher in men,smoking habit,urban residents,viral load below the detection limit,duration of treatment under 3 months,normal triglyceride count,taking integrase inhibitors,stable job,and those with university or higher education,(P<0.05).Conclusions1.A high percentage of central nervous system toxicities occurred in HIV/AIDS patients in Kunming after using HIV antiretroviral therapy.2.The incidence of anxiety,depression,and sleep disturbance was significantly different among patients with different combinations of antiviral regimens,with integrase inhibitor-containing regimens being lower than protease inhibitor regimens and nonnucleoside reverse transcriptase inhibitor regimens.3.In the self-reported(PRO)symptom burden of HIV patients,self-reported outcomes were better overall for patients on integrase inhibitor-containing regimens than for other regimens.4.Quality of survival scores of HIV/AIDS patients in Kunming were higher than those reported in China,and integrase inhibitor-containing regimens were higher than protease inhibitor and non-nucleoside reverse transcriptase inhibitor regimens.5.Antiviral regimens containing integrase inhibitors are beneficial in improving patients’ quality of life,reducing the incidence of central nervous system toxicities,and improving patient self-reported outcomes,and are currently better optimized treatment options. |
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