title: Incidence, medical and socio-behavioural predictors of psychiatric events in an 11-year follow-up of HIV-infected patients on antiretroviral therapy.
abstract: 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.
authors.affiliation: INSERM, U912 (SESSTIM), Marseille, France. camelia.protopopescu@inserm.fr
authors.forename: Camelia
authors.initials: C
authors.lastname: Protopopescu
authors.forename: François
authors.initials: F
authors.lastname: Raffi
authors.forename: Cécile
authors.initials: C
authors.lastname: Brunet-François
authors.forename: Dominique
authors.initials: D
authors.lastname: Salmon
authors.forename: Renaud
authors.initials: R
authors.lastname: Verdon
authors.forename: Philippe
authors.initials: P
authors.lastname: Reboud
authors.forename: Maria Patrizia
authors.initials: MP
authors.lastname: Carrieri
authors.forename: Catherine
authors.initials: C
authors.lastname: Leport
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
authors.forename: Laurent
authors.initials: L
authors.lastname: Michel
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006678:HIV / Q000472:pathogenicity; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology*; D017320:HIV Protease Inhibitors / Q000494:pharmacology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012919:Social Behavior; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D017320:HIV Protease Inhibitors