Neuropsychiatric Adverse Events Following Antiretroviral Therapy in People Living with HIV: A Real-World Study of Dynamic Trends and Risk Factors in Hangzhou, China

Wenhui Zhang; Yi Wang; Er Li; Dingyan Yan; Jianhua Yu; Mingli Zhu; Jinchuan Shi; Liping Zheng

doi:10.2147/IDR.S419308

Neuropsychiatric Adverse Events Following Antiretroviral Therapy in People Living with HIV: A Real-World Study of Dynamic Trends and Risk Factors in Hangzhou, China

Infect Drug Resist. 2023 Aug 2:16:5007-5019. doi: 10.2147/IDR.S419308. eCollection 2023.

Authors

Wenhui Zhang^#^{1

2}, Yi Wang^#^{2

3}, Er Li¹, Dingyan Yan^{1

2}, Jianhua Yu², Mingli Zhu⁴, Jinchuan Shi^#², Liping Zheng^#¹

Affiliations

¹ Department of Nursing, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
² Department of Infection, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
³ Institute of Hepatology and Epidemiology, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
⁴ Medical Laboratory, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: Neuropsychiatric adverse events (NPAEs) occur frequently in people living with human immunodeficiency virus (PLWH) receiving antiretroviral therapy (ART). This study aimed to assess the dynamic trends and risk factors of NPAEs among PLWH in Hangzhou taking efavirenz (EFV)- or dolutegravir (DTG)- or elvitegravir (EVG)-based regimens.

Patients and methods: A total of 287 ART-naive PLWH were included in this study, EFV (400mg)- (n = 122), EFV (600mg)- (n = 37), DTG- (n = 73), EVG-based (n = 47) and other ART regimens (n = 8) as the initial ART regimen were administered for 12 months. All data were collected at five time points within a 12-month follow-up. The Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale were used to evaluate sleep disorders and anxiety and depression symptoms, respectively. The dynamic trends and potential risk factors of NPAEs were investigated using a generalized linear mixed model.

Results: Mean age was 29.4 (SD: 7.5) years with 97.2% males. After 12 months of ART, the prevalence of sleep disorders and anxiety decreased significantly, although only a slight improvement was observed for depression. In addition, there was a significant positive correlation between sleep disorders, anxiety, and depression. The risk factors for NPAEs differed slightly depending on the choice of ART regimen, but the seven factors most commonly associated with NPAEs were age, sex, marital status, education level, smoking status, body mass index, and WHO clinical stage. Treatment-induced changes in CD4-positive T-cell count and virological suppression did not depend on the particular choice of ART regimen.

Conclusion: The prevalence of sleep disorders and anxiety changed significantly over time on ART and the risks of these disorders were associated with seven common clinical and demographic factors.

Keywords: antiretroviral therapy; anxiety; depression; people living with HIV; sleep disorders.

Grants and funding

This research was supported by grants from the Infectious Diseases of Hangzhou Medical Key Subject, Hangzhou Biomedicine and Health Industry Development Project (2022WJCY174), Medical Science and Technology Project of Zhejiang Province (2023KY196 and 2023KY978), Guidance Programs of Hangzhou Bureau of Science and Technology (20211231Y050) and Medical Science and Technology Project of Hangzhou (A20210014).