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系統識別號 U0026-1307201518443600
論文名稱(中文) 愛滋病感染者使用efavirenz和憂鬱的關聯
論文名稱(英文) The association between the use of efavirenz and the occurrence of depressive disorders among HIV-treated patients
校院名稱 成功大學
系所名稱(中) 公共衛生研究所
系所名稱(英) Graduate Institute of Public Health
學年度 103
學期 2
出版年 104
研究生(中文) 李佳雯
研究生(英文) Chia-Wen Li
學號 t86024021
學位類別 碩士
語文別 英文
論文頁數 40頁
口試委員 召集委員-陳怡樺
指導教授-李中一
共同指導教授-柯乃熒
口試委員-柯文謙
中文關鍵字 世代研究  人類免疫不全病毒  抗反轉錄病毒療法  憂鬱症  Cox比例風險模式 
英文關鍵字 Cohort studies  Human immunodeficiency virus  Active antiretroviral therapy  Depressive disorder  Cox proportional hazard model 
學科別分類
中文摘要 高效能抗反轉錄病毒療法(highly active antiretroviral therapy)問世後大幅改善人類免疫人類免疫不全病毒感染者(以下簡稱愛滋感染者)之存活。抗反轉錄病毒藥物efavirenz可能產生短期的中樞神經副作用,然而,長期使用是否會增加感染者憂鬱甚至是自殺的風險還尚未有定論。本研究目的旨在研究愛滋病感染者發生憂鬱和使用efavirenz的關聯性。本研究利用2000年至2010年台灣健保資料庫,研究分析了7286位追蹤時間大於6個月且服用藥物大於6個月的愛滋感染者,將其分為efavirenz暴露組和efavirenz非暴露組,暴露組服藥後新發生憂鬱的發生率是每千人年12.2,非暴露組為每千人年12.5,兩組之發生率並無顯著差異(p=0.822)。Cox比例風險模型分析發現:愛滋感染者服藥後發生憂鬱的獨立危險因子包括:投保金額低於新台幣17820元(調整後風險比值為2.59,95% 信賴區間1.79-3.76, p<0.001)、以及介於新台幣17821至26400元之間(調整後風險比值為1.55,95% 信賴區間 1.04-2.31 p=0.030)、住在南台灣(調整後風險比值為1.49,95%信賴區間 1.21-1.84 p=0.002)、以及過去有除了憂鬱以外的精神病史(調整後風險比值為4.59,95% 信賴區間 3.51-6.01 p<0.001)。本研究長期觀察資料顯示愛滋感染者使用efavirenz並不會增加憂鬱症發生的風險,反之,過去有精神病史的愛滋感染者有顯著較高的風險在治療過程中發生憂鬱症之診斷。
英文摘要 The use of highly active antiretroviral therapy (HAART) could improve the survival among people living with human immunodeficiency virus (HIV). One of the antiretroviral drugs – efavirenz could cause short-term side effects of central nervous system. However, it remained controversial as to whether efavirenz would cause depression or even suicidal attempt when applied for a longer period of time. The study purpose was to determine the association between the use of efavirenz and depressive disorders. This study analyzed HIV-infected patients who stayed in the registry for more than 6 months after HIV diagnosis and took HAART for more than 6 months. Data were retrieved from the National Health Insurance Research Database from 2000 to 2010. The HIV-infected patients were categorized into efavirenz-treated group and non-efavirenz-treated group. After up to 11 years of follow-up, the incidence rate of depressive disorders for the efavirenz-treated group was estimated at 12.2/1,000 person-year (PY) while that for the control group was 12.5/1,000 PY (p=0.822). The Cox proportional hazard model suggested that the independent risk factors for the onset of depressive disorders among people living with HIV after HAART included a insurance premium of less than 17820 New Taiwan Dollars (NTD) (adjusted hazard ratio [aHR] 2.59 95% confidence interval [CI] 1.79-3.76, p<0.001), and between 17821 and 26400 NTD (aHR 1.55 95% CI 1.04-2.31, p=0.030), living in Southern Taiwan (aHR 1.49 95% CI 1.21-1.84, p=0.002), and with a past history of psychiatric disorders (excluding depressive disorders) (aHR 4.59 95% CI 3.51-6.01, p=0.030). We concluded the use of efavirenz did not increase the risk of depressive disorders among HIV-treated patients. Instead, patients with a past history of psychiatric disorders were at increased risk of developing depressive disorders.
論文目次 中文摘要 I
Abstract IV
Chapter 1 Preface 1
1.1 Background and significance 1
1.2 Research Aim 3
Chapter 2 Literature Review 4
2.1 The risk factors influencing the prognosis of people living with HIV 4
2.2 HIV infection and depressive disorders 5
2.3 The associations between efavirenz and depressive disorders 6
Chapter 3 Methodology 9
3.1 Data source 9
3.2 Study population 9
3.3 Research variables 10
3.4 Statistical analysis 11
3.5 Sensitivity analysis 11
Chapter 4 Results 13
4.1 Study population 13
4.2 Incidence and risk factors for developing depressive disorders 14
4.3 Sensitivity analysis 16
4.3.1 The first scenario for sensitivity analysis 16
4.3.2 The second scenario for sensitivity analysis 17
4.3.3 The third scenario for sensitivity analysis 17
Chapter 5 Discussion 19
Strength 21
Limitations 21
Conclusion 22
Reference 24
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