ABSTRACT
Depression is one of the main psychiatric co-morbidities in HIV infection, presenting with a significantly higher prevalence than in the general population (around 35 percent). Its presence has been associated with poor quality of life, HIV disease progression and poor adherence to antiretroviral therapy. Although antidepressive treatment has demonstrated effectiveness on the management of depressive symptoms, improvement of clinical and laboratory parameters, and enhancement of antiretroviral adherence, depression is frequently under diagnosed and under treated in these patients. We analyzed the main international findings on depression prevalence, risk factors, con-sequences and management in people with HIV disease.
La depresión es una de las principales co-morbilidades psiquiátricas en el curso de la infección por VIH, presentándose con una prevalencia significativamente mayor que en población general (alrededor de 35 por ciento). Su presencia se ha asociado a deterioro de la calidad de vida, progresión de la enfermedad por VIH y disminución en la adherencia a la terapia anti-retroviral. El adecuado tratamiento antidepresivo ha demostrado ser efectivo en el manejo de la sintomatología depresiva, en la mejoría de parámetros clínicos y de laboratorio, y en reforzar la adherencia a la terapia anti-retroviral. A pesar de su importancia, la depresión suele ser sub-diagnosticada y sub-tratada en estos pacientes. En este trabajo se revisan los principales hallazgos internacionales sobre prevalencia, factores de riesgo, consecuencias y abordaje de la depresión en personas infectadas por VIH.
Subject(s)
Humans , Depression/etiology , HIV Infections/psychology , Antidepressive Agents/therapeutic use , Diagnostic and Statistical Manual of Mental Disorders , Depression/therapy , Prevalence , Psychotherapy , Risk FactorsABSTRACT
El embarazo adolescente es un importante problema de Salud Pública, que se asocia a consecuencias biológicas, psicológicas y sociales negativas tanto para la madre como para el hijo. Uno de los riesgos frente a los que las madres adolescentes están particularmente vulnerables es a la depresión posparto (DPP). Existen extensas investigaciones sobre el fenómeno de la DPP, pero los estudios en madres adolescentes son limitados y suelen provenir de países desarrollados. En Chile no existen estudios publicados que se aboquen específicamente a la DPP en adolescentes. Por lo mismo, es que esta revisión pretende dar cuenta de los principales hallazgos internacionales y nacionales sobre prevalencia, factores de riesgo, consecuencias y abordaje de la DPP en general, y en madres adolescentes en particular, con el propósito de fortalecer el conocimiento de los profesionales que trabajan con estas jóvenes, ya sea en el área de salud mental, obstetricia o pediatría.
Adolescent pregnancy is an important public health issue associated with negative biological, psychological and social consequences for the mother and the child. One of the main risks adolescent mothers is particularly vulnerable to postpartum depression. Literature on postpartum depression is broad, but studies regarding the phenomenon in adolescent mothers are scarce, and come mostly from developed countries. In Chile there are no published studies centered on postpartum depression in adolescents. Therefore, this article aims to describe the main international and national findings on the prevalence, risk factors, consequences and management of postpartum depression in general, and in adolescents in particular, with the goal of strengthening the knowledge of professionals caring for adolescent mothers in mental health, obstetric and pediatric services.
Subject(s)
Humans , Adolescent , Female , Depression, Postpartum/epidemiology , Pregnancy in Adolescence , Depression, Postpartum/diagnosis , Depression, Postpartum/therapy , Prevalence , Risk Factors , Social Support , Socioeconomic FactorsABSTRACT
Background: Chile, a middle-income country with an HIV epidemic of moderate proportions (global infection rate 0.2%) began a government sponsored, free, highly active antiretroviral therapy (HAART) for patients from the public health system in 2001 reaching in 2004 a 100% coverage. Arriaran Foundation (AF) is the largest public AIDS care center for adults in the country. Aim: To show the present status of the AF population and the evolution of mortality. Material and Methods: Review of AF database from 1991-2004 that at 12/31/2004 had a total cumulative population of 2,259 adult patients; an active census of 1,065 patients and admitting rate 160-190 patients per years. Results: The global mortality registered was 33.4%, with decreasing annual mortality from 15.7% of its active population in 1995 to 1.9% in 2004. As of 12/31/2004, 817 patients (76.7%) were receiving antiretroviral therapy (ART); and 19.3% either did not require nor accept it. Thirty one percent received Combivir® and nevirapine, with undetectable viral load (<400 copies per ml) in 78%. Thirty percent received Combivir® and efavirenz with undetectable viral load in 80% at last count. Both regimens were used mainly as first therapy. Lopinavir/ritonavir was received by 6.3% of patients, mainly for post failure therapy and 58% had undetectable viral load. A baseline CD4 count <200 x mm3 was present in 70% of patients, 45.3% had a count below 100 and 47.8% had clinical AIDS. At the last follow up assessment, CD4 count was <200 in 36.8%, <100 in 10.6% and 200-350 in 44.9%. Conclusion: The expanded access program to ART in a public, comprehensive AIDS care center in Chile has been highly successful in reaching high undetectability (75%), reducing mortality and improving immune status despite very advanced baseline disease.