Suicide Rate of HIV Positive People in Switzerland Has Fallen since Advent of Combination Antiretroviral Therapy

		SUMMARY: The likelihood of suicide among HIV positive men and women in the Swiss HIV Cohort decreased over time since the introduction of highly active antiretroviral therapy (HAART), according to a report in the February 2010 American Journal of Psychiatry. The suicide rate among people with HIV, however, remains higher than that of the Swiss general population.

By Liz Highleyman

Prior research has found elevated rates of suicide among HIV positive people, but the impact of HAART is unclear. It is well known that effective antiretroviral treatment extends survival and improves quality of life, but people with HIV remain at risk for depression.

Olivia Keiser from the University of Bern and colleagues examined trends over time and predictors of suicide during the pre-HAART (1988-1995) and HAART (1996-2008) eras among HIV positive participants in the Swiss HIV Cohort Study and members of the general population in the Swiss National Cohort (a longitudinal study of mortality).

The investigators calculated standardized mortality ratios comparing HIV positive patients and members of the general population, and used Poisson regression analysis to identify risk factors for suicide.

Results

	Between 1988 and 2008, the Swiss HIV Cohort Study followed 15,275 HIV positive people for a median duration of 4.7 years.
	Within this cohort, a total of 150 people committed suicide, for a rate of 158.4 per 100,000 person-years.
	Among HIV positive men, standardized mortality ratios declined from 13.7 in the pre-HAART era to 3.5 in the late HAART era.
	Among HIV positive women, standardized mortality ratios declined from 11.6 to 5.7, respectively.
	During both periods, suicide rates tended to be higher among men, older individuals, injection drug users, and patients with advanced clinical stages of HIV disease.
	62% of patients who committed suicide had mental or psychiatric illness.
	An increase in CD4 cell count was associated with a decreased risk of suicide.

Based on these findings, the investigators concluded, "Suicide rates decreased significantly with the introduction of HAART, but they remain above the rate observed in the general population, and risk factors for suicide remain similar."

"HIV-infected patients remain an important target group for suicide prevention," they added.

2/9/10

Reference
O Keiser, A Spoerri, MW Brinkhof, and others. Suicide in HIV-Infected Individuals and the General Population in Switzerland, 1988-2008. American Journal of Psychiatry 167(2): 143-150. (Abstract) February 2010.