Effective HIV Treatment Drove Swift Decline in Suicides

[Jim Allen]

Suicide is a painful topic that most of us sadly are familiar with.  Anyhow, I'm not surprised with the results of this analysis indicating post-1996 the suicide rate dropped off, neither am I surprised that despite this drop suicide rates remain higher than the national average.

Full POZ.com write-up; https://www.poz.com/article/effective-hiv-treatment-drove-swift-decline-suicides

In short:

The introduction of highly effective combination antiretroviral (ARV) treatment in 1996 precipitated a steep drop in the suicide rate among people living with HIV in Switzerland, aidsmap reports. However, this decline ultimately leveled off and has not seen a significant shift in more recent years, even as treatments have continued to improve.

Publishing their findings in the Journal of the International AIDS Society, researchers led by Matthias Egger, MD, of the Institute of Social and Preventive Medicine in Bern, Switzerland, analyzed data on 20,139 people with HIV who were followed for a cumulative 184,402 years between 1988 and 2017. Among them 204 people died by suicide, for a suicide rate of 111 per 100,000 cumulative years of follow-up.

Among men and women with HIV, the suicide rate per 100,000 cumulative years of follow-up was a respective 446 and 149 cases during 1988 to 1996, a respective 99 and 75 cases during 1996 to 1998, and a respective 72 and 34 cases during 2009 to 2017.

By comparison, between 1988 and 2017, the suicide rate in the general population fell from 33 to 20 cases per 100,000 cumulative years of follow-up.

The study found no association between taking Sustiva (efavirenz), which is included in various combination tablets such as Atripla (efavirenz/tenofovir disoproxil fumarate/emtricitabine), and suicide. Sustiva has been associated with suicide and suicidal behaviors in some other studies. It is possible no such association was seen here because clinicians avoided prescribing the drug to those with mental health problems.

Similarly, no association was seen between Tivicay (dolutegravir) and suicide.

“Suicide rates have decreased substantially among people living with HIV in the last three decades but have remained about three times higher than in the general population since the introduction of [combination ARV treatment],” the study authors concluded. “Continued emphasis on suicide prevention among men and women living with HIV is important.”

[harleymc]

This is strong reinforcement for the idea that mental health interventions should be one of the priorities in health care for people living with HIV.

[Jim Allen]

Fully agree with you.

The focus has been for a long time on getting people onto treatment. This is, of course, understandable but as this slowly is getting better we also need far better holistic care including mental health support.

[harleymc]

I read this when it came out, but thought I'd let it sit for a while.

There wAs no examination of whether the deAths by own hand in the pre 1996 era were in fact all suicides, or whether they included self or assisted euthenasia.

I'm sure I'm not unique among the longtermers in having attended some fantastic euthenasia parties.

[em]

the movie it's my party 1996 .

[em]

BPM beats per minute touches on this topic . I recall watching it's  my party  when it came out in 1996 and it gave me plenty to think about having already been HIV positive for a while and not seeing any thing positive coming down the road any time soon ..

[Jim Allen]

There wAs no examination of whether the deAths by own hand in the pre 1996 era were in fact all suicides, or whether they included self or assisted euthenasia.

From this "we could not distinguish between suicide and assisted suicide" I am presuming the totals in the study for suicide recorded in both pre & post-1996 era included assisted suicide.