Mortality from suicide among people living with HIV and the general Swiss population: 1988-2017. Journal of the International AIDS Society
Ruffieux et al. for the Swiss HIV Cohort Study (SHCS) and the Swiss National Cohort (SNC) aimed to assess the mortality rates due to suicide in persons living with HIV and the general population in Switzerland, to explore risk factors and time trends in suicide over almost 30 years, from the pre-cART era up to recent years. The author team analysed data from the Swiss HIV Cohort Study from the pre-cART (1988-1995), earlier cART (1996-2008) and later cART (2009-2017) eras.
Overall, 20’136 persons living with HIV were included, of whom 204 (1.0%) died by suicide. In men, standardized mortality ratios (SMRs) for suicide declined from 12.9 (95% CI 10.4-16.0) in the pre-cART era to 2.4 (95% CI 1.2-5.1) in the earlier cART and 3.1 (95% CI 2.3-4.3) in the later cART era. In women, the corresponding ratios declined from 14.2 (95% CI 7.9-25.7) to 10.2 (3.8-27.1) and to 3.3 (95% CI 1.5-7.4).
Factors associated with death due to suicide included:
- Gender (adjusted hazard ratio 0.58 (95% CI 0.38-0.87) comparing women with men)
- Nationality (1.95 (95% CI 1.34-2.83) comparing Swiss with other)
- Centers for Disease Control and Prevention clinical stage (0.33 (95% CI 0.24-0.46) comparing stage A with C)
- Transmission group (2.64 (95% CI 1.71-4.09) for injection drug use and 2.10 (95% CI 1.36-3.24) for sex between men compared to other)
- Mental health (2.32 (95% CI 1.71-3.14) for a history of psychiatric treatment vs. no history).
There was no association with age.
In conclusion, since the introduction of cART in 1996, mortality rates due to suicide have significantly decreased in men and women living with HIV in Switzerland, but no important improvements in SMRs were observed in men in more recent years, despite the advent of more tolerable, more efficacious and less complex antiretroviral drug regimens in the later cART period. Furthermore, it is noteworthy that the SMRs were larger than those reported in the literature for conditions with worse prognosis. Hence, in Switzerland and elsewhere, there is a continued need to monitor depression, suicidality in HIV-positive people, and to develop tailored suicide prevention programs aimed at reducing suicide risk in people living with HIV.