A recent European study presented at 14ª International AIDS Conference found that the suicide rate among people living with HIV in British Columbia had fallen 35 1996 times since and was already close to the level of the general population. However, a second study from Denmark found psychiatric drug use rates, especially sleeping pills and tranquilizers, about two or three times higher among people living with HIV than in the general population, and there was a large increase in antipsychotics seven or eight years after diagnosis.
Suicide rates in British Columbia
Rates of depression, anxiety and suicide are highest among people living with HIV compared to the general population. But a longitudinal survey of 5229 people on antiretroviral (ART) treatment in British Columbia between 1996 and 2012 found that the suicide rate decreased by 961 suicides by each 100.000 patients per year (a rate of about 1% per year) to 28 per 100.000 inhabitants (below 0,03%) - an index almost thirty-five times lower. In 2011, the last full year of data, there were actually no more suicides recorded in the cohort of British Columbia. In total, there were eighty-two people (2%) killed during the study period.
The 28 rate for 100.000 inhabitants is still 3 times higher than in the general population, and yet the rarest presence of suicides is even lower among people living with HIV, the greater becomes the confidence interval around the actual rate so that the "real" rate may vary considerably with this.
During the study period 17% of people with HIV (911) died of causes other than suicide. Among the other 4318 patients, in the unvaried analysis, those with less than 95% self-reported adherence to ART had 6,25 times more chances of committing suicide. The suicide rate decreased by 23% for each increase of 100 cells / mm3 of the CD4 count and multiplied by more than 3 at each significant increase in viral load. This line of reasoning seems to support the idea that people living on treatment failure may have a higher suicidal risk.
Suicide was also almost 4 times higher among injecting drug users even in a multivariate analysis, as the presenter Jasmine Gurm of the BC Center for Excellence in HIV / AIDS noted, overdose can sometimes appear as suicides and vice versa.
Other findings are more absurd, however. Among all patients, those who have never had an AIDS-defining illness have been associated with an increase in 6,6 times in the suicide rate - although this may be partly explained by the fact that there are more non-suicide related deaths among people with AIDS . Among 4318 dying from other causes, however, in a multivariate analysis, suicide was 4,45 times more likely among people who had never had a AIDS-defining illnesses than among those who had.
Gurm commented that people needed a certain amount of energy to commit suicide, so people who were very ill may be less likely to be able to kill themselves, but that does not explain why after having had a diagnosis of AIDS was persistently associated with an 77% reduction in suicide risk. Perhaps people who have had more diagnoses of AIDS-defining illnesses have received more intensive monitoring and support, or perhaps in this population, being threatened with death they have, paradoxically, had something that gave them more motivation to live.
Psychiatric prescription in Denmark
The Danish study, also presented at the conference, looked at the use of psychotropic drugs - antidepressants, tranquillizers, sleeping pills, anxiolytic drugs and antipsychotics in a group of 3615 seropositive adult people of the country between 1995 and 2009. He compared drug prescriptions among 32.535 members of the general population, each person with HIV matched with 9 matched for age and sex of members of the general population.
By comparing the prescriptions of these drugs between 32.535 members of the general population, matching each person with HIV-positive members 9 corresponding by age and gender in the general population.
People with HIV were certainly prescribed more psychotropic drugs. During the observation period, the HIV-positive population received twice as many prescriptions for tranquilizers and three times more prescriptions for sleeping pills, sedatives and tranquilizers
In terms of how much time people spend on various drugs, rather than just stick to the ones they have been prescribed, people living with HIV were much more likely to spend more time on antipsychotics than the general population. But they spend 76% longer with anxiolytics, 2.28 times longer with antidepressants, and 4,42 longer with sedatives and sleeping pills. Antidepressants were prescribed almost exclusively at gay men who use little more than 3 times the amount that the general population uses; use by heterosexual was not higher than average.
The researchers looked at drug use over time, starting 2 years before the diagnosis of HIV seropositivity and continuing to 10 years after diagnosis (Denmark can do this because they keep records of prescriptions for all centralized patients).
HIV positive people have had higher use rates of psychotropic drugs to the general population before their diagnosis of HIV: in the general population, in the year before diagnosis there was a 22% higher consumption of antidepressants, 68% higher in refers to anxiolytics, and twice as sedatives and sleeping pills. Editor's note: It seems to me that people who are already using drugs often have low self-esteem problems and this, apparently, can lead to "almost suicidal" behavior that causes them to put themselves in real risk situations countless times and this ends up determining the contagion and, at the other end of the rope, this "apparent" increase in the number of people with a history of psychotropic use. I speak of a little chair, since in my personal history there are innumerable situations where I put myself face to face with death simply for not having my death as something very disastrous for humanity. I lacked two very important things: Self love and self forgiveness. Life for almost twenty years with HIV has brought me these attributes; today I love myself so much more and I love life so intensely that, for example, I hate sleeping because I consider it a waste of time and, to rest in dignity, I resort to the prescription of my psychiatrist, who is always sympathetic to my rest needs . It was not so, and I would have gone mad or severely ill.
In 2 years after diagnosis, antidepressant use increased to double that in the general population and twice as high then. The use of sedatives or "sleeping pills" He doubled in the year after diagnosis, and then, was about 3 times higher than in the general population. For anxiolytic drugs, the use grew in the first year after diagnosis, but then began to fall until, in 5 6 or years after diagnosis, their use was not higher than in the general population. However, their use began to rise again 8 years after diagnosis.
The use of antipsychotics cohort of individuals serologically positive for HIV was less than the general population before the diagnosis and continued to be used in smaller or similar levels to 6 years after diagnosis. After that, its use skyrocketed, twice that in the general population. The researchers speculate that this, and the similar increase later use of anxiolytics, can track cognitive problems and yet, although the use of antipsychotics increase with time since diagnosis, this growth is not related to age. Editor's note: From this point on, young HIV-positive people begin with the use (?) / Abuse (?) Of these drugs at an early age and that early aging associated with HIV infection may have an effect of dynamics still unapproachable in society something must be done to mitigate these damages.
There was no strong association between antiretroviral therapy and psychotropic drug use. Use of sedatives and antidepressants was slightly higher in people on HAART, and use of anxiolytic drugs was about 25% lower, but the differences were not significant. There was no relationship between the use of efavirenz (Sustiva) and psychotropic drugs, although the researchers speculated that physicians could specifically exclude people with psychological problems from treatment with efavirenz.
The researcher criticized the overuse of sleeping pills and sedatives in HIV-positive patients - especially in that there is an association between drug abuse and the development of dementia related to AIDS.
Written by Gus Cairns
Translated by Claudio Souza the original Suicide Rates and Psychiatric Drug Use Among People with HIV reviewed by Mara Macedo in 12 / 08 / 2015
J Gurm, S Guillemi, E Ding, et al. Declining suicide rates among people living with HIV (PLHIV) initiating HAART between August 1996 - June 2012 in the HAART Observational Medical Evaluation and Research cohort in British Columbia, Canada. 14th European AIDS Conference (EACS 2013). Brussels. October 16-19, 2013. Abstract PS 5 / 3.
LD Rasmussen, D Obel, G Kronborg, et al. Utilization of psychotropic drugs prescribed to persons with and without HIV infection: a Danish nationwide population-based cohort study. 14th European AIDS Conference (EACS 2013). Brussels. October 16-19, 2013. Abstract PS 5 / 4.