Determinants of suicide and accidental or violent death in the Australian HIV Observational Database

Résumé

textbfBACKGROUND: Rates of suicide and accidental or violent death remain high in HIV-positive populations despite significantly improved prognosis since the introduction of cART. textbfMETHODS: We conducted a nested case-control study of suicide and accidental or violent death in the Australian HIV Observational Database (AHOD) between January 1999 and March 2012. For each case, 2 controls were matched by clinic, age, sex, mode of exposure and HIV-positive date to adjust for potential confounding by these covariates. Risk of suicide and accidental or violent death was estimated using conditional logistic regression. textbfRESULTS: We included 27 cases (17 suicide and 10 violent/accidental death) and 54 controls. All cases were men who have sex with men (MSM) or MSM/ injecting drug use (IDU) mode of exposure. Increased risk was associated with unemployment, living alone, suicidal ideation, and textgreater2 psychiatric/cognitive risk factors. CD4 cell count of textgreater500 cells/microL and HIV-positive date textgreater/=1990 (1990-1999, post-2000) were associated with decreased risk. CD4 cell count textgreater/=500 cells/microL remained a significant predictor of reduced risk in a multivariate model adjusted for employment status, accommodation status and HIV-positive date. textbfCONCLUSIONS: After adjustment for psychosocial factors, the immunological status of HIV-positive patients contributed to the risk of suicide and accidental or violent death. The number of psychiatric/cognitive diagnoses contributed to the level of risk but many psychosocial factors were not individually significant. These findings indicate a complex interplay of factors associated with risk of suicide and accidental or violent death. AUSTRALIE SUICIDE-COMPLÉTÉ SIDA MALADIE-PHYSIQUE MALADIE-CHRONIQUE