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

Rates of suicide and accidental or violent death remain high in HIV-positive populations despite significantly improved prognosis since the introduction of cART. We conducted a nested case-control study of suicide and accidental or violent death in the Australian HIV Observational Database (AHOD) be...

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Bibliographic Details
Published in:	PloS one 2014-02, Vol.9 (2), p.e89089-e89089
Main Authors:	McManus, Hamish, Petoumenos, Kathy, Franic, Teo, Kelly, Mark D, Watson, Jo, O'Connor, Catherine C, Jeanes, Mark, Hoy, Jennifer, Cooper, David A, Law, Matthew G
Format:	Article
Language:	eng
Subjects:	Accidents Accidents - mortality Acquired immune deficiency syndrome Adult AIDS Alcohol Alcohol use Analysis Australia Case-Control Studies Cause of Death CD4 antigen Cognitive ability Comorbidity Data bases Data collection Databases, Factual - statistics & numerical data Death Drug abuse Drug overdose Employment Ethics Exposure Health risks Hepatitis HIV HIV (Viruses) HIV Infections - epidemiology HIV patients HIV-1 Homicide - statistics & numerical data Homosexuality, Male - statistics & numerical data Human immunodeficiency virus Humans Immunology Infections Male Medical diagnosis Medical prognosis Medicine Mental disorders Middle Aged Mortality Population Prognosis Psychiatry Risk analysis Risk factors Risk reduction Sex Sexually transmitted diseases STD Studies Substance abuse treatment Suicide Suicide - statistics & numerical data Suicides & suicide attempts Violence - statistics & numerical data Young Adult
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Summary:	Rates of suicide and accidental or violent death remain high in HIV-positive populations despite significantly improved prognosis since the introduction of cART. 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. 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 (Odds Ratio (OR) 5.86, 95% CI: 1.69-20.37), living alone (OR 3.26, 95% CI: 1.06-10.07), suicidal ideation (OR 6.55, 95% CI: 1.70-25.21), and >2 psychiatric/cognitive risk factors (OR 4.99, 95% CI: 1.17-30.65). CD4 cell count of >500 cells/µL (OR 0.25, 95% CI: 0.07-0.87) and HIV-positive date ≥1990 (1990-1999 (OR 0.31, 95% CI: 0.11-0.89), post-2000 (OR 0.08, 95% CI: 0.01-0.84)) were associated with decreased risk. CD4 cell count ≥500 cells/µL remained a significant predictor of reduced risk (OR 0.15, 95% CI: 0.03-0.70) in a multivariate model adjusted for employment status, accommodation status and HIV-positive date. 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.
ISSN:	1932-6203 1932-6203