Results from a recent study indicate that depression and thoughts of suicide are still common in people with HIV, even though HIV-related health outcomes have improved with the advent of combination antiretroviral therapy.

Based on their results, the authors of the study emphasized the importance of properly diagnosing and treating depression in HIV-positive individuals.

“The results of our study indicate that mood disturbances are still common in individuals with HIV despite modern treatment. It is important for HIV patients to recognize that these symptoms exist and to seek treatment for them. In the same vein, clinicians should be aware that mood symptoms often co-occur in HIV infection, and they should regularly evaluate their patients and refer them for appropriate care,” said Dr. David Moore, lead investigator of the study, in correspondence with The AIDS Beacon.

“Our hope is that our study highlights for patients, families, and providers that risk of depression and suicide exist for persons living with HIV/AIDS, and that this risk needs to be taken seriously and treatments should be considered. Suicide can be a difficult topic to discuss, but if it is not taken on directly, it can lead to poor and unwanted outcomes,” he added.

Depression is common in people with HIV (see related AIDS Beacon news), and suicide in particular is a major concern in the HIV-positive community.

Previous studies have identified social isolation, lack of social support, and abuse of illegal drugs as prominent risk factors and indicators for suicidal behavior in people with HIV.

However, results from previous studies comparing the rates of suicidal thoughts and behavior among HIV-positive and negative individuals have been conflicting and inconsistent. In addition, many studies were performed before the advent of combination antiretroviral therapy, when the prognosis for people with HIV was much poorer.

In this study, researchers investigated the lifetime rate of suicidal behavior in 1,560 HIV-positive individuals at six medical centers in the United States. They also assessed risk factors for depression and suicidal thoughts in people with HIV.

The authors evaluated participants’ levels of depression using a computerized questionnaire. They also collected information on participants’ sex, age, race, use of psychiatric drugs such as antidepressants, use of antiretrovirals, history of drug or alcohol abuse, and HIV-related outcomes such as CD4 (white blood cell) counts and viral loads (amount of HIV in the blood).

The majority of participants (75 percent) were male, 43 percent were Caucasian, and 43 percent were African-American. The average age of participants was 43 years old.

Results showed that 63 percent of participants reported symptoms of depression currently or at some point in the past. Overall, 26 percent of patients reported having had thoughts of suicide and 13 percent of participants reported having attempted suicide in their lifetimes.

In response to a question about suicidal thoughts and/or attempts in the past two weeks, 79 percent of participants reported no thoughts of suicide, 20 percent reported suicidal thoughts but no intent to commit suicide, and less than 2 percent reported a current suicide attempt.

Participants who had thought about, planned, or attempted suicide reported more severe depression symptoms and significantly lower overall health-related quality of life than participants who had not.

Results also showed that participants who reported a lifetime suicide attempt were significantly less likely to be on a Sustiva (efavirenz)-containing antiretroviral regimen. The authors speculated that physicians are not as likely to prescribe Sustiva to patients with significant psychiatric problems. Sustiva has been linked to side effects that affect the central nervous system such as dizziness, anxiety, depression, and insomnia.

Risk factors that were significantly associated with lifetime suicidal behavior included African-American race (a finding consistent with past studies), use of mood-altering drugs or psychiatric medications, and lower mental health-related quality of life.

The authors explained that increased suicidal behavior in African-American HIV-positive individuals may indicate that the stigma associated with HIV infection increases depression in this population.

The researchers found no link between suicide attempts and length of HIV infection. Participants with a history of thinking about or attempting suicide had higher viral loads, but the study authors hypothesized that this was due to lower medication adherence in depressed participants.

For more information, please see the study in Journal of Affective Disorders (abstract).