Antiretroviral Drugs Cut Suicide Rate in Swiss AIDS Patients, a Study Finds

A recent study led by an HIV expert at the University of Bern finds suicides among Swiss AIDS patients declined by more than 50 percent following the introduction of highly active antiretroviral therapy (HAART) in 1996.

Dr. Olivia Keiser and her team analyzed data from the Swiss HIV Cohort Study and the Swiss National Cohort, a longitudinal study of mortality in Switzerland's general population. From 1988 to 2008, 15,275 patients were followed in the SHCS for a median duration of 4.7 years. Of these, 150 died by suicide (rate 158.4 per 100,000 person-years).

"In men, standardized mortality ratios declined from 13.7 (95 percent confidence interval [CI]=11.0-17.0) in the pre-HAART era to 3.5 (95 percent CI=2.5-4.8) in the late HAART era," the authors wrote. "In women, ratios declined from 11.6 (95 percent CI=6.4-20.9) to 5.7 (95 percent CI=3.2-10.3). In both periods, suicide rates tended to be higher in older patients, in men, in injection drug users, and in patients with advanced clinical stage of HIV illness," the researchers reported. Keiser noted 62 percent of those who killed themselves also had a mental illness.

The study's findings could prove significant in developing countries, where there is ongoing debate among wealthy donor nations about whether providing costly antiretrovirals is a better use of resources than inexpensive interventions like mosquito nets, antibiotics, and water filters. Asked whether she would expect to find similar results in African countries with high AIDS rates, Keiser said there is no way to know since little data exist on suicide in Africa.

Professor Lourens Schlebusch of the Nelson R. Mandela School of Medicine at the University of Natal said recent research there points to soaring suicide rates among young black South Africans in the last decade. While academic problems, incest, stress, and depression were the leading causes of suicide, Schlebusch said, people with AIDS were 36 times as likely as others to take their lives.

The study, "Suicide in HIV-Infected Individuals and the General Population in Switzerland, 1988-2008," was published in the American Journal of Psychiatry (2009; doi:10.1176/appi.ajp.2009.09050651).

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