Suicide risk and prevalence of major depressive disorder (MDD) among individuals infected with HIV-1 subtype C versus B in Southern Brazil

The impact of sleep disturbances on suicide risk among people living HIV: An eleven-year national cohort

OBJECTIVES

The suicide rate among individuals who experience sleep disturbances is five times higher than in the general population. Up to 70 % of people living with HIV (PLHIV) experience sleep disturbances. This study's purpose was to determine whether this population has higher rates of suicide compared to those without sleep disorders. Possible risk factors were also explored.

METHODS

A secondary analysis of nationwide data on all males and females over 15 years old with HIV living in Taiwan was conducted from January 1, 2005, to December 31, 2016. Sleep disturbances were identified through recorded diagnoses and medical treatments. Cox proportional hazard models and hazard ratios (HRs) and mediation analysis were employed to estimate the association between sleep disturbances and suicide risk during the follow-up period.

RESULTS

Of the 5680 PLHIV, 72 suicide events were reported. The suicide incidence rate among PLHIV suffering from sleep disturbances was 769 per 100,000 person-years. Sleep disturbances were associated with a significantly increased risk of suicide (AHR = 1.75, 95 % CI 1.02-3.02, p = 0.0429). A premium-based monthly salary of <24,000 (NT $) was also associated with an increased hazard of suicide (AHR = 4.14, 95 % CI 1.60-10.75, p = 0.0035). The pathway effect analysis using potential outcomes showed that depression did not mediate the effect of sleep disturbance on suicide.

CONCLUSIONS

Sleep disturbances were associated with higher suicide rates, even after adjusting for pre-existing depression. These findings suggest that paying attention to suicidal ideation among PLHIV suffering from sleep disturbances is necessary.

Global overview of suicidal behavior and associated risk factors among people living with human immunodeficiency virus: A scoping review

Death by suicide is a major public health problem. People living with human immunodeficiency virus (PLHIV) have higher risk of suicidal behavior than the general population. The aim of this review is to summarize suicidal behavior, associated risk factors, and risk populations among PLHIV. Research studies in six databases from January 1, 1988, to July 8, 2021, were searched using keywords that included "HIV," "suicide," and "risk factors." The study design, suicide measurement techniques, risk factors, and study findings were extracted. A total of 193 studies were included. We found that the Americas, Europe, and Asia have the highest rates of suicidal behavior. Suicide risk factors include demographic factors, mental illness, and physiological, psychological, and social support. Depression is the most common risk factor for PLHIV, with suicidal ideation and attempt risk. Drug overdosage is the main cause of suicide death. In conclusion, the current study found that PLHIV had experienced a high level of suicidal status. This review provides an overview of suicidal behavior and its risk factors in PLHIV with the goal of better managing these factors and thus preventing death due to suicide.

Self-inflicted violence and suicide in people living with HIV/AIDS: a systematic review

OBJECTIVES

to analyze intellectual productions on self-inflicted violence and suicide in people living with HIV/AIDS.

METHODS

a systematic review, carried out between March and April 2021, in the PubMed®/MEDLINE®, Web of Science and LILACS databases, subsidized in the Strengthening the Reporting of Observational Studies in Epidemiology. The period outlined was from 2011 to 2020.

RESULTS

a total of 199 studies were identified, and 16 composed the final sample, grouped into the categories: Sociodemographic characteristics of victims of self-inflicted violence/suicide and their intervening factors (pointing to young adults, especially homosexuals, with low social support and a history of mental illness or substance abuse as usual victims); Successful measures for suicide prevention/control in people living with HIV/AIDS (suggesting more frequent psychosocial and clinical follow-up of those starting antiretroviral and immunocompromised treatment).

CONCLUSIONS

biopsychosocial follow-up, analysis of sociodemographic profile and intervening factors should be frequent in this population for disease prevention/control.

Violência autoprovocada e suicídio em pessoas que vivem com HIV/AIDS: revisão sistemática

RESUMO Objetivos: analisar as produções intelectuais sobre a violência autoprovocada e suicídio em pessoas que vivem com HIV/AIDS. Métodos: revisão sistemática, realizada entre março e abril de 2021, nas bases PubMed®/MEDLINE®, Web of Science e LILACS, subsidiada no instrumento Strengthening the Reporting of Observational Studies in Epidemiology. O período delineado foi de 2011 a 2020. Resultados: identificaram-se 199 estudos, e 16 compuseram a amostra final, sendo agrupados nas categorias: Características sociodemográficas das vítimas de violência autoprovocada/suicídio e seus fatores intervenientes (apontando adultos jovens, especialmente homossexuais, com baixo suporte social e histórico de doenças mentais ou abuso de substâncias como as vítimas usuais); Medidas exitosas para prevenção/controle de suicídio em pessoas vivendo com HIV/AIDS (sugerindo acompanhamento psicossocial e clínico mais frequente daqueles em início de tratamento antirretroviral e imunodeprimidos). Conclusões: acompanhamento biopsicossocial, análise do perfil sociodemográfico e dos fatores intervenientes devem ser frequentes nesta população, para prevenção/controle do agravo.

IgG intrathecal synthesis in HIV-associated neurocognitive disorder (HAND) according to the HIV-1 subtypes and pattern of HIV RNA in CNS and plasma compartments

We hypothesized that humoral immunity stimulation in the CNS in HIV-1C patients would be lower than that in HIV-1B due to a defective Tat chemokine dimotif (C30C31) that might influence cellular trafficking and CNS inflammation. Sixty-eight paired CSF and blood samples from people with HIV (PWH), free of CNS opportunistic infections, were included, HIV-1B (n = 27), HIV-1C (n = 26), and HIV negative (n = 25). IgG intrathecal synthesis was assayed using quantitative and qualitative methods. IgG oligoclonal bands (OCB) in CSF were observed in 51% of PWH, comparable between HIV-1B and HIV-1C, as well as the medians of IgG intrathecal synthesis formulas. The group with HIV infection aviremic in CSF and blood showed 75% of OCB. There was a poor positive correlation between the IgG quotient and GDS. The impact of HIV-1 on IgG intrathecal production was not subtype dependent. Low-grade CNS intrathecal IgG production persists in HIV CNS infection even in PWH with CSF and blood HIV RNA controlled.

Rates and risk factors for suicidal ideation, suicide attempts and suicide deaths in persons with HIV: a systematic review and meta-analysis

BACKGROUND

People living with HIV/AIDS (PLWHA) must contend with a significant burden of disease. However, current studies of this demographic have yielded wide variations in the incidence of suicidality (defined as suicidal ideation, suicide attempt and suicide deaths).

AIMS

This systematic review and meta-analysis aimed to assess the lifetime incidence and prevalence of suicidality in PLWHA.

METHODS

Publications were identified from PubMed (MEDLINE), SCOPUS, OVID (MEDLINE), Joanna Briggs Institute EBP and Cochrane Library databases (from inception to before 1 February 2020). The search strategy included a combination of Medical Subject Headings associated with suicide and HIV. Researchers independently screened records, extracted outcome measures and assessed study quality. Data were pooled using a random-effects model. Subgroup and meta-regression analyses were conducted to explore the associated risk factors and to identify the sources of heterogeneity. Main outcomes were lifetime incidence of suicide completion and lifetime incidence and prevalence of suicidal ideation and suicide attempt.

RESULTS

A total of 185 199 PLWHA were identified from 40 studies (12 cohorts, 27 cross-sectional and 1 nested case-control). The overall incidence of suicide completion in PLWHA was 10.2/1000 persons (95%CI: 4.5 to 23.1), translating to 100-fold higher suicide deaths than the global general population rate of 0.11/1000 persons. The lifetime prevalence of suicide attempts was 158.3/1000 persons (95%CI: 106.9 to 228.2) and of suicidal ideation was 228.3/1000 persons (95%CI: 150.8 to 330.1). Meta-regression revealed that for every 10-percentage point increase in the proportion of people living with HIV with advanced disease (AIDS), the risk of suicide completion increased by 34 per 1000 persons. The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations for the suicide deaths was graded as 'moderate' quality.

CONCLUSIONS

The risk of suicide death is 100-fold higher in people living with HIV than in the general population. Lifetime incidence of suicidal ideation and attempts are substantially high. Suicide risk assessments should be a priority in PLWHA, especially for those with more advanced disease.

Cerebrospinal fluid pleocytosis as a predictive factor for CSF and plasma HIV RNA discordance and escape

The aims of this study were to investigate the frequency of HIV-1 RNA level discordance between the cerebrospinal fluid (CSF) and plasma and of CSF viral escape (CVE) in patients with HIV-1 subtype C on antiretroviral therapy, and evaluate the CSF white blood cell (WBC) performance characteristics in predicting CSF discordance in HIV+ group and the frequency of cognitive impairment in individuals with CSF HIV discordance or escape. HIV-1 RNA levels were assessed in plasma and CSF samples from 68 HIV+ participants without opportunistic infection. CSF discordance was found in 7.4% and CVE in 10%, with comparable frequencies between HIV-1B and C. Twenty samples (29%) showed increased CSF WBC counts. This group had higher CSF and plasma HIV-1 RNA levels than the group with normal WBC counts (p < 0.0001 and 0.006, respectively). The odds of CSF discordance were 18 times higher for a person with CSF WBC count of > 5 cells/mm3 than the group with normal CSF WBC count. CSF WBC counts (cut-off of 15 cells/mm3) showed high-performance characteristics as a predictive biomarker of CSF discordance (AUC the ROC curve 0.98). The frequency of cognitive impairment for CSF escape or discordance was 83% and 80%. The odds of cognitive impairment in these groups were 19 and 15 times higher than those for an HIV(-) person. Viral discordance or escape in the CNS occurs at a comparable frequency for HIV-1C and HIV-1B. The CSF WBC count was effective as a predictive biomarker of CSF and plasma discordance.

Prevalence of and factors associated with major depressive disorder among HIV-positive individuals in Guangdong, China

BACKGROUND

People living with HIV may suffer from mental disorders. We aimed to explore the prevalence of and factors associated with major depressive disorder (MDD) among HIV-positive individuals in Guangdong, China, about which little is known.

METHODS

A cross-sectional study was conducted to recruit HIV-positive individuals from the Centers for Disease Prevention and Control of Guangzhou, Zhongshan, and Yangjiang from September 2007 to September 2008. Data were collected by questionnaires. MDD was diagnosed and assessed by two psychiatrists using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Patient Edition (SCID-I/P) based on the DSM-IV criteria. Multiple logistic regression analyses were conducted to explore the factors associated with MDD.

RESULTS

The prevalences of lifetime MDD and current MDD among the 339 included participants were 22.71% (95% confidence interval [CI]: 18.25-27.17%) and 12.09% (95%CI: 8.62%-15.57%), respectively. The results of multiple logistic regression showed that patients with AIDS had a higher risk of lifetime MDD (odds ratio [OR] = 2.69, 95%CI: 1.38-5.26) and current MDD (OR = 3.51, 95%CI: 1.59-7.75) than HIV-infected individuals. Participants with more number of negative life events were more likely to have lifetime MDD (OR = 2.33, 95%CI: 1.34-4.06) and current MDD (OR = 3.77, 95%CI: 1.76-8.09) than individuals with fewer negative life events. Individuals with higher score of social support were less likely to have lifetime MDD (OR = 0.45, 95%CI: 0.26-0.80) and current MDD (OR = 0.46, 95%CI: 0.21-0.97) than individuals with less social support.

CONCLUSIONS

The prevalence of MDD was high among HIV-positive individuals in China. AIDS diagnosis, decreased social support, and an increased number of negative life events were risk factors for MDD.