Abstract PS5/3
Declining Suicide Rates among People Leaving with HIV (PLHIV) Initiating HAART between August 1996 - June 2012 in the HAART Observational Medical Evaluation and Research Cohort in British Columbia, Canada Print
J. Gurm1, S. Guillemi1, E. Ding1, V. Strethlau2, J.S.G. Montaner1,3, R.S. Hogg1,4
1BC Centre for Excellence in HIV/AIDS, Vancouver, Canada, 2University of British Columbia, Department of Psychiatry, Vancouver, Canada, 3University of British Columbia, Faculty of Medicine, Vancouver, Canada, 4Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada
Objectives: Throughout the HAART era, suicide rates among people living with HIV/AIDS (PLHIV) were markedly higher than in the general population. We sought to identify factors associated with suicide among PLHIV who initiated HAART in British Columbia (BC), Canada.
Methods: Our analysis included participants from the HAART Observational Medical Evaluation and Research (HOMER) cohort, a retrospective study of all treatment naive individuals who initiated HAART in BC from August 1996 to June 2012. Clinical and socio-demographic data were obtained through a linkage with the Drug Treatment Program at the BC Centre for Excellence in HIV/AIDS. Mortality data was obtained through a linkage with the BC Vital Statistics Registry. Logistic regression and Cox proportional hazards models were used to identify factors associated with suicide.
Results: Between August 1996 and June 2012, there were 993 deaths among 5229 HOMER participants, 82 of which were suicides - a rate 27-fold greater than the suicide rate in the general population. Death earlier in the HAART era (earlier calendar year of death) (OR = 0.88; 95% CI [0.81 - 0.96]), younger age (OR = 0.96; 95% CI [0.93 - 0.99]), history of injection drug use (OR = 1.88; 95% CI [0.84-4.19]), higher last CD4 count (OR = 1.20 95% CI [1.05 - 1.36]), and never having an AIDS defining illness (OR = 6.58; 95% CI [2.32 - 18.69]) were independently associated with suicide.
Conclusion: Modern HAART has transformed HIV from a terminal illness to a chronic, manageable condition, likely contributing to the reduced incidence of suicide over time in the HOMER cohort. Despite this trend, suicide remains a serious concern in this population. Our findings suggest that factors other than HIV disease/disease progression, such as injection drug use, may be more relevant clinical indicators and targets for intervention within the context of suicide risk.
 Univariate (n=993) OR(95% CI)p-valueMultivariate (n=993) OR(95% CI)p-value
AIDS Defining Illness (ever) <0.001 <0.001
Yes1.00 (--) 1.00 (--) 
No9.39 (3.40, 25.88) 6.58 (2.32, 18.69) 
History of Injection Drug Use 0.134 0.038
No1.00 (--) 1.00 (--) 
Yes2.02 (1.02, 4.14) 1.88 (0.84, 4.19) 
Unknown1.84 (0.86, 3.92) 0.92 (0.38, 2.22) 
[Factors associated with suicide]
 Univariate (n=993) OR(95% CI)p-valueMultivariate (n=993) OR(95% CI)p-value
Age at death (years)0.96 (0.93, 0.98)<0.0010.96 (0.93, 0.99)0.004
Calendar year of death0.87 (0.82, 0.92)<0.0010.88 (0.81, 0.96)0.004
Nadir CD4 (cells/mm^3)1.71 (1.47, 1.99)<0.0011.26 (0.99, 1.61)0.061
Last CD4 (cells/mm^3)1.24 (1.15, 1.34)<0.0011.20 (1.05, 1.36)0.008
Year of HIV diagnosis (by 1st ARV date, or earliest AIDS defining illness, or 1st detectable VL)0.85(0.79, 0.93)<0.0010.92(0.83, 1.02)0.122
[Table 1: Factors associated with suicide continued]
[Suicide rates in the HOMER cohort from 1996 - 2012]

Assigned speakers:
Jasmine Gurm , BC Centre for Excellence in HIV/AIDS , Vancouver , Canada

Assigned in sessions:
17.10.2013, 14:00-16:00, Parallel Session, PS5, People Living Long Term with HIV, Gold Hall