It is unknown if the increasing suicide rate (particularly among White men) and the increased risk of suicide among those who use drugs in the US general population are mirrored among people with HIV (PWH). We estimated suicide rates in PWH in the US and Canada from 2000-2015.
Adults (aged 20-79) in the NA-ACCORD were followed from the later of enrollment into the cohort or 1/1/2000 to the first of death, loss to follow-up (2 years after last CD4 or HIV RNA), or 12/31/2015. Cause of death was ascertained by death certificate or electronic medical record notation. Suicide incidence rates (IR) and 95% confidence intervals (stratified by sex, Black/White race, history of injection drug use (IDU), and calendar year were calculated per 100,000 person years (pys). Adjusted incidence rate ratios (IRR) and 95% confidence intervals ([,]) were estimated using Poisson regression; Black/White race, IDU, diagnosed bipolar affective disorder, major depression, schizophrenia, HIV-associated dementia, efavirenz prescription, calendar year, and decade of age were in the final model.
Among 81,123 adults contributing 547,278 pys (median follow-up of 5.6 years), 217 suicides were identified. Women were excluded from analyses due to limited outcomes (N=2 suicides, IR=4.17 [0.51,15.07]). Among men, 17% of White and 35% of Black men had a history of IDU. The suicide rate was 43.06 [37.30, 48.81]. This was higher in White vs. Black men from 2000-15 (Figure 1); overall there was a 4.4-fold greater suicide rate among White (66.55 [56.04, 77.06]) vs. Black (15.16 [9.73, 20.58]) men. Compared to Black non-IDUs, the suicide rate was greater among White IDU (IRR=9.87 [5.08, 19.17]), White non-IDU (IRR=5.52 [2.96, 10.29]), and Black IDU (IRR=2.21 [1.03, 4.72]) in the adjusted model. Under-ascertainment of suicide is possible (and may be differential by subgroups), which would underestimate suicide rates.
Suicide rates were much lower in women (vs. men) with HIV, corroborative of US general population findings. Among men with HIV, suicide rates were higher among White (vs Black) men. White men with a history of IDU had the highest rates of suicide, followed by White non-IDU, Black IDU, and Black non-IDU, suggesting the association between drug use and suicide in the general population may also be reflected in men with HIV. Men with HIV warrant targeted suicide prevention efforts, particularly White men with a history of IDU.