Amsterdam 2015
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| Abstract #2096 - Comorbidity - double jeopardy | ||||
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Session: 23.6: Comorbidity - double jeopardy (Parallel) on Wednesday @ 16.30-18.00 in 202 Chaired by Margalit Lorber, Simon Rackstraw Authors: Presenting Author: Mrs M.Patrizia Carrieri - Inserm UMR912, Aix-Marseille Université UMR_S912, ORS PACA, France |
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| Additional Authors: | ||||
| Aim: HIV infection constitutes a particular context which may influence the desire to continue living. In 2010, suicide accounted for 5% of deaths in people living with HIV (PLWH) in France, higher than the 2% in the general population. Previous studies have shown that experience of discrimination in PLWH is associated with attempted suicide. However, suicide is also highly prevalent among PLWH who are drug dependent and those who have several comorbidities (depression and Hepatitis C (HCV)). It is still unclear whether suicide risk is more strongly related to the burden of comorbidities and experiencing discrimination than is HIV. This study aimed at characterizing the association between suicide risk and experience of discrimination and comorbidities (in particular HCV co-infection) in a representative sample of PLWH followed-up in specialized HIV outpatient services in France. | ||||
| Method / Issue: The ANRS VESPA2 cross-sectional survey (April 2011-January 2012) collected socio-demographic and behavioral data (through face-to-face administered questionnaires), as well as medical data (physician questionnaires) among 3,022 HIV-infected adults recruited in 73 French HIV hospital departments. We ed patients with medically documented HIV-HCV co-infection who had available data concerning suicide ideation during their lifetime (n=2,973). Patients at suicide risk were defined as those who had thought about and planned to commit suicide over the previous year, in order to assess current high to very high suicidal lethality. A multivariate Poisson regression with stepwise backward ion enabled us to estimate the relationship between experiencing discrimination and suicide risk, after adjustment for other potential correlates and confounders (Model 1, M1). As HCV co-infection was strongly associated in the univariate analysis, a second model (Model 2, M2) was built in the same way, this time systematically adjusted for co-infection with chronic HCV in order to assess its impact on suicide risk. | ||||
| Results / Comments: Among the study sample, 6.3% patients constituted a suicide risk. After adjustment for addictive behaviors as well as demographic, socioeconomic and clinical factors, those who had experienced discrimination (IRR [95%CI]: 1.39 [1.19 1.61] -same estimates in both M1 and M2) and those co-infected with chronic HCV (IRR [95%CI]: 1.70 [1.02 2.84], M2) were more likely to constitute a suicide risk. Conversely, the injecting drug users (IDU) HIV transmission group, which was significantly associated with suicide risk in the univariate analysis (IRR: 1.77, p-value=0.024), was no longer significant in the multivariate analysis. Individuals who reported feeling lonely (35%) were four (M1) to five times more likely (M2) to constitute a suicide risk than others. | ||||
| Discussion: HCV co-infected PLWH present a non-negligible risk of suicide, while IDU PLWH are not significantly more at risk than others. Psychosocial factors like experiencing discrimination and feelings of loneliness are major cofactors of suicide risk. Access to HCV treatment, especially in the era of potent and less toxic HCV treatments, remains a priority in this population in order to improve mental health. Comprehensive care models based on both psychiatric screening of mental disorders and peer/community social interventions need to be rapidly introduced into routine HIV care. | ||||
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