Association Between Efavirenz as Initial Therapy for HIV-1 Infection and Increased Risk for Suicidal Ideation or Attempted or Completed Suicide

Abstract

Background The relationship between efavirenz use and suicidality is not well defined. Objective Compare time to suicidality with efavirenz-containing versus efavirenz-free antiretroviral regimens for initial treatment of HIV. Design Participant-level data were analyzed from four AIDS Clinical Trials Group (ACTG) antiretroviral-naïve studies conducted from 2001 to 2010. Within each study, participants were randomly assigned to an efavirenz-containing (n=3241) or efavirenz-free regimen (n=2091). Setting ACTG sites; 74% enrolled in the United States. Patients Antiretroviral-naïve participants. Intervention Efavirenz versus efavirenz-free regimens. Measurements Suicidality was defined as suicidal ideation, attempted or completed suicide. Groups were compared with a hazard ratio (HR) and 95% confidence interval (CI) estimated from a Cox model stratified by study. Results 73% were men, median age was 37 years; 32% had documented psychiatric history or received psychoactive medication within 30 days prior to study entry. Median follow-up was 96 weeks. Suicidality incidence per 1000 person-years was 8.08 (47 events) in the efavirenz group and 3.66 (15 events) in the efavirenz-free group, HR: 2.28 (95% CI: 1.27 to 4.10, p=0.006). Incidence of attempted or completed suicide was 2.90 (17 events) and 1.22 (5 events) in the efavirenz and efavirenz-free groups, respectively, HR: 2.58 (95% CI: 0.94 to 7.06, p=0.065). Eight suicide deaths in the efavirenz group and one in the efavirenz-free group were reported. Limitations There was not a standardized questionnaire regarding suicidal ideation or attempt. Efavirenz was open-label in three of four studies. Conclusions Initial treatment with an efavirenz-containing antiretroviral regimen was associated with a two-fold increased hazard of suicidality compared to a regimen without efavirenz.

Updates in Psychosomatic Medicine: 2014

“…The articles were Updates in Psychosomatic Medicine related to 15 subspecialties: cardiac psychiatry, [4][5][6][7][8][9] collaborative care/integrated behavioral health, 10,11 emergency psychiatry, 12,13 HIV psychiatry, [14][15][16][17][18][19][20] neuropsychiatry, 21-31 pediatric psychosomatic medicine, 32-36 psychodermatology, [37][38][39][40][41][42][43][44][45] psychonephrology, 46-55 psycho-oncology and palliative care, [56][57][58][59][60][61][62][63][64] serious mental illness, [65][66][67][68][69][70][71][72] somatic symptom disorders, 73 suicide, 74-78 transplant psychiatry, [79][80][81][82][83][84]…”

“…Patients with HIV infection who have ANI have to be identified, and attempts should be made to protect cognition. 18 The old standby first-generation NNRTI antiretroviral agent efavirenz, which is a component of standard treatment for HIV infection, is associated with an increased risk of suicidality.…”

Switching antiretroviral regimes for the treatment of HIV: safety implications

“…Although it is a generally safe and effective drug, EFV is associated with central nervous system side effects, and prescribing information contains warnings of serious psychiatric side effects, including suicide [47]. In an analysis of four big independent clinical trials, an increased risk was found of developing suicidal ideas or attempted or completed suicides in patients receiving EFV [55], although in two other cohorts this question is not confirmed [1, 56,57]. EFV use may worsen neurocognitive function or be associated with less improvement in impaired neurocognitive function than other antiretrovirals [55].…”

Resistance to Resilience: Journey of a Young Girl from Home to ART Center

“…There are clear linkages between poverty and HIV and this story clearly portrays how poverty can make people vulnerable and push them towards transactional sex [6,7]. HIV is an illness which is accompanied by the issues of suicidal thoughts, experiences of violence, issues of moral burden and guilt [8][9][10][11]. However, an optimistic attitude has the power to change the course of life.…”