1. No baseline differences observed between patients exposed to efavirenz and nevirapine compared to those never exposed, regarding both depression and suicide.
2. No significant associations found between efavirenz and suicidal ideation in persons living with HIV in Uganda.
Evidence Rating Level: 2 (Good)
Study Rundown: The authors of this study examined the effects of an HIV treatment, efavirenz, which is a nonnoncleoside reverse transcriptase inhibitor used commonly in both low and high-income countries. The purpose of this study was to assess the associations between efavirenz use and depression and suicide ideation in persons living with HIV in Uganda. Generally, they observed there was not an increased risk for suicide in Uganda with efavirenz use. This study had several limitations. Of note, assignment between the treatment groups to efavirenz and nevirapine groups was nonrandom. Further, depression was measured through subjective reporting via a self-reported questionnaire.
Relevant Reading: Associated Factors of Suicidal Thoughts in HIV-Positive Individuals
In-Depth [prospective cohort]: In this prospective cohort study, a total of 692 patients were included and observed every 3 to 4 months from 2005 to 2015. The measurements of interest included depression and suicidal ideation. Depression was measured through a 15-item depression subscale of the Hopkins Symptom Checklist that was previously validated in the study population. The incidence of first suicide ideation was 3.1 and 7.4 per 100 person-years for the efavirenz- and nevirapine-exposed groups. The difference was -4.2 (CI, -6.8 to -1.5) events per 100 person-years. Further, efavirenz use was not significantly associated with suicidal ideation (adjusted odds ratio, 0.61 (CI, 0.30 to 1.25); P = 0.178) with the GEE model. Similarly, efavirenz was not significantly associated with suicidal ideation based on the Cox proportional hazards regression model.
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