No Increased Risk of Suicidality in HIV Patients Starting an Efavirenz-Containing Regimen

PHILADLEPHIA, PAResults from a cohort analysis showed no evidence of an increased risk of suicidality or suicide attempt among patients starting an efavirenz-containing compared to an efavirenz-free regimen, researchers presented at IDWeek 2014.

Ella Nkhoma, PhD, Global Pharmacovigilance and Epidemiology, Bristol-Myers Squibb, Wallingford, CT, and researchers conducted a study to compare the incidence rate of suicidality, including suicide attempt, in patients initiating an efavirenz-containing vs. efavirenz-free antiretroviral regimen.

Dr. Nkhoma and colleagues analyzed administrative claims from a U.S. commercial and a public insurance database (Medicaid), from 2006–2013. Antiretroviral-naïve patients aged >12 years who were starting an efavirenz-containing or efavirenz-free regimen with >6 months of continuous enrollment prior to antiretroviral initiation were identified for the analysis.

Suicidality was defined as ICD-9-CM diagnosis codes for suicidal ideation or attempt.  Suicide attempt was defined as an inpatient or emergency department claim with a diagnosis code for suicide attempt, as well as an expanded definition that also included diagnosis codes for injuries consistent with suicide attempt with a psychiatric diagnosis during the same encounter.

From the commercial database, there were 11,187 patients on an efavirenz-containing regimen, and 8,796 patients on an efavirenz-free regimen. From the Medicaid database, there were 2,224 patients on an efavirenz-containing regimen, and 2,930 on an efavirenz-free regimen.

Across both databases, patients initiating an efavirenz-free regimen had a higher prevalence of depression and other psychiatric disorders. In general, there was a higher incidence rate for all outcomes in the Medicaid population. The use of efavirenz was not associated with increased suicidality or suicide attempt.

Dr. Nkhoma noted that as per the analysis, “HIV patients with depression and psychiatric disorders were less likely to be prescribed efavirenz.” Even after a propensity score adjustment, researchers did not find definitive evidence of an increased risk of suicidality or suicide attempt among this population.  However, she added, “other risk factors such as family history, socioeconomic status, and psychiatric evaluation were not captured.”