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The full report is titled “Association Between Efavirenz as Initial Therapy for HIV-1 Infection and Increased Risk for Suicidal Ideation or Attempted or Completed Suicide. An Analysis of Trial Data.” It is in the 1 July 2014 issue of Annals of Internal Medicine (volume 161, pages 1-10). The authors are K.R. Mollan, M. Smurzynski, J.J. Eron, E.S. Daar, T.B. Campbell, P.E. Sax, R.M. Gulick, L. Na, L. O’Keefe, K.R. Robertson, and C. Tierney.
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Efavirenz is a common and highly effective component of antiretroviral therapy for HIV infection. However, there is concern that people who receive efavirenz as part of their HIV regimen may be more likely to have suicidal thoughts and attempts and to actually commit suicide than people who do not receive it.
To study many similar patients who were receiving or not receiving efavirenz.
Patients enrolled in 4 large clinical trials in which they were randomly assigned to regimens that did or did not contain efavirenz. This allowed the researchers to detect a relatively uncommon event and be more confident that the patients receiving efavirenz were similar to those who did not receive it.
Data were collected from each patient on symptoms consistent with suicidal thoughts. Study records that indicated suicide, suicide attempts, or suicidal thoughts were examined. All of these data were compared systematically.
Patients whose regimen contained efavirenz were approximately twice as likely to experience suicidal thoughts or to attempt or actually commit suicide as those not receiving efavirenz. Adverse events were uncommon.
The 4 randomized clinical trials had not been designed to specifically look at the question of suicide risk with different drug regimens. The trials were not blinded (that is, patients and providers knew whether they were receiving efavirenz).
Patients with HIV who start antiretroviral therapy should discuss any history of depression or suicidal thoughts or attempts with their health care provider before choosing an antiretroviral regimen.
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