Background: Risk factors for suicidality among people with HIV (PWH) may evolve over their disease course, particularly as they develop comorbidities such as mental health disorders over time. Setting: This study compared the leading risk factors of suicide ideation/attempt among PWH in South Carolina across different combination antiretroviral therapy (cART) eras. Methods: A statewide cohort of PWH who were diagnosed between 2005 and 2016, with a follow-up record until 2020, was involved in the study. A Cox proportional hazards model was used to examine the association of suicide ideation/attempt and predictors, including demographics, HIV-related characteristics, and mental health conditions. Results: Among 8567 PWH, the incidence of suicide ideation/attempt increased from 537.7 per 100,000 person-years [95% confidence interval (CI): 460.2 to 615.1] in the early cART cohort (2005–2008) to 782.5 (95% CI: 697.6 to 867.4) in the late cART cohort (2009–2016). Leading risk factors of suicide ideation/attempt changed across the cART cohort. In the early cART cohort, PWH with suicide ideation/attempt were more likely to be White and diagnosed with bipolar disorder (P’s < 0.05). In the late cART cohort, suicide ideation/attempt was positively associated with transmission through injection drug use, anxiety, posttraumatic stress disorder, schizophrenia, and personality disorder (P’s < 0.05). Conclusions: Mental health conditions have emerged as more prominent risk factors for suicide ideation/attempt in the late cART cohort. Enhanced access to psychiatric care could facilitate the early identification of mental health conditions, enabling timely counseling or psychosocial interventions that may mitigate mental health issues and, consequently, reduce the likelihood of suicide ideation/attempts among PWH.

中文翻译：

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HIV 感染者的自杀意念和企图：2005 年至 2020 年全州人口水平队列分析

背景：HIV 感染者 (PWH) 自杀的危险因素可能会随着他们的病程而变化，特别是当他们随着时间的推移出现精神健康障碍等合并症时。 环境：这项研究比较了南卡罗来纳州不同联合抗逆转录病毒治疗 (cART) 时代的感染者自杀意念/企图的主要危险因素。 方法：这项研究涉及全州范围内的 2005 年至 2016 年间确诊的感染者队列，随访记录直至 2020 年。使用 Cox 比例风险模型来检查自杀意念/企图与预测因素的关联，包括人口统计、艾滋病毒相关特征和心理健康状况。 结果：在 8567 名 PWH 中，自杀意念/企图的发生率从早期 cART 队列（2005-2008）中的每 10 万人年 537.7 例 [95% 置信区间 (CI)：460.2 至 615.1] 增加到 782.5 例（95% CI：697.6）到 867.4）在晚期 cART 队列（2009-2016）中。在整个 cART 队列中，自杀意念/企图的主要危险因素发生了变化。在早期 cART 队列中，有自杀意念/企图的 PWH 更有可能是白人并被诊断患有双相情感障碍（P's < 0.05）。在晚期 cART 队列中，自杀意念/企图与注射吸毒、焦虑、创伤后应激障碍、精神分裂症和人格障碍的传播呈正相关。P's < 0.05）。 结论：在晚期 cART 队列中，心理健康状况已成为自杀意念/企图的更突出的危险因素。增加获得精神科护理的机会可以促进及早识别精神健康状况，从而能够及时进行咨询或社会心理干预，从而减轻精神健康问题，从而降低感染者自杀意念/企图的可能性。