January 26, 2015

Widely used HIV drug linked to higher suicide risk

Authors: Katie R. Mollan, MS; Marlene Smurzynski, PhD; Joseph J. Eron, MD; Eric S. Daar, MD; Thomas B. Campbell, MD; Paul E. Sax, MD; Roy M. Gulick, MD; Lumine Na, MS; Lauren O’Keefe, BS; Kevin R. Robertson, PhD; and Camlin Tierney, PhD

People with HIV whose treatment includes the widely used antiretroviral drug efavirenz appear to have double the risk of suicidal thoughts, attempts, and completion compared to HIV patients not taking the medication

Study co-author Dr. Joseph Eron shared that “Efavirenz is a very important and effective antiretroviral medication that is the foundation for much of HIV therapy worldwide.” Dr. Eron explained that “suicidality (i.e. suicidal thoughts or suicidal behavior or suicide death) is a very serious adverse event that requires clinicians to actively engage patients to assess risk”. This new study demonstrates a clear association between efavirenz and suicidality.

Although the absolute risk of suicidality is relatively small, Eron explained that it appears to be persistent, lasting as long as patients take the drug. Antiretroviral treatment typically is lifelong, helping people with the AIDS-causing virus live healthier lives.

“Clinicians should be aware of this ongoing risk, and talk to their patients to assess suicidality,” Eron added. That means looking for any history of depression or suicidal thoughts or attempts, the study noted.

Good alternatives to efavirenz do exist for patient who may need to start, or to switch to, another therapy. In settings where alternative therapies are not available, the benefits of efavirenz-based therapy with management of depression will usually outweigh the risks of no treatment, especially for people with low CD4 cell counts.


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