title: Determinants of suicide and accidental or violent death in the Australian HIV Observational Database.
abstract: BACKGROUND
  Rates of suicide and accidental or violent death remain high in HIV-positive populations despite significantly improved prognosis since the introduction of cART.
  
  
  METHODS
  We conducted a nested case-control study of suicide and accidental or violent death in the Australian HIV Observational Database (AHOD) between January 1999 and March 2012. For each case, 2 controls were matched by clinic, age, sex, mode of exposure and HIV-positive date to adjust for potential confounding by these covariates. Risk of suicide and accidental or violent death was estimated using conditional logistic regression.
  
  
  RESULTS
  We included 27 cases (17 suicide and 10 violent/accidental death) and 54 controls. All cases were men who have sex with men (MSM) or MSM/ injecting drug use (IDU) mode of exposure. Increased risk was associated with unemployment (Odds Ratio (OR) 5.86, 95% CI: 1.69-20.37), living alone (OR 3.26, 95% CI: 1.06-10.07), suicidal ideation (OR 6.55, 95% CI: 1.70-25.21), and >2 psychiatric/cognitive risk factors (OR 4.99, 95% CI: 1.17-30.65). CD4 cell count of >500 cells/µL (OR 0.25, 95% CI: 0.07-0.87) and HIV-positive date ≥1990 (1990-1999 (OR 0.31, 95% CI: 0.11-0.89), post-2000 (OR 0.08, 95% CI: 0.01-0.84)) were associated with decreased risk. CD4 cell count ≥500 cells/µL remained a significant predictor of reduced risk (OR 0.15, 95% CI: 0.03-0.70) in a multivariate model adjusted for employment status, accommodation status and HIV-positive date.
  
  
  CONCLUSIONS
  After adjustment for psychosocial factors, the immunological status of HIV-positive patients contributed to the risk of suicide and accidental or violent death. The number of psychiatric/cognitive diagnoses contributed to the level of risk but many psychosocial factors were not individually significant. These findings indicate a complex interplay of factors associated with risk of suicide and accidental or violent death.
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Hamish
authors.initials: H
authors.lastname: McManus
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Kathy
authors.initials: K
authors.lastname: Petoumenos
authors.affiliation: Holdsworth House GP, Sydney, Australia.
authors.forename: Teo
authors.initials: T
authors.lastname: Franic
authors.affiliation: Brisbane Sexual Health and HIV Service, Brisbane, Queensland, Australia.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Kelly
authors.affiliation: National Association of People with HIV Australia, Sydney, Australia.
authors.forename: Jo
authors.initials: J
authors.lastname: Watson
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia ; RPA Sexual Health, Royal Prince Alfred Hospital, Sydney, Australia ; Central Clinical School, Sydney University, Sydney, Australia.
authors.forename: Catherine C
authors.initials: CC
authors.lastname: O'Connor
authors.affiliation: Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Jeanes
authors.affiliation: Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hoy
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: David A
authors.initials: DA
authors.lastname: Cooper
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Law
mesh_terms: D000059:Accidents / Q000401:mortality*; D000328:Adult; D001315:Australia; D016022:Case-Control Studies; D002423:Cause of Death; D016208:Databases, Factual / Q000706:statistics & numerical data; D015658:HIV Infections / Q000453:epidemiology; D015497:HIV-1; D006708:Homicide / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D013405:Suicide / Q000706:statistics & numerical data*; D014754:Violence / Q000706:statistics & numerical data*; D055815:Young Adult