愛滋病毒感染者死於自殺、事故、暴力和藥物濫用的風險仍然較高
資料來源：Dana Rosenfeld 博士 / 2022 年 11 月 29 日 / aidsmap / 財團法人台灣紅絲帶基金會編譯
圖片/Shutterstock.com
愛滋病毒感染者死於自殺、藥物濫用、事故和暴力的風險仍然高於普通人群。 一組在 16 個歐洲國家工作的科學家發表在《愛滋病》雜誌上的研究發現，透過注射吸毒感染愛滋病毒的人、感染愛滋病毒的男性以及東歐的愛滋病毒感染者自殺或意外/暴力死亡的風險更高。他們還發現，在診斷出患有愛滋病後的一年裡，自殺死亡率更高。
抗反轉錄病毒療法問世後，愛滋病毒感染者的自殺死亡率有所下降，但仍然很高。 儘管不同研究的數字和比例各不相同，但最可靠的結論是，愛滋病毒感染者的自殺率是普通人群的兩倍到幾乎八倍。 2017 年英國公共衛生部的一項研究發現，在愛滋病毒診斷後的第一年，愛滋病毒感染者的自殺率是全球人口的五倍。 在那項研究中，診斷後第一年的自殺人數佔世代中所有自殺死亡人數的十分之四。
確定死因
眾所周知，區分自殺死亡和其他原因死亡是非常困難的。 如果有人從高處墜落，可能不清楚那是意外，他們是想結束自己的生命，還是其他人將他們推下。 藥物過量、事故和暴力導致的死亡都可能與自殺相混淆。由於自殺死亡的恥辱，長期以來人們一直懷疑，有些死亡可能不會被正式歸類為自殺，以顧及倖存者的感受。
了解更多：最艱難的結果：愛滋病毒和自殺
由於這些原因導致的死亡可能具有相似的風險因素（例如，冒險行為、精神疾病和其他恥辱感），因此該研究的作者試圖確定愛滋病毒感染者自殺的死因率，物質使用、暴力/事故以及這三種原因的任意組合（複合結果）。 他們分析了來自 EuroSIDA 的數據，該數據集包含超過 23,000 名 18 歲及以上的 HIV 感染者的臨床、人口統計和治療信息，他們生活在歐洲以及以色列和阿根廷。該團隊重點關注在 2007 年至 2019 年間至少接受過一次追蹤（例如，透過一次或多次記錄的門診就診、CD4 細胞計數或病毒載量）的參與者。參與者樣本總數為 17,881 人，參與者平均追蹤時間八年。
他們發現總體死亡率為每 10,000 人年 121 人的追蹤。 換句話說，在追蹤一年的 10,000 名愛滋病毒感染者中，預計會有 121 人死亡。在這些年發生的大約 1,800 例死亡中，藥物使用佔 5%，暴力/事故佔 3%，自殺佔 2%。自殺率為每 10,000 人年追蹤 2.7 人：在追蹤一年的 10,000 名愛滋病毒感染者中，人們可能預計每年自殺人數少於 3 人。
特別是易感染愛滋病毒的弱勢群體
愛滋病毒感染者自殺死亡在愛滋病診斷後的 12 個月內特別高：在這個樣本中，在過去 12 個月內被診斷為愛滋病的人自殺的風險是沒有愛滋病史的參與者的九倍。在多變量分析中，沒有其他因素與自殺相關。
研究人員還發現，男性死於事故或暴力的風險是女性的兩倍，而透過注射吸毒感染 HIV 的參與者死於暴力、事故或藥物濫用的風險更高。那些透過注射吸毒感染愛滋病毒的人死於暴力/事故的風險是樣本中男同性戀和雙性戀男性的兩倍多。相同的死亡風險差異也適用於復合結局導致的死亡。
分析還發現了地域差異。東歐的愛滋病毒感染者因暴力、事故或藥物使用而死亡的風險更高，這可能是由於該地區注射吸毒率較高。在歐洲以及以色列和阿根廷，愛滋病毒感染者的自殺死亡率低於瑞士和法國愛滋病毒感染者的自殺率，但與英國愛滋病毒感染者的自殺率大致相似。由於事故/暴力或物質使用，愛滋病毒感染者的平均死亡率高於英國的愛滋病毒感染者。
建議
作者建議特別注意透過注射吸毒感染 HIV 的人更高的死亡風險。他們提請注意東歐較高的注射吸毒率，這可能是由於吸毒治療的可及性較低，以及該地區總體自殺率較高以及愛滋病毒感染者獲得照護的機會和照護品質較差。
他們還建議更加關注識別和治療 HIV 感染者可能導致自殺的心理健康挑戰。鑑於最近被診斷出患有愛滋病的人自殺率很高，他們建議愛滋病毒提供者應該考慮在過去 12 個月內被診斷出患有愛滋病的人的心理健康狀況。
如果您受到此問題的影響，可以在英國撥打 116 123 聯繫撒瑪利亞人，在美國，全國預防自殺生命線是 1-800-273-8255。 可以在 www.befrienders.org 或通過此維基百科頁面找到其他國際求助熱線。
參考文獻：
T Tusch ES at al. 愛滋病毒感染者自殺、物質使用導致的死亡和暴力/意外死亡的發生率和風險因素。《愛滋病》，印刷前線上發表，2022 年 10 月 12 日。
DOI: 10.1097/QAD.0000000000003402
People living with HIV still at higher risk of death by suicide, accident, violence, and substance use
Dr Dana Rosenfeld / 29 November 2022 / aidsmap
Ground Picture/Shutterstock.com
The risk of death by suicide, substance use, accident, and violence remains higher among people living with HIV than in the general population. Research by a team of scientists working across 16 European countries, published in the journal AIDS, found that people who acquired HIV through injection drug use, men living with HIV, and people living with HIV in Eastern Europe had a higher risk of death by suicide or by accident/violence. They also found higher rates of death by suicide in the year following an AIDS diagnosis.
Rates of death by suicide among people living with HIV dropped after antiretroviral therapies became available, but remain high. Although the numbers and proportions vary across different studies, the most reliable conclusions are that suicide rates among people living with HIV are between twice as high and almost eight times as high as in the general population. A 2017 Public Health England study found that the suicide rate among people living with HIV was five times that of the global population in the first year after an HIV diagnosis. In that study, suicides in the first year after diagnosis represented four in ten of all deaths by suicide in the cohort.
Identifying cause of death
Distinguishing between deaths from suicide and deaths from other causes is notoriously difficult. If someone falls from a height, it might not be clear whether that was an accident, they intended to take their own life or another person pushed them off. Deaths by drug overdose, accidents and violence can all be confused with suicides. Because of the stigma of death by suicide, it has long been suspected that some deaths may not be officially classified as suicides to spare survivors’ feelings.
Find out more: The hardest outcome of all: HIV and suicide
Because deaths by these causes may share similar risk factors (for example, risk-taking behaviours, mental ill health, and other stigmas), the authors of the study sought to identify the rates of causes of death among people living with HIV by suicide, substance use, violence/accident, and any combination of these three causes (a composite outcome). They analysed data taken from EuroSIDA, a data set of clinical, demographic, and therapeutic information on over 23,000 people living with HIV, aged 18 and over and living across Europe and in Israel and Argentina. The team focused on participants who were followed up at least once (for example, through one or more recorded clinic visit, CD4 cell count or viral load) between 2007 to 2019. The total participant sample was 17,881, with participants followed up for an average of eight years.
They found that the overall death rate was 121 per 10,000 person years of follow up. In other words, in a group of 10,000 people living with HIV followed up for a year, one might expect there to be 121 deaths. Substance use accounted for 5%, violence/accident for 3%, and suicide for 2% of the approximately 1,800 deaths that occurred during these years. The rate of suicide was 2.7 per 10,000 person years of follow up: in a group of 10,000 people living with HIV followed up for a year, one might expect there to be fewer than three suicides per year.
Especially vulnerable groups of people living with HIV
Deaths by suicide among people living with HIV were especially high during the 12 months after an AIDS diagnosis: in this sample, the risk of suicide was nine times higher among those with an AIDS diagnosis in the past 12 months than it was among participants with no history of AIDS. No other factors were associated with suicide in multivariable analysis.
The researchers also found that men had twice the risk of death by accident or violence than women, and that participants who had acquired HIV through injection drug use had a higher risk of death from violence, accident, or substance use. Those who had acquired HIV through injection drug use had more than twice the risk of death by violence/accident than did gay and bisexual men in the sample. The same differences in risk of death applied to death due to the composite outcome.
Analysis also uncovered geographical differences. People living with HIV in in Eastern Europe had a higher risk of death from violence, accident, or substance use, likely due to higher rates of injection drug use in that region. The rates of death by suicide among people living with HIV across Europe and in Israel and Argentina was lower than found in studies of people living with HIV in Switzerland and France, but roughly similar to suicide rates among people living with HIV in the United Kingdom. Average rates of death among people living with HIV due to accident/violence or substance use were higher than those among people living with HIV in the UK.
Recommendations
The authors recommend that particular attention is paid to higher risk of death for people in who acquired HIV through injection drug use. They draw attention to the higher rate of injection drug use in Eastern Europe, possibly due to lower access to treatment for drug use, and to the region’s higher overall suicide rates and poorer access to and quality of care for people living with HIV.
They also recommend a greater focus on identifying and treating mental health challenges among people living with HIV that could lead to suicide. Given the high suicide rates among people with a recent AIDS diagnosis, they suggest that HIV providers should consider the mental health of individuals who had received an AIDS diagnosis within the previous 12 months.
If you are affected by this issue, Samaritans can be contacted in the UK on 116 123, and in the US, the National Suicide Prevention Lifeline is 1-800-273-8255. Other international helplines can be found at www.befrienders.org or via this Wikipedia page.
References
Tusch ES at al. Incidence and risk factors for suicide, death due to substance use, and violent/accidental death in persons living with HIV. AIDS, online ahead of print, 12 October 2022.
DOI: 10.1097/QAD.0000000000003402