Suicide and accidental or violent death continues to occur in HIV-positive populations despite significantly improved prognosis since the introduction of cART. The combined effects of psychosocial factors and HIV-infection on risk are poorly understood. In this study we analysed predictors of confirmed cases of suicide as well as of accidental or violent death to develop adjusted models of risk associated with both psychosocial and HIV-related factors.
Methods: We conducted a retrospective nested case-control study of suicide and accidental or violent death in the Australian HIV Observational Database between January 1999 and March 2012. For each case, 2 controls were matched by clinic, age, sex, mode of exposure and HIV-positive diagnosis date. Psychosocial risk factors and HIV infection parameters were collected. Risk of suicide and accidental or violent death was estimated using conditional logistic regression.
Results: We included 27 cases (17 suicide and 10 accidental/violent death) and 54 controls. 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 later HIV-positive diagnosis date (p=0.04) were associated with decreased risk. Depression was not a significant predictor of risk (OR 1.87, 95% CI:0.67-5.25). 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 diagnosis date.
Conclusions: After adjustment for psychosocial factors, 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.
The case is of a 30 year-old HIV positive Zimbabwean woman (UK resident) who arrived in Australia in January 2011 on a one-year working visa. She was diagnosed with HIV in 2003 in the UK and commenced on Atripla® in 2005. She was first seen in Adelaide in May 2011, requesting a script for Atripla.®.
Background: Liquid based anal Papanicolaou smears, followed by High Resolution Anoscopy (HRA) guided biopsies are increasingly being advocated to identify areas of High Grade Anal Intraepithelial Neoplasia (HGAIN). We hypothesized that the ability to identify HGAIN would increase with experience of the anoscopist, and that comparison with contemporary Papanicolaou smears might yield insights into technical abilities.
Indigenous Australians experience a greater burden of sexually transmitted infections, however are less likely than the general population to access sexual health services. We examined the effectiveness of an Indigenous cultural appropriateness audit in assessing a sexual health clinic with low rates of Indigenous clients.
Despite the high proportion of young people annually accessing general practices, including Aboriginal Medical Services (AMS), testing for Chlamydia trachomatis remains relatively low in urban areas. A project officer was employed within the Institute of Urban Indigenous Health (IUIH) to serve a mentoring and facilitation role for the SE Queensland network of AMS and their sexual health workers, with a view to improving testing, management and follow-up of chlamydia and other STIs by community controlled medical services.
Monocytes are a heterogeneous cell population having specialised functions and differing phenotype. They are a link between innate immune system and adaptive immune system therefore, to identify if immune activation exists in HIV-1 individuals with controlled virema and recovered CD4 T cell counts, we assessed cell surface monocyte activation markers (MAM) within the monocyte subsets.
Involving consumers in healthcare decisions is important for high quality care. We previously tested a brief, consumer-led intervention consisting of three questions in a trial employing trained, standardized patients. The intervention enhanced discussion of evidence and increased patient involvement. We now report a research translation study which tested implementation with real patients at a reproductive and sexual health clinic.