The HIV antiretroviral Sustiva (efavirenz) doubles the rate of suicidality—suicidal thoughts and behaviors—among those starting therapy for the first time, although the overall risk remains minimal, aidsmap reports. Researchers examined four AIDS Clinical Trials Group studies of 5,332 treatment-naive people with HIV who were enrolled between 2001 and 2007. They compared the risk of suicidal thoughts or attempts, both successful and unsuccessful, between 3,241 participants randomized to take regimens containing Sustiva and 2,091 randomized to take Sustiva-free regimens. The investigators presented their findings as the IDWeek conference in San Francisco.

During a median follow-up period of 150 weeks, 47 people in the Sustiva group experienced suicidality, for a rate of 8.08 per 1,000 person years, compared with 15 people in the Sustiva-free group, for a rate of 3.66 per person years. Consequently, Sustiva was found to increase the risk of suicidality by a factor of 2.28. There were 17 attempted or completed suicides in the Sustiva group, for a rate of 2.90 per 1,000 person years, compared with 5 in the Sustiva-free group, for a rate of 1.22 per 1,000 person years.

The investigators concluded that clinicians should carefully monitor for suicidality in those taking regimens including Sustiva. Sustiva is a component of the single-pill combination therapy Atripla (efavirenz/tenofovir/emtricitabine).

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