Taking the HIV medication Sustiva (efavirenz) is not significantly associated with the development of suicidal thoughts, according to a new study. However, the researchers behind the study did conclude that, among those with preexisting mental health problems, there may indeed be a link between going on a Sustiva-containing antiretroviral (ARV) regimen and experiencing such thoughts.

Sustiva is included in Atripla (efavirenz/tenofovir/emtricitabine).

Publishing their findings in the Journal of Acquired Immune Deficiency Syndromes, the study authors analyzed data from a cohort of 597 people enrolled in routine care for HIV at five sites in the United States. All participants started ARV treatment between 2011 and 2014. During the study’s follow-up, they completed questionnaires designed in part to identify suicidal thoughts.

At the time they started ARV treatment, 38 percent of the participants reported suicidal thoughts or depressive symptoms. Thirty-one percent had a prior diagnosis of depression, post-traumatic stress disorder, or bipolar disorder or psychosis.

The participants were followed for a median 19 months, or 13,132 cumulative months. During that time, 147 (25 percent) of them began a Sustiva-containing regimen.

During the follow-up period, 89 (15 percent) of the participants, including 69 of those not taking a Sustiva-containing regimen and 20 of those taking a Sustiva-containing regimen, reported experiencing suicidal thoughts after starting ARVs. This indicated that 7.12 percent of those not taking a Sustiva-containing regimen experienced such thoughts in a one-year period compared with 5.81 percent of those taking a Sustiva-containing regimen.

However, the researchers found that the difference in the rate of suicidal thoughts between the two groups was not statistically significant, meaning it could have been driven by chance. When adjusting the data to account for various factors, including the possibility that physicians had prescribed non-Sustiva-containing regimens to those with mental health problems, the researchers found that taking the drug was associated with a 21 percent higher rate of suicidal thoughts, but this finding was also not statistically significant.

Looking just at the group with a prior mental health diagnosis, the study authors adjusted the data and found that taking a Sustiva-containing regimen was associated with a 76 percent increased risk of suicidal thoughts. This finding was also not statistically significant.

The researchers concluded that there was “no strong evidence” that starting a Sustiva-containing regimen increased the risk of suicidal thoughts. However, of their study population in particular, they wrote: “For participants with a history of mental health issues, efavirenz may have a stronger effect on suicidal thoughts.”

To read the study abstract, click here.