Depression, Suicidality, and HIV
To the Editor: Studies to evaluate the impact of the HIV infection with regard to depression and suicidality have shown conflicting results. One study noted a dramatic and sustained rise in depressive symptoms as AIDS develops (1). However, a large study in HIV-seropositive military applicants found that infection with HIV does not in and of itself appear to increase the risk of suicide (2). We report an unusual, tragic case of depression, suicidal acquisition of HIV, and premature death.
Mr. A, a 36-year-old man with a history of multiple suicide attempts, was hospitalized with a drug overdose. He gave a bizarre account of having inoculated himself in the forearm vein with blood drawn in an insulin syringe from a person known to be suffering from AIDS in exchange for $40. He expected to die of AIDS within 2 weeks; when he did not, he took an overdose of barbiturates. Multiple serological studies for HIV were done until seroconversion occurred during the 22nd week from the time of the alleged self-inoculation. Lymphadenopathy and diarrhea associated with seroconversion prompted medical attention. He was recovering from serious depression and was devastated to learn that he succeeded in acquiring the HIV infection. Despite close psychiatric and medical follow-up, the HIV infection progressed to AIDS in 4 years, and he eventually died of an opportunistic infection.
There have been only anecdotal reports of similar cases. A homosexual individual with suicidal thoughts who repeatedly sought sexual partners infected with HIV succeeded in becoming infected (3). A 41-year-old woman from France inoculated herself with blood obtained from a friend terminally ill with AIDS, and prophylactic zidovudine failed to prevent infection (4). A 27-year-old man, in a suicide attempt, injected himself with blood from an individual infected with HIV and human coronavirus, and seroconversion occurred with both of the viruses (5). These cases indicate that some suicidal individuals are at risk for self-infection with HIV. The emotional, physical, and economic burden imposed by HIV and related infections on the depressed individual are enormous. Unless the perception of HIV infection as a fatal disease can change, more cases of suicidal acquisition of HIV are to be expected. Such occurrences are of epidemiological and economic significance and demand further insight into the problem.
1. Lyketsos CG, Hoover DR, Guccione M, Dew MA, Wesch JE, Bing EG, Treisman GJ: Changes in depressive symptoms as AIDS develops. Am J Psychiatry 1996; 153:1430–1437Google Scholar
2. Dannenberg AL, McNeil JG, Brundage JF, Brookmeyer R: Suicide and HIV infection: mortality follow-up of 4147 HIV-seropositive military service applicants. JAMA 1996; 276:1743–1746Google Scholar
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