# Perceived disabling physical pain and suicidal ideation in aging people living with HIV cured of hepatitis C: A multi‐center survey in France (ANRS CO13 HEPAVIH)

## TL;DR

This study finds that disabling physical pain is strongly linked to suicidal thoughts in older people with HIV who have been cured of hepatitis C, emphasizing the need for pain and mental health screening in their care.

## Contribution

The study identifies disabling physical pain as an independent risk factor for suicidal ideation in HCV-cured PWH, beyond depression and social factors.

## Key findings

- Disabling physical pain triples the risk of suicidal ideation in HCV-cured PWH after adjusting for depression and substance use.
- Lower social relationships-related quality of life is independently associated with increased suicidal ideation.
- The study recommends integrating pain and mental health screening into routine HIV care to prevent suicidal behaviors.

## Abstract

Suicidal ideation (SI) is highly prevalent among people living with HIV (PWH) and those with chronic hepatitis C virus (HCV) infection. Individuals with long‐term HIV–HCV co‐infection face specific health challenges, including heightened physical pain. We aimed to assess whether disabling physical pain is associated with SI in aging PWH who have been cured of HCV, after controlling for potential correlates or confounders such as depression and psychoactive substance use.

We analysed data from HCV‐cured PWH who participated in a multi‐center cross‐sectional survey embedded within the French ANRS CO13 HEPAVIH cohort. We performed a multivariable logistic regression model with SI (score >0 for the ninth item of the Patient Health Questionnaire‐9) as the outcome. Disabling physical pain was assessed using an answer ≥'very much' to the third item from the WHOQOL‐HIV BREF questionnaire.

Study population comprised 396 HCV‐cured PWH (73.2% male), among whom 17.7% reported SI and 11.9% reported disabling physical pain. Participants reporting disabling physical pain had a three‐fold higher risk of SI (adjusted odds ratio [95% confidence interval]: 3.07 [1.29–7.34]), after adjustment for depression (5.52 [2.66–11.43]), substance use, and lower social relationships‐related quality of life (0.72 [0.64–0.80]).

These findings highlight that disabling physical pain should be systematically addressed among PWH cured of HCV, given its independent association with SI. Routine HIV follow‐up care should integrate systematic screening for pain, mental health problems, and lack of social support. Timely referral to specialized services may help prevent future suicidal behaviours in this population.