Supplement: Tables and Figures

Transcription

1 Supplement: Tables and Figures Supplement Table 1. Baseline Characteristics by Study and Efavirenz Assignment Supplement Table 2. Baseline Psychoactive Medications by Efavirenz Assignment* Supplement Table 3. Suicidality Events by Country Supplement Table 4. Restricted to the United States: Suicidality Events by Study Supplement Table 5. Association Between Baseline Characteristics and Hazard of Suicidality (ITT Approach)* Supplement Table 6. Restricted to the United States: Association Between Baseline Characteristics and Hazard of Suicidality (ITT DSMB) Supplement Table 7. Restricted to the United States: Association Between Baseline Characteristics and Hazard of Suicidality (ITT Approach) Supplement Table 8. Cause of Death Classifications (ITT) Supplement Figure 1. Association between efavirenz and hazard of suicidality, according to baseline characteristics (ITT DSMB primary approach). Supplement Figure 2. Association between efavirenz and hazard of suicidality, according to baseline characteristics (ITT sensitivity approach).

2 Supplement Table 1. Baseline Characteristics by Study and Efavirenz Assignment Characteristic A5095 (N=765) A5095 -free (N=382) A5142 (N=502) A5142 -free (N=255) A5175 (N=1045) A5175 -free (N=526) A5202 (N=929) Country Brazil (15%) 76 (14%) Haiti (7%) 32 (6%) India (16%) 86 (16%) Malawi (14%) 74 (14%) Peru (8%) 48 (9%) South Africa (2%) 8 (3%) 140 (13%) 70 (13%) A5202 -free (N=928) Thailand (6%) 33 (6%) United States 765 (100%) 382 (100%) 490 (98%) 247 (97%) 140 (13%) 70 (13%) 929 (100%) 928 (100%) Zimbabwe (7%) 37 (7%) Sex Male 620 (81%) 309 (81%) 410 (82%) 195 (76%) 562 (54%) 270 (51%) 760 (82%) 775 (84%) Female 145 (19%) 73 (19%) 92 (18%) 60 (24%) 483 (46%) 256 (49%) 169 (18%) 153 (16%) Race or ethnic group (United States) N White Non-Hispanic 313 (41%) 149 (39%) 187 (38%) 88 (36%) 39 (28%) 23 (33%) 371 (40%) 375 (40%) Black Non-Hispanic 271 (35%) 142 (37%) 186 (38%) 109 (44%) 59 (42%) 26 (37%) 315 (34%) 300 (32%) Hispanic 165 (22%) 83 (22%) 103 (21%) 45 (18%) 38 (27%) 18 (26%) 210 (23%) 219 (24%) Asian 10 (1%) 5 (1%) 11 (2%) 4 (2%) 1 (1%) 0 (0%) 13 (1%) 19 (2%) American Indian/Alaska Native 3 (0%) 3 (1%) 2 (0%) 0 (0%) 0 (0%) 2 (3%) 9 (1%) 5 (1%) Other 3 (0%) 0 (0%) 1 (0%) 1 (0%) 3 (2%) 1 (1%) 11 (1%) 10 (1%) Race or ethnic group (Multinational non-us) N White Non-Hispanic (0%) 0 (0%) 55 (6%) 22 (5%) Black Non-Hispanic (100%) 8 (100%) 442 (49%) 219 (48%) Hispanic (0%) 0 (0%) 170 (19%) 96 (21%) Asian (0%) 0 (0%) 238 (26%) 119 (26%) -- --

3 Characteristic A5095 (N=765) A5095 -free (N=382) A5142 (N=502) A5142 -free (N=255) A5175 (N=1045) A5175 -free (N=526) A5202 (N=929) A5202 -free (N=928) Age, years Median (Q1, Q3) 37 (31, 43) 37 (32, 43) 38 (32, 44) 37 (32, 44) 34 (29, 41) 34 (29, 41) 38 (31, 45) 38 (31, 45) < (20%) 61 (16%) 94 (19%) 42 (16%) 287 (27%) 146 (28%) 201 (22%) 203 (22%) (60%) 243 (64%) 285 (57%) 156 (61%) 607 (58%) 310 (59%) 483 (52%) 474 (51%) (20%) 78 (20%) 123 (25%) 57 (22%) 151 (14%) 70 (13%) 245 (26%) 251 (27%) Pre-treatment CD4 count, Median (Q1, Q3) x 10 9 cells/l (0.077, 0.333) (0.079, 0.344) (0.043, 0.315) (0.070, 0.300) (0.089, 0.228) (0.096, 0.235) (0.103, 0.333) (0.081, 0.335) (20%) 65 (17%) 134 (27%) 49 (19%) 137 (13%) 63 (12%) 163 (18%) 176 (19%) (27%) 126 (33%) 125 (25%) 89 (35%) 519 (50%) 238 (45%) 228 (25%) 233 (25%) (30%) 103 (27%) 138 (28%) 81 (32%) 389 (37%) 225 (43%) 341 (37%) 315 (34%) > (23%) 87 (23%) 103 (21%) 36 (14%) 0 (0%) 0 (0%) 196 (21%) 204 (22%) HIV-1 RNA, log 10 copies/ml Median (Q1, Q3) 4.77 (4.38, 5.41) 4.76 (4.40, 5.28) 4.81 (4.42, 5.25) 4.76 (4.47, 5.20) 5.02 (4.59, 5.44) 5.06 (4.55, 5.49) 4.67 (4.34, 4.95) 4.65 (4.31, 5.12) < 100, (61%) 231 (60%) 314 (63%) 163 (64%) 509 (49%) 245 (47%) 714 (77%) 667 (72%) 100, (39%) 151 (40%) 188 (37%) 91 (36%) 536 (51%) 280 (53%) 215 (23%) 261 (28%) History of AIDS None recorded 627 (82%) 303 (79%) 413 (82%) 209 (82%) 932 (89%) 472 (90%) 775 (83%) 778 (84%) Yes 138 (18%) 79 (21%) 89 (18%) 46 (18%) 113 (11%) 54 (10%) 154 (17%) 150 (16%) Injection drug history None recorded 683 (89%) 341 (89%) 454 (90%) 227 (89%) 1,014 (97%) 516 (98%) 840 (90%) 857 (92%) Yes 82 (11%) 41 (11%) 48 (10%) 28 (11%) 31 (3%) 10 (2%) 89 (10%) 71 (8%) Psychiatric history or psychoactive medication* None recorded 521 (68%) 255 (67%) 339 (68%) 176 (69%) 880 (84%) 432 (82%) 492 (53%) 529 (57%) Yes 244 (32%) 127 (33%) 163 (32%) 79 (31%) 165 (16%) 94 (18%) 437 (47%) 399 (43%) Psychoactive medication* None recorded 640 (84%) 320 (84%) 472 (94%) 247 (97%) 996 (95%) 495 (94%) 711 (77%) 744 (80%) Yes 125 (16%) 62 (16%) 30 (6%) 8 (3%) 49 (5%) 31 (6%) 218 (23%) 184 (20%) Depression-related history or antidepressant medication* None recorded 618 (81%) 297 (78%) 405 (81%) 214 (84%) 958 (92%) 472 (90%) 638 (69%) 653 (70%) Yes 147 (19%) 85 (22%) 97 (19%) 41 (16%) 87 (8%) 54 (10%) 291 (31%) 275 (30%)

4 Characteristic Antidepressant medication* A5095 (N=765) A5095 -free (N=382) A5142 (N=502) A5142 -free (N=255) A5175 (N=1045) A5175 -free (N=526) A5202 (N=929) A5202 -free (N=928) None recorded 670 (88%) 335 (88%) 476 (95%) 250 (98%) 1,006 (96%) 505 (96%) 764 (82%) 783 (84%) Yes 95 (12%) 47 (12%) 26 (5%) 5 (2%) 39 (4%) 21 (4%) 165 (18%) 145 (16%) Body mass index, kg/m 2 Median (Q1, Q3) (21.8, 27.6) (21.9, 27.5) (22.0, 27.8) (21.9, 28.1) (20.2, 25.2) (20.1, 24.8) (22.2, 27.9) (22.1, 28.1) Underweight (< 18.5) 29 (4%) 16 (4%) 21 (4%) 9 (4%) 91 (9%) 61 (12%) 37 (4%) 33 (4%) Normal (<25) 377 (52%) 181 (48%) 241 (49%) 127 (51%) 680 (65%) 343 (65%) 438 (47%) 448 (48%) Overweight (<30) 221 (30%) 131 (35%) 155 (31%) 72 (29%) 201 (19%) 87 (17%) 317 (34%) 301 (32%) Obese (30+) 104 (14%) 47 (13%) 79 (16%) 43 (17%) 73 (7%) 35 (7%) 136 (15%) 146 (16%) Baseline weight, kg Median (Q1, Q3) 74 (65, 84) 75 (65, 84) 74 (64, 86) 73 (65, 83) 61 (54, 70) 60 (53, 69) 75 (66, 86) 75 (66, 86) < (15%) 56 (15%) 85 (17%) 37 (15%) 490 (47%) 264 (50%) 123 (13%) 100 (11%) 60-< (51%) 191 (50%) 240 (48%) 135 (53%) 443 (42%) 208 (40%) 469 (50%) 483 (52%) (34%) 132 (35%) 174 (35%) 82 (32%) 112 (11%) 54 (10%) 337 (36%) 345 (37%) =efavirenz. *Prescription psychoactive (or antidepressant) medication ongoing within 30 days before study entry.

5 Supplement Table 2. Baseline Psychoactive Medications by Efavirenz Assignment* Generic name (Trade name) Efavirenz (n=3241) Efavirenz-free (n=2091) Psychoactive Drug Category No. of participants on medication prestudy 422 (13%) 285 (14%) Antidepressant No. of participants on medication prestudy 325 (10%) 217 (10%) Bupropion (Wellbutrin, Zyban) 59 (2%) 42 (2%) Trazodone (Desyrel) 54 (2%) 42 (2%) Sertraline (Zoloft) 46 (1%) 28 (1%) Amitriptyline (Amitrip, Elavil, Endep, Enovil, Trepiline, Tryptanol) 40 (1%) 23 (1%) Citalopram (Celexa) 38 (1%) 23 (1%) Paroxetine (Paxil) 40 (1%) 20 (1%) Escitalopram (Lexapro) 28 (1%) 25 (1%) Fluoxetine (Prozac, Sarafem) 27 (1%) 18 (1%) Venlafaxine (Effexor) 21 (1%) 20 (1%) Mirtazapine (Remeron) 14 (<0.5%) 12 (1%) Doxepin (Adapin, Sinequan) 4 (<0.5%) 7 (<0.5%) Nortriptyline (Aventyl, Pamelor) 6 (<0.5%) 2 (<0.5%) Duloxetine (Cymbalta) 4 (<0.5%) 2 (<0.5%) Imipramine (Janimine, Tofranil) 1 (0%) 2 (<0.5%) Desipramine (Norpramin, Pertofrane) 1 (0%) 0 (0%) Anti-Anxiety No. of participants on medication prestudy 106 (3%) 77 (4%) Alprazolam (Niravam, Xanax) 36 (1%) 30 (1%) Lorazepam (Ativan, Tavor, Temesta) 29 (1%) 24 (1%) Clonazepam (Clonopin, Klonopin, Rivotril) 25 (1%) 13 (1%) Diazepam (Diastat, Valium, Valrelease, Zetran) 12 (<0.5%) 6 (<0.5%) Buspirone (BuSpar) 10 (<0.5%) 4 (<0.5%) Clorazepate Dipotassium (ClorazeCaps, ClorazeTabs, GenENE, Tranxene) 1 (0%) 2 (<0.5%) Chlordiazepoxide (Librium) 0 (0%) 1 (0%) Mood Stabilizing No. of participants on medication prestudy 83 (3%) 42 (2%) Gabapentin (Neurontin) 39 (1%) 24 (1%) Divalproex Sodium (Depakote) 19 (1%) 9 (<0.5%) Lamotrigine (Lamictal) 11 (<0.5%) 7 (<0.5%) Carbamazepine (Atretol, Epitol, Tegretol) 9 (<0.5%) 3 (<0.5%) Oxcarbazepine (Trileptal) 4 (<0.5%) 1 (0%) Lithium Carbonate (Eskalith, Lithane, Lithobid, Lithotabs) 3 (<0.5%) 1 (0%) Topiramate (Topamax) 3 (<0.5%) 0 (0%) Valproate Sodium (Depakene Syrup, DPA sodium) 1 (0%) 0 (0%) Lithium Citrate (Cibalith-S Syrup, Eskalith Lithobid) 1 (0%) 0 (0%) Antipsychotic No. of participants on medication pre-study 42 (1%) 35 (2%) Quetiapine (Seroquel) 14 (<0.5%) 15 (1%) Olanzapine (Zyprexa) 11 (<0.5%) 8 (<0.5%) Risperidone (Risperdal) 8 (<0.5%) 7 (<0.5%) Ziprasidone (Geodon) 4 (<0.5%) 2 (<0.5%) Aripiprazole (Abilify) 1 (0%) 4 (<0.5%)

6 Generic name (Trade name) Efavirenz (n=3241) Efavirenz-free (n=2091) Chlorpromazine (Ormazine, Thorazine) 1 (0%) 1 (0%) Haloperidol (Haldol) 1 (0%) 1 (0%) Amitriptyline & Perphenazine (Etrafon, Triavil) 2 (<0.5%) 0 (0%) Fluphenazine (Permitil, Prolixin) 1 (0%) 1 (0%) Haloperidol Decanoate (Haldol Decanoate) 0 (0%) 1 (0%) Fluphenazine Decanoate (Prolixin Decanoate) 1 (0%) 0 (0%) Trifluoperazine (Stelazine) 1 (0%) 0 (0%) Thioridazine (Mellaril) 0 (0%) 1 (0%) Attention deficit hyperactivity disorder (ADHD) No. of participants on medication prestudy 7 (<0.5%) 10 (1%) Methylphenidate (Concerta, Metadate (CD/ER), Methylin, Ritalin (SR/LA)) 4 (<0.5%) 5 (<0.5%) Amphetamine Salts (Adderall (XR)) 1 (0%) 4 (<0.5%) Atomoxetine (Strattera) 2 (<0.5%) 1 (0%) Antipsychotic & Antidepressant No. of participants on medication prestudy 0 (0%) 1 (0%) Amitriptyline & Chlordiazepoxide (Limbitrol (DS)) 0 (0%) 1 (0%) * Prescription medication ongoing within 30 days before study entry; prescribing indication was not collected

7 Supplement Table 3. Suicidality Events by Country A. Intention-to-Treat Data Safety Monitoring Board Approach Efavirenz-containing Efavirenz-free Country n Events PYs IR (95% CI)* n Events PYs IR (95% CI)* Total n United States (6.38, 12.27) (2.06, 6.63) 3951 India (0.93, 27.62) (0.00, 27.98) 255 Brazil (0.00, 16.42) (0.23, 51.29) 231 South Africa (0.10, 21.55) (0.00, 27.45) 230 Malawi (0.00, 14.71) (0.00, 29.52) 221 Peru (0.18, 39.00) (0.33, 72.82) 134 Zimbabwe (0.00, 28.92) (0.00, 56.12) 110 Haiti (0.00, 35.19) (0.00, 71.50) 100 Thailand (10.84, ) (0.00, 71.88) 100 B. Intention-to-Treat Approach Efavirenz-containing Efavirenz-free Country n Events PYs IR (95% CI)* n Events PYs IR (95% CI)* Total n United States (6.17, 11.09) (2.08, 6.12) 3951 India (2.86, 20.54) (0.84, 25.19) 255 Brazil (0.05, 10.86) (0.10, 22.12) 231 South Africa (0.05, 11.06) (0.10, 21.75) 230 Malawi (0.00, 7.70) (0.00, 15.61) 221 Peru (3.71, 34.89) (0.16, 34.73) 134 Zimbabwe (0.00, 14.30) (0.00, 28.38) 110 Haiti (0.00, 16.52) (0.00, 32.91) 100 Thailand (5.13, 48.20) (0.00, 32.90) 100 IR=incidence rate per 1000 PYs. PYs=person-years. Countries are ordered by sample size. *Exact Poisson 95% confidence interval for crude incidence rate per 1000 PYs

8 Supplement Table 4. Restricted to the United States: Suicidality Events by Study A. Intention-to-Treat Data Safety Monitoring Board Approach Efavirenz-containing Efavirenz-free Study n Events PYs IR (95% CI)* n Events PYs IR (95% CI)* A (2.98, 17.68) (0.07, 15.30) A (3.52, 16.06) (0.49, 14.56) A (5.22, 37.52) (0.00, 23.39) A (5.28, 13.34) (2.05, 7.87) B. Intention-to-Treat Approach Efavirenz-containing Efavirenz-free Study n Events PYs IR (95% CI)* n Events PYs IR (95% CI)* A (3.86, 11.84) (0.25, 7.45) A (3.52, 16.06) (0.49, 14.56) A (4.82, 28.62) (0.11, 23.33) A (5.28, 13.34) (2.05, 7.87) IR=incidence rate per 1000 PYs. PYs=person-years. *Exact Poisson 95% confidence interval for crude incidence rate per 1000 PYs

9 Supplement Table 5. Association Between Baseline Characteristics and Hazard of Suicidality (ITT Approach)* Univariate Models Characteristic DF n HR (95% CI) Randomly assigned treatment group Multivariable model (n=5318, 83 events) P- value HR (95% CI) P-value Efavirenz-containing vs. Efavirenz-free (1.26, 3.49) (1.17, 3.23) Sex Female vs. Male (0.51, 1.43) (0.46, 1.37) 0.41 Race or ethnic group, United States only White vs. Black (0.91, 2.81) Hispanic vs. Black 0.74 (0.33, 1.63) Age categories <30 vs. 45 years (1.44, 6.08) (1.71, 7.48) vs. 45 years 1.64 (0.82, 3.27) 1.81 (0.90, 3.63) CD4 count categories vs. >0.349 x10 9 cells/l (0.19, 0.98) (0.18, 1.09) vs. >0.349 x10 9 cells/l 0.47 (0.24, 0.94) 0.55 (0.27, 1.15) vs. >0.349 x10 9 cells/l 0.87 (0.47, 1.60) 0.90 (0.49, 1.67) HIV-1 RNA categories 100,000 vs. <100,000 copies/ml (0.45, 1.17) (0.51, 1.42) 0.53 History of AIDS Yes vs. No (0.50, 1.72) (0.68, 2.62) 0.40 Injection drug history Yes vs. No (1.82, 5.72) < (1.50, 4.88) <0.001 Psychiatric history or psychoactive Rx Yes vs. No (2.35, 5.88) < (2.33, 6.03) <0.001 BMI categories Underweight (< 18.5) vs. Normal (<25) (0.62, 3.05) Overweight (<30) vs. Normal (<25) 0.68 (0.39, 1.17) Obese (30+) vs. Normal (<25) 0.68 (0.32, 1.43) Weight categories <60 vs. 80 kg (0.67, 2.29) (0.77, 2.86) <80 vs. 80 kg 0.85 (0.50, 1.44) 0.84 (0.49, 1.44) BMI=body mass index. DF=degrees of freedom. HR=hazard ratio. ITT=intention-to-treat. *All on-study follow-up was included (ITT approach); Cox model Wald CI and p-values are presented, each model was stratified by study. In multivariable analysis, race or ethnic group was omitted because analysis of this covariate was restricted to the United States, and BMI category was omitted due to collinearity with body weight and missing height observations; otherwise covariates were included in this multivariable model.

10 Supplement Table 6. Restricted to the United States: Association Between Baseline Characteristics and Hazard of Suicidality (ITT DSMB)* Univariate Models Multivariable model (n=3821, 51 events) Characteristic DF n HR (95% CI) P-value HR (95% CI) Randomly assigned treatment group P- value Efavirenz-containing vs. Efavirenz-free (1.23, 4.38) (1.06, 3.82) Sex Female vs. Male (0.32, 1.57) (0.26, 1.43) 0.26 Race or ethnic group White vs. Black (0.89, 3.12) (0.63, 2.41) 0.47 Hispanic vs. Black 0.81 (0.34, 1.92) 0.75 (0.31, 1.79) Age categories <30 vs. 45 years (0.76, 4.16) (0.88, 5.08) vs. 45 years 1.54 (0.73, 3.25) 1.66 (0.78, 3.54) CD4 count categories vs. >0.349 x10 9 cells/l (0.12, 0.95) (0.08, 0.87) vs. >0.349 x10 9 cells/l 0.54 (0.24, 1.21) 0.49 (0.20, 1.18) vs. >0.349 x10 9 cells/l 0.88 (0.44, 1.74) 0.85 (0.42, 1.69) HIV-1 RNA categories 100,000 vs. <100,000 copies/ml (0.52, 1.73) (0.50, 1.93) 0.95 History of AIDS Yes vs. No (0.57, 2.25) (0.75, 3.88) 0.20 Injection drug history Yes vs. No (1.44, 5.47) (1.16, 4.59) Psychiatric history or psychoactive Rx Yes vs. No (2.28, 7.82) < (1.85, 6.64) <0.001 BMI categories Underweight (< 18.5) vs. Normal (<25) (0.61, 4.94) Overweight (<30) vs. Normal (<25) 0.64 (0.33, 1.22) Obese (30+) vs. Normal (<25) 0.53 (0.21, 1.38) Weight categories <60 vs. 80 kg (0.93, 4.40) (1.14, 6.41) <80 vs. 80 kg 1.23 (0.65, 2.33) 1.28 (0.67, 2.45) BMI=body mass index. DF=degrees of freedom. DSMB=data safety monitoring board. HR=hazard ratio. ITT=intention-to-treat. *Cox model Wald CI and p-values are presented, each model was stratified by study. Multivariable analysis was restricted to participants of white, black, or Hispanic race or ethnic group with complete covariate information; BMI was omitted due to collinearity with body weight and missing height observations.

11 Supplement Table 7. Restricted to the United States: Association Between Baseline Characteristics and Hazard of Suicidality (ITT Approach)* Univariate Models Multivariable model (n=3821, 62 events) Characteristic DF n HR (95% CI) P-value HR (95% CI) P-value Randomly assigned treatment group Efavirenz-containing vs. Efavirenzfree (1.29, 4.16) (1.14, 3.71) Sex Female vs. Male (0.37, 1.51) (0.34, 1.55) 0.41 Race or ethnic group White vs. Black (0.91, 2.81) (0.69, 2.27) 0.35 Hispanic vs. Black 0.74 (0.33, 1.63) 0.72 (0.32, 1.62) Age categories <30 vs. 45 years (1.04, 5.23) (1.31, 6.91) vs. 45 years 1.83 (0.88, 3.79) 2.00 (0.95, 4.18) CD4 count categories vs. >0.349 x10 9 cells/l (0.19, 1.05) (0.20, 1.39) vs. >0.349 x10 9 cells/l 0.51 (0.25, 1.07) 0.58 (0.26, 1.27) vs. >0.349 x10 9 cells/l 0.83 (0.44, 1.55) 0.83 (0.44, 1.57) HIV-1 RNA categories 100,000 vs. <100,000 copies/ml (0.45, 1.38) (0.43, 1.49) 0.48 History of AIDS Yes vs. No (0.44, 1.71) (0.54, 2.72) 0.65 Injection drug history Yes vs. No (1.84, 5.89) < (1.53, 5.14) <0.001 Psychiatric history or psychoactive Rx BMI categories Yes vs. No (2.39, 7.19) < (1.96, 6.13) <0.001 Underweight (< 18.5) vs. Normal (<25) Overweight (<30) vs. Normal (<25) 0.64 (0.36, 1.16) Obese (30+) vs. Normal (<25) 0.53 (0.22, 1.26) (0.50, 3.97) Weight categories <60 vs. 80 kg (0.65, 2.79) (0.77, 3.86) <80 vs. 80 kg 0.97 (0.56, 1.68) 0.99 (0.56, 1.73) BMI=body mass index. DF=degrees of freedom. HR=hazard ratio. ITT=intention-to-treat. *Cox model Wald CI and p-values are presented, each model was stratified by study. Multivariable analysis was restricted to participants of white, black, or Hispanic race or ethnic group with complete covariate information; BMI was omitted due to collinearity with body weight and missing height observations.

12 Supplement Table 8. Cause of Death Classifications (ITT) United States * Multinational All Participants (Total) Efavirenz Efavirenz-free Efavirenz Efavirenz-free Efavirenz Efavirenz-free n=2324 n=1627 n=917 n=464 n=3241 n= PY PY PY PY PY PY Cause of Freq Freq Freq Freq Freq Freq death (%) Incidence (%) Incidence (%) Incidence (%) Incidence (%) Incidence (%) Incidence Suicide (0.26) (0.06) (0.22) (0.25) (0.05) 0.18 Substance Abuse (0.13) (0.12) (0.09) (0.10) 0.36 Homicide (0.22) (0.06) Accident (0.22) (0.18) (0.22) (0.22) (0.14) 0.53 Unknown (0.13) (0.06) (0.55) (0.25) (0.05) 0.18 Other cause (1.29) (1.29) (2.84) (3.23) (1.73) (1.72) 6.42 All causes, (2.02) (1.72) (4.03) (3.23) (2.59) (2.06) total 7.67 ITT= intention-to-treat. PY=person-years. Incidence is presented per 1000 PY. Death frequency and incidence are summarized using the intentionto-treat approach to account for all deaths reported during study follow-up. *United States: Suicide method: gunshot (n=3), hanging (1), overdose (n=2: 1 efavirenz, 1 efavirenz-free), method not reported (1). Substance abuse: substance not reported (2), cocaine (1), heroin (1), amphetamine (1). Accident type: motor vehicle (n=6: 4 efavirenz, 2 efavirenz-free), asphyxia (1 efavirenz-free), fire (1 efavirenz). Multinational (n): Brazil (231), Haiti (100), India (255), Malawi (221), Peru (134), South Africa (230), Thailand (100), Zimbabwe (110). Suicide method: hanging (1), method not reported (1). Homicide: assassinated by gunshot (1), stabbed during a street quarrel (1). Accident type: motor vehicle (1), earthquake (1). Other cause: e.g., infection, cancer, organ failure.

13 Supplement Figure 1. Association between efavirenz and hazard of suicidality, according to baseline characteristics (ITT DSMB primary approach). DSMB=data safety monitoring board. IR=crude incidence rate. ITT=intention-to-treat. PY=person-years. Rx=medication. Univariate estimated hazard ratios were quantified from a Cox model with a Wald CI and p-value, stratified by study, and are plotted on a logarithm scale. The continuous age variable presents the efavirenz association when age is held fixed at 25, 35, and 45 years old. *The first p-value tests the main effect of efavirenz; subsequent p-values test for an interaction between efavirenz and the baseline characteristic. Race or ethnic group was limited to white, black and Hispanic participants enrolled in the United States.

14 Supplement Figure 2. Association between efavirenz and hazard of suicidality, according to baseline characteristics (ITT sensitivity approach). IR=crude incidence rate. ITT=intention-to-treat. PY=person-years. Rx=medication. Univariate estimated hazard ratios were quantified from a Cox model with a Wald CI and p-value, stratified by study, and are plotted on a logarithm scale. The continuous age variable presents the efavirenz association when age is held fixed at 25, 35, and 45 years old. *The first p-value tests the main effect of efavirenz; subsequent p-values test for an interaction between efavirenz and the baseline characteristic. Race or ethnic group was limited to white, black and Hispanic participants enrolled in the United States.