HIV infection and risk of overdose

Abstract

Drug overdose is a common cause of non-AIDS death among people with HIV and the leading cause of death for people who inject drugs. People with HIV are often exposed to opioid medications during their HIV care experience; others may continue to use illicit opioids despite their disease status. In either situation, there may be a heightened risk for nonfatal or fatal overdose. The potential mechanisms for this elevated risk remain controversial. We systematically reviewed the literature on the HIV–overdose association, meta-analyzed results, and investigated sources of heterogeneity, including study characteristics related to hypothesize biological, behavioral, and structural mechanisms of the association. Forty-six studies were reviewed, 24 of which measured HIV status serologically and provided data quantifying an association. Meta-analysis results showed that HIV seropositivity was associated with an increased risk of overdose mortality (pooled risk ratio 1.74, 95% confidence interval 1.45, 2.09), although the effect was heterogeneous (Q = 80.3, P <0.01, I2 = 71%). The wide variability in study designs and aims limited our ability to detect potentially important sources of heterogeneity. Causal mechanisms considered in the literature focused primarily on biological and behavioral factors, although evidence suggests structural or environmental factors may help explain the greater risk of overdose among HIV-infected drug users. Gaps in the literature for future research and prevention efforts as well as recommendations that follow from these findings are discussed.

Overdose Education and Naloxone for Patients Prescribed Opioids in Primary Care: A Qualitative Study of Primary Care Staff

“…We recruited participants from internal medicine, family medicine and HIV practices (as HIV infection is associated with an increased risk of overdose mortality). [23][24][25][26] We emailed practice administrators, who identified convenient dates for attendance by available clinical staff. Focus groups were scheduled over lunch, provided as compensation.…”

Injection Drug Use and Hepatitis C as Risk Factors for Mortality in HIV-Infected Individuals

“…The excess mortality associated with a history of IDU varies considerably between settings (3), suggesting that IDU may be a proxy for more direct causes of death such as violence (4), overdose (5), higher rates of smoking (6), poorer ART adherence (7), more frequent bacterial infections (8), or greater overall organ system injury (9, 10). Interventions to end or reduce substance abuse may reduce excess mortality among IDU via effects on these risk factors (11).…”

Non-Fatal Opioid Overdose and Major Depression among Street-Recruited Young Heroin Users

“…In addition, our study used a very precise definition of opioid overdose among heroin users, who, as has frequently been found in other studies, were also heavy users of cocaine or other drugs. It is often the case in research on non-fatal overdose that the definitions or description of the typical symptoms of overdose are described poorly [10,16,17,19,26], or not at all in the article [18]. A minimum quality requirement in self-reported non-fatal overdose/NFOO studies should always be to provide participants with a clear and precise description of these events.…”