HIV infection and risk of overdose: a systematic review and meta-analysis

Details

• Alternative Title:
  AIDS
• Personal Author:
  Green, Traci C. ; McGowan, Samuel K. ; Yokell, Michael A. ; Pouget, Enrique R. ; Rich, Josiah D.
• Description:
  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, I(2) = 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.
• Subjects:
  Analgesics, Opioid Drug Overdose Female HIV Seropositivity Humans Male Risk Assessment Risk Factors Socioeconomic Factors Substance Abuse, Intravenous
• Keywords:
  Chlorination Fatal HIV Household Water Treatment Mortality Opioid Overdose Safe Water Storage
• Source:
  AIDS. 2012; 26(4):403-417
• Pubmed ID:
  22112599
• Pubmed Central ID:
  PMC3329893
• Document Type:
  Journal Article
• Funding:
  T32 DA013911/DA/NIDA NIH HHSUnited States/ ; R21 CE001846/CE/NCIPC CDC HHSUnited States/ ; P30 AI042853-02/AI/NIAID NIH HHSUnited States/ ; 5T32DA013911/DA/NIDA NIH HHSUnited States/ ; K24 DA022112/DA/NIDA NIH HHSUnited States/ ; K24 DA022112-01A2/DA/NIDA NIH HHSUnited States/ ; T32 DA013911-01/DA/NIDA NIH HHSUnited States/ ; P30-AI-42853/AI/NIAID NIH HHSUnited States/ ; P30 AI042853/AI/NIAID NIH HHSUnited States/ ; R21CE001846-01/CE/NCIPC CDC HHSUnited States/ ; K24DA022112/DA/NIDA NIH HHSUnited States/
• Volume:
  26
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:218c9c0af01607e3fd157459ff1e4c7f0eb7be4c4fba803d4febc16c91476a6e
• Download URL:
  https://stacks.cdc.gov/view/cdc/33346/cdc_33346_DS1.pdf
• File Type:
  [PDF - 368.71 KB ]