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DRUG OVERDOSE DEATHS AMONG PERSONS WITH HIV IN NEW YORK CITY, 2007-2015
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"....Care-seeking by PWH presents an opportunity to avert preventable deaths, including OD deaths.....Over three-quarters (76.1%) of decedents were retained in HIV care in the 12 months prior to death, and 51.0% were Virally Suppressed...Three-quarters of both AOD and IOD decedents were retained in care prior to death, but more IOD decedents were VS (79.5% vs. 49.0%) "
Reported by Jules Levin
CROI 2018 March 4-7 Boston MA
Sarah L. Braunstein1, Rebekkah S. Robbins1, Demetre C. Daskalakis1
1New York City Department of Health and Mental Hygiene (DOHMH), New York City, USA
"....Preventable deaths, including those due to drug overdose (OD), are a significant public health concern in New York City (NYC). The rate of unintentional drug OD death in NYC increased 143% between 2010 and 2016. Drug OD deaths among persons with HIV (PWH) in NYC have not been described. Care-seeking by PWH presents an opportunity to avert preventable deaths, including OD deaths.....Over three-quarters (76.1%) of decedents were retained in HIV care in the 12 months prior to death, and 51.0% were Virally Suppressed...Three-quarters of both AOD and IOD decedents were retained in care prior to death, but more IOD decedents were VS (79.5% vs. 49.0%).............IOD decedents were nearly all male (90.9%), mostly white (70.5%), older (22.7% aged 60+) and men who have sex with men (MSM) (65.9%). MSM with AOD death were younger and living in lower-poverty areas than IDU with AOD death (Figure 3). MSM with IOD death were mostly white and also living in lower-poverty areas compared with non-MSM with IOD death.
More than three-quarters of both AOD (78%) and IOD (77%) decedents were retained in HIV care in the 12 months prior to death, but more IOD decedents were virally suppressed (72% vs. 50% of AOD decedents) (Figure 4)."
Program Abstract:
Preventable deaths, including those due to drug overdose (OD), are a significant public health concern in New York City (NYC). The rate of unintentional drug OD death in NYC increased 143% between 2010 and 2016; trends in drug OD death among persons with HIV (PWH) in NYC have not been described. Care-seeking by PWH presents an opportunity to avert preventable deaths, including OD deaths.
We selected PWH from the NYC HIV Surveillance Registry who died during 2007-2015, resided in NYC at death, and died due to OD (classified as accidental (AOD (ICD10 codes X40-X44)) or intentional (IOD (ICD10 codes X60-X64))). We compared the demographics of PWH who died of AOD versus IOD, and analyzed CD4 and viral load (VL) tests from surveillance to evaluate retention in care and viral suppression (VS) (VL≤200 cc/mL) in the 12 months prior to death as markers of care-seeking.
From 2007-2015, 670 PWH died of either AOD or IOD in NYC (Table 1). While the rate of OD deaths in PWH declined during the full period, from 64 per 100,000 in 2007 to 47 per 100,000 in 2015 , it increased from 2013 (36 per 100,000) to 2015 (47 per 100,000).
Decedents during 2007-2015 were predominantly male (70.6%), black (37.3%) or Latino/Hispanic (36.3%), aged 40-59 years (74.1%), and persons who inject drugs (PWID) (53.5%). Over three-quarters (76.1%) of decedents were retained in HIV care in the 12 months prior to death, and 51.0% were VS. Of the total, 626 (93.4%) deaths were classified as AOD and 44 (6.6%) as IOD. AOD decedents were also predominantly male (69.2%), black (39.0%) and Latino/Hispanic (37.9%), aged 40-59 years (75.6%), and PWID (48.2%). However, IOD were nearly all male (90.9%), mostly white (70.5%), older (22.7% aged 60+) and men who have sex with men (MSM) (65.9%). Three-quarters of both AOD and IOD decedents were retained in care prior to death, but more IOD decedents were VS (79.5% vs. 49.0%).
A sizeable number of NYC PWH died of OD in the last decade, and OD death rates in recent years increased. Pre-death care patterns reveal frequent interaction with the health care system, underscoring missed opportunities for harm-reduction and suicide prevention interventions for PWH. Differences in the demographic profiles of AOD and IOD decedents warrant further exploration. Interventions for PWID and MSM who are long-term survivors may need to be further tailored to prevent OD-associated mortality in the context of HIV care.
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