Individuals With HIV May Be at Higher Risk of Opioid Overdose Death

The opioid overdose death rate for persons living with HIV (PLWHIV) was 42.7% greater in 2015 than in 2011 even though the total death rate among PLWHIV decreased, according to a new study.

Investigators presented their findings in an oral abstract session at the Annual Conference on Retroviruses and Opportunistic Infections (CROI 2019) on March 7, 2019.

The team combed the National HIV Surveillance System and pulled data on unintentional opioid overdose deaths among PLWHIV in the United States and District of Columbia between 2011 and 2015. The calculation for death rate was per 100,000 persons with HIV and was examined by demographic, geographic, and HIV transmission categories.

According to the data, a total of 1363 deaths attributable to opioid overdose were among people with HIV between 2011 and 2015, with a 42.7%-greater rate in 2015 (33.1 per 100,000) than in 2011 (23.2 per 100,000). Although the rate of all deaths among PLWH was 12.7% less in 2015 (1630.6 per 100,000) than in 2011 (1,868.8 per 100,000), the rate of opioid overdose deaths was higher among all subgroups, including by age, sex, and race/ethnicity.

The opioid overdose death rate was highest in 2015 among persons aged 50-59 years at death (41.9 per 100,000), females (35.2 per 100,000), whites (49.1 per 100,000), persons who inject drugs (137.4 per 100,000), and the Northeast US Census region (60.6 per 100,000), compared to their respective counterparts.

“Differences in opioid overdose deaths among subgroups of persons with diagnosed HIV call for targeted prevention efforts,” the investigators concluded. “Intensified overdose prevention is needed for achieving optimal care of persons with diagnosed HIV and to further decrease mortality.”

In an exclusive interview with Contagion®, (see video above) study co-author and presenter Karin Bosh, PhD, a US Centers for Disease Control and Prevention epidemiologist in the Division of HIV/AIDS Prevention, attributed the spike in overdose death rates among PLWHIV partially to the rise in opioid use overall in the Unites States.

"Looking at the US population overall there have been kind of 3 waves to this opioid epidemic. "Recently an increase in heroin and then most recently an increase in synthetic opioids most likely the result of illicitly manufactured fentanyl," Dr. Bosh said. "We're still in the early stages of our analysis so we have not yet looked at if there were specific types of opioids that were related to this large increase."

The study, “Opioid Overdose Deaths Among Persons With HIV Infection, United States, 2011-2015,” was presented on Thursday, March 7, 2019, at CROI 2019 in Seattle, Washington.