Overdose Deaths Encroach on Life Expectancy Gains Among People Living With HIV

People living with HIV are disproportionately affected by social problems pertaining to criminalized substances such as overdose and chemical dependence, and amid the opioid epidemic these baseline challenges compound enough to mitigate gains in treatment access.

Like so many places around the world, the Canadian province of British Columbia has been hard hit by overdose deaths in recent years, culminating in the declaration of a public health emergency there in 2016.

A team of experts from the University of California, the University of British Columbia, and the British Columbia Centre for Excellence in HIV/AIDS assessed the impact of drug overdoses on people living with HIV in British Columbia, identifying factors associated with mortality by using competing risk methodology.

Patients in the dataset began treatment with antiretroviral therapy between April 1996-December 2017, through the publicly funded Drug Treatment Program.

Overall, the 10,362 people living with HIV in the analysis had a median age of 40 years and follow-up of 6.93 years.

Of these individuals, 26% were identified as using criminalized injection substances. The largest statistical loss in life expectancy occurred during the 2014-2017 overdose wave. The life expectancy for the greater patient population was 55 years in this period; when overdose deaths are excluded the life expectancy increases a full decade to 65 years of age. Results were presented at the International AIDS Society (IAS) AIDS 2020 Virtual Sessions.

Authors identified the “harm reduction era” of 2002-2007 as having a lower overdose hazard for people living with HIV than during the 2014-2017 overdose wave. The team concluded that survival gains for people living with HIV in British Columbia have been blunted by the overdose crisis, a conclusion which likely holds in other places plagued by the opioid epidemic.