Meeting NewsPerspective

Opioid overdose deaths rising among people living with HIV

SEATTLE — Despite a more than 12% decrease in the overall rate of death among people living with HIV between 2011 and 2015 in the United States, deaths attributed to opioid overdose in this population rose by more than 42% during the same time period, according to findings presented at CROI.

“Our analysis sought to assess unintentional opioid deaths, specifically among persons with HIV because we know that persons with HIV infection are more likely to have chronic pain, and more likely to receive opioid treatments and receive higher doses of opioids,” Karin A. Bosh, PhD, from the CDC’s Division of HIV/AIDS Prevention, said during a news conference. “In addition, they are more likely to have a substance use disorder and mental illness than the general U.S. population.”

According to the CDC, overdose deaths in the U.S. have tripled in the last decade, and the misuse of opioids and deaths related to opioid abuse are expected to substantially increase over the next few years. The opioid crisis poses many challenges to public health officials and physicians, including infectious disease clinicians.

“The opioid epidemic has been declared a nationwide public health emergency in the United States,” Bosh said. “In the U.S. general population, from 1999 to 2017, unintentional opioid overdose deaths increased about fivefold, and this was fueled by changes in the drug supply and the number of people prescribed opioids.”

For their study, Bosh and colleagues reviewed data from the National HIV Surveillance System and included 1,363 unintentional opioid overdose deaths that occurred between 2011 and 2015 among people diagnosed with HIV in the U.S.

According to their findings, although the rate of all deaths among persons diagnosed with HIV was 12.7% less in 2015 compared with 2011, the rate of opioid overdose deaths was 42.7% greater in 2015 compared with 2011.

When Bosh and colleagues examined the rates of opioid overdose deaths by age, sex, race/ethnicity, transmission category and U.S. Census region of residence at death, the rates were still higher for 2015 compared with those of 2011, except in the West.

“The rate of opioid overdose deaths was substantially higher among persons whose most likely route of HIV transmission included injection drug use,” Bosh said.

Opioid overdose deaths were highest among adults aged 50 to 59 years, females, whites, people who inject drugs and people living in the Northeast, according to the abstract.

Bosh noted that the study had some limitations because “changes over time in how opioid deaths are identified and reported might affect our analysis,” and they looked at only the crude rate of overdose deaths among persons with HIV, which did not allow for comparison with the general U.S. population.

“In the future we are planning to calculate adjusted rates so that we can make these comparisons in the direction and magnitude of changes between people with HIV and the U.S. general population,” Bosh concluded. “The findings from our analysis underscore the importance of intensified overdose prevention by those providing care and services to persons with HIV and better integration of HIV and substance use disorder treatment.” – by Marley Ghizzone

Reference:

Bosh KA, et al. Abstract 147. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle.

Disclosure: Bosh reports no relevant financial disclosures.

SEATTLE — Despite a more than 12% decrease in the overall rate of death among people living with HIV between 2011 and 2015 in the United States, deaths attributed to opioid overdose in this population rose by more than 42% during the same time period, according to findings presented at CROI.

“Our analysis sought to assess unintentional opioid deaths, specifically among persons with HIV because we know that persons with HIV infection are more likely to have chronic pain, and more likely to receive opioid treatments and receive higher doses of opioids,” Karin A. Bosh, PhD, from the CDC’s Division of HIV/AIDS Prevention, said during a news conference. “In addition, they are more likely to have a substance use disorder and mental illness than the general U.S. population.”

According to the CDC, overdose deaths in the U.S. have tripled in the last decade, and the misuse of opioids and deaths related to opioid abuse are expected to substantially increase over the next few years. The opioid crisis poses many challenges to public health officials and physicians, including infectious disease clinicians.

“The opioid epidemic has been declared a nationwide public health emergency in the United States,” Bosh said. “In the U.S. general population, from 1999 to 2017, unintentional opioid overdose deaths increased about fivefold, and this was fueled by changes in the drug supply and the number of people prescribed opioids.”

For their study, Bosh and colleagues reviewed data from the National HIV Surveillance System and included 1,363 unintentional opioid overdose deaths that occurred between 2011 and 2015 among people diagnosed with HIV in the U.S.

According to their findings, although the rate of all deaths among persons diagnosed with HIV was 12.7% less in 2015 compared with 2011, the rate of opioid overdose deaths was 42.7% greater in 2015 compared with 2011.

When Bosh and colleagues examined the rates of opioid overdose deaths by age, sex, race/ethnicity, transmission category and U.S. Census region of residence at death, the rates were still higher for 2015 compared with those of 2011, except in the West.

“The rate of opioid overdose deaths was substantially higher among persons whose most likely route of HIV transmission included injection drug use,” Bosh said.

Opioid overdose deaths were highest among adults aged 50 to 59 years, females, whites, people who inject drugs and people living in the Northeast, according to the abstract.

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Bosh noted that the study had some limitations because “changes over time in how opioid deaths are identified and reported might affect our analysis,” and they looked at only the crude rate of overdose deaths among persons with HIV, which did not allow for comparison with the general U.S. population.

“In the future we are planning to calculate adjusted rates so that we can make these comparisons in the direction and magnitude of changes between people with HIV and the U.S. general population,” Bosh concluded. “The findings from our analysis underscore the importance of intensified overdose prevention by those providing care and services to persons with HIV and better integration of HIV and substance use disorder treatment.” – by Marley Ghizzone

Reference:

Bosh KA, et al. Abstract 147. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle.

Disclosure: Bosh reports no relevant financial disclosures.

    Perspective

    The epidemic of overdose deaths — particularly relating to opioids — in the U.S. is a public health emergency. I think that the question this study was meant to answer is: “Does this affect persons who are living with HIV as it has affected the whole U.S. population?” The answer seems to be “yes.” Although overall deaths related to HIV are coming down, the number of deaths relating to opioid overdoses in persons with HIV has gone up. I think the message is, in the same way the opioid crisis is affecting the U.S. population as a whole, it is also affecting persons living with HIV. These are substantial increases in deaths.

    The general recommendation that applies to the general population should be borne in mind for this subgroup of patients as well. I think this is a very useful study because I do not think this question has been thought about very much, and yet across the country it is, as I said, a public health emergency.

    • Kevin M. De Cock, MD, FRCP, DTM&H
    • Director, CDC’s country mission in Kenya

    Disclosures: De Cock reports no relevant financial disclosures.

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