Disclosures: The authors report no relevant financial disclosures.
December 07, 2020
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Stimulant-related deaths more common among people with HIV

Disclosures: The authors report no relevant financial disclosures.
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Stimulant-related deaths were more common among people with HIV than those without, with one in five drug-related deaths among people with HIV involving methamphetamine, a study in San Francisco found.

“Drug-related death prevention is a more urgent priority than ever before. As an addiction medicine fellow, I see how opioids — and specifically fentanyl — are driving much of the overdose crisis,” Ayesha A. Appa, MD, an infectious diseases and addiction medicine fellow at University of California, San Francisco, and Zuckerberg San Francisco General, told Healio.

Ayesha A. Appa

“As a concurrent infectious diseases fellow and HIV primary care provider at an urban safety net clinic in San Francisco, I also see how destructive methamphetamine use disorder can be and how people living with HIV (PWH) who inject drugs are particularly vulnerable, at disproportionate risk of death,” Appa said. “We wanted to ask how drug-related deaths may be different (or similar) across different epidemiologic groups, with the goal of providing the most effective information about how to prevent drug-related deaths in particular clinical settings.”

Appa and colleagues performed a cross-sectional study of individuals aged 14 years or older who died from drug-related causes including alcohol in San Francisco from Jan. 1, 2007, through Dec. 31, 2018. According to the study, researchers identified these individuals by searching San Francisco drug-related death records from the California Electronic Death Reporting System and then further assessed death certificates to identify decedents who had HIV.

Overall, the study identified 6,764 individuals whose deaths were related to drug use, of whom 223 had HIV.

According to the study, stimulants including cocaine, amphetamine, methamphetamine and methylphenidate were involved in 40% (n = 90) of drug-related deaths among PWH compared with 29% (n = 1,919) of those without HIV (P < .01). Additionally, the researchers found that methamphetamine-related deaths were more common among PWH than those without HIV (21% vs. 13%; P < .01). In contrast, the study showed that alcohol-related deaths were less common among PWH (26%) than those without HIV (26% vs. 46%; P < .01).

Further analysis showed that acute infection was more commonly involved in drug-related deaths among PWH than those without HIV (26% vs. 8%; P < .01) and PWH had a more than fivefold increased adjusted odds of acute infection involved in drug-related death (adjusted OR = 5.58; 95% CI, 4.02-7.74).

According to the study, the most described specific infections reported as a cause of death were sepsis or septic shock (31% of PWH with an infection-related death vs. 49% without HIV with an infection-related death), pneumonia (29% vs. 41%), endocarditis (8% vs. 8%), skin and soft tissue infection (2% vs. 7%) and bacteremia (3% vs. 5%).

“In addition to opioid overdose prevention, health care providers serving PWH who use drugs should consider incorporating stimulant-specific efforts into drug-related death prevention, as well as enhanced efforts to prevent infection, such as expansion of harm reduction services and vaccination promotion,” Appa said.