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Association of History of Injection Drug Use with External Cause-Related Mortality Among Persons Linked to HIV Care in an Urban Clinic, 2001–2015

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Abstract

High mortality rates among persons with HIV with a history of injection drug use (PWID) are thought to be driven in part by higher rates of external cause-related mortality. We followed 4796 persons aged 18–70 engaged in continuity HIV care from 2001 to 2015 until death or administrative censoring. We compared cause-specific (csHR) and subdistribution hazards (sdHR) of death due to external causes among PWID and persons who acquired their HIV infection through other routes (non-IDU). We standardized estimates on age, sex, race, and HIV-related health status. The standardized csHR for external cause-related death was 3.57 (95% CI 2.39, 5.33), and the sdHR was 3.14 (95% CI 2.16, 4.55). The majority of external cause-related deaths were overdose-related and standardized sdHR was 4.02 (95% CI 2.40, 6.72). Absolute rate of suicide was low but the csHR for PWID compared to non-IDU was most elevated for suicide (6.50, 95% CI 1.51, 28.03). HIV-infected PWID are at a disproportionately increased risk of death due to external causes, particularly overdose and suicide.

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Funding

This work was supported by NIH grants U01 DA036935 and P30 AI094189. The funders have had no influence on the design of this analysis or reporting of results.

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA

    Kanal Singh, Bryan Lau, Richard D. Moore & Catherine R. Lesko

  2. Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Geetanjali Chander & Richard D. Moore

  3. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Jessie K. Edwards

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  1. Kanal Singh
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Correspondence to Catherine R. Lesko.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Singh, K., Chander, G., Lau, B. et al. Association of History of Injection Drug Use with External Cause-Related Mortality Among Persons Linked to HIV Care in an Urban Clinic, 2001–2015. AIDS Behav 23, 3286–3293 (2019). https://doi.org/10.1007/s10461-019-02497-6

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