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Abstract
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BACKGROUND: Preventable deaths, including those due to drug overdose (OD), are a significant public health concern in New York City (NYC); the rate of unintentional drug OD death in NYC increased 143% from 2010-2016. Trends in drug OD death among persons with HIV (PWH) in NYC have not been described.
METHODS: We selected PWH from the NYC HIV Registry who died during 2007-2017, resided in NYC at death, and died due to drug OD. We characterized PWH who died of drug OD and analyzed CD4 and viral load (VL) tests from surveillance to evaluate retention in care and viral suppression (VS) (VL<200 cc/mL) in the 12 months prior to death as markers of care-seeking.
RESULTS: From 2007-2017, 870 NYC PWH died of drug OD. Of the total OD deaths, 821 (94.4%) deaths were classified as accidental overdose deaths and 49 (5.6%) as intentional overdose deaths. While the rate of OD deaths among PWH declined during the full period, from 58.5 per 100,000 in 2007 to 47.9 per 100,000 in 2017, it increased from 2014 (30.9/100,000) to 2016 (53.3/100,000) and stayed high through 2017 (47.9/100,000). Decedents during 2007-2017 were predominantly male (70.8%), Black (38.0%) or Latino/Hispanic (38.7%), aged 40-59 years (73.2%), and had a history of injection drug use (43.0%). Over three-quarters (80.1%) of decedents were retained in HIV care in the 12 months preceding death; 45.4% were VS.
CONCLUSIONS: A sizeable number of PWH died of OD in the last decade, and OD death rates in recent years increased. Pre-death care patterns reveal frequent interaction with the health care system, underscoring missed opportunities for harm-reduction and suicide prevention interventions for PWH.
Language: en |