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Research Summary

Increased Risk of Overdose Death among People with HIV Infection

Injection drug use (IDU) and HIV infection are overlapping epidemics, and overdose is the most common cause of death among people with IDU. Some studies have indicated an increased risk of overdose death among people with HIV infection. Researchers conducted a meta-analysis and systematic review to assess the relationship between overdose and HIV infection. The literature search found 27 studies containing enough information to calculate the relative risk of overdose death by HIV infection status. Twenty-four of the studies determined HIV status via biological testing.

  • For the meta-analysis, the pooled relative risk of overdose death for HIV-infected people (compared with those not infected) was 1.60 in all studies and 1.74 in the 24 studies with biological testing. For the 16 studies including only people with IDU, the relative risk was 1.48.
  • Potential causal mechanisms for overdose identified in the systematic review included reduced pulmonary function, reduced hepatic function, and high-risk behaviors. Protective factors included enrollment in opioid agonist treatment, while poverty and incarceration were associated with increased overdose risk.


Despite substantial heterogeneity in study designs, this meta-analysis confirmed that people with HIV infection have a higher risk of overdose death than those not infected with HIV. Because all overdoses are preventable, HIV care providers should educate patients with IDU on how to prevent, recognize, and respond to an overdose. Alexander Y. Walley, MD, MSc


Green TC, McGowan SK, Yokell MA, et al. HIV infection and risk of overdose: a systematic review and meta-analysis. AIDS. 2012;26(4):403–417.