Study Shows Link Between Recent Drug Use, Homelessness And Death In HIV–Infected Persons With Alcohol Problems

in Health & Medicine, News Releases, School of Medicine
January 30th, 2008

Contact: Gina M. Digravio, 617-638-8491 | gina.digravio@bmc.org

(Boston) – Researchers from Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) have found that recent drug use and homelessness are associated with increased short-term mortality in HIV-infected persons with alcohol problems. These findings appear in the January 2008 issue of the journal AIDS.

Since the advent of combination active antiretroviral therapy (ART) in 1996, mortality in HIV-infected patients with access to ART has decreased substantially. However, several studies have noted smaller mortality improvements in patients infected with HIV from injection drug use compared with other transmission routes. This study provides further explanation of these prior findings, demonstrating that recent drug use and recent homelessness have stronger associations with mortality than prior injection drug use.

From 1997 to 2005, laboratory and interview data were collected every six months on a cohort of 595 subjects with HIV infection and alcohol problems. Of the 595 subjects who were followed, 31 (five percent) died within six months of their last study interview, while 99 (16.6 percent) died overall. The researchers found recent heroin or cocaine use and homelessness, but not heavy alcohol use, was linked to this increased mortality. Analyses controlled for age, prior injection drug use, immune status and use of anti-HIV medications. Overdose, liver-related conditions and HIV-related conditions were the three most common categories for the deaths.

“Many of the deaths in this cohort such as those caused by overdose, trauma and infection were likely acute, preventable and attributable to recent drug use or homelessness,” said lead author Alexander Walley, MD, clinician investigator in the section of general internal medicine at BMC and medical director of the Boston Public Health Commission’s Narcotic Addiction Clinic.

According to the researchers, integration of effective substance abuse treatment with HIV care, along with housing programs have been demonstrated to be effective. “Getting our patients on anti-HIV medications is not enough. We need to address drug use and homelessness and offer patients substance abuse treatment and housing,” added Walley.

This study was supported by the National Institute on Alcohol Abuse and Alcoholism.

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