People Living With HIV Have Increased Non-fatal Overdose Risk With Each Additional Medication

People living with HIV (PLWH) are exposed to many medications and their potential risks. In this study of 250 adult PLWH, researchers assessed the association of an increasing number of sedating, non-sedating (both opioid and non-opioid), non-antiretroviral (ARV), and overall medications with the self-reported outcomes of lifetime and past-year non-fatal overdose.

• At baseline, participants were prescribed a median of 10 medications (2 sedating); 80% received sedating medications, 50% received opioid prescriptions, and 42% were co-prescribed opioid and non-opioid sedating medications. The most common non-opioid sedating medications were gabapentin (22%), mirtazapine (16%), trazodone (14%), hydroxyzine (12%), and diphenhydramine (10%). The most common benzodiazepine was clonazepam (7%).
• 45% of participants reported lifetime non-fatal overdose and 7% reported past-year non-fatal overdose.
• Odds of lifetime non-fatal overdose were significantly higher with each additional sedating medication (odds ratio [OR], 1.3), any opioid (OR, 2.3), and any opioid agonist treatment medication (OR, 4.8).
• Odds of past-year non-fatal overdose were higher with each additional sedating (OR, 1.2) and non-ARV (OR, 1.1) medication and any opioid agonist treatment (OR, 2.7).

Comments: Polypharmacy is common among PLWH and has the potential for increased harm as this population ages. The increased risk with opioid agonist treatment is likely because PLWH with opioid use disorder are perhaps more likely to both overdose and be initiated on opioid agonist treatment. The study is limited by absence of information about current medications at the time of non-fatal overdose. Nonetheless, it suggests that providers should carefully assess the risks and benefits of all medications among PLWH.

Kevin L. Kraemer, MD, MSc

Reference: Kim TW, Walley AY, Heeren TC, et al. Polypharmacy and risk of non-fatal overdose for patients with HIV infection and substance dependence. J Subst Abuse Treat. 2017;81:1-10.