Recent drug use, homelessness and increased short-term mortality in HIV-infected persons with alcohol problems

AIDS. 2008 Jan 30;22(3):415-20. doi: 10.1097/QAD.0b013e3282f423f8.

Abstract

Objective: To assess the impact of recent heavy alcohol use, heroin/cocaine use, and homelessness on short-term mortality in HIV-infected persons.

Methods: Survival in a longitudinal cohort of 595 HIV-infected persons with alcohol problems was assessed at 6-month intervals in 1996-2005. The time-varying main independent variables were heavy alcohol use (past 30 days), heroin/cocaine use (past 6 months), and homelessness (past 6 months). Date of death was determined using the Social Security Death Index. Outcomes were limited to deaths occurring within 6 months of last assessment to ensure recent assessments of the main independent variables. Cox proportional hazards models were fit to the data.

Results: Death within 6 months of their last assessment occurred in 31 subjects (5.2%). Characteristics at study entry included mean age 41 years, 25% female, 41% African-American, 24% with CD4 cell count < 200 cells/mul; 41% taking antiretroviral therapy, 30% heavy alcohol use, 57% heroin or cocaine use, and 28% homelessness. Heroin or cocaine use [hazard ratio (HR), 2.43; 95% confidence interval (CI), 1.12-5.30)] and homelessness (HR, 2.92; 95% CI, 1.32-6.44), but not heavy alcohol use (HR, 0.57; 95% CI, 0.23-1.44), were associated with increased mortality in analyses adjusted for age, injection drug use ever, CD4 cell count, and current antiretroviral therapy.

Conclusions: Recent heroin or cocaine use and homelessness are associated with increased short-term mortality in HIV-infected patients with alcohol problems. Optimal management of HIV-infected patients requires regular assessments for drug use and homelessness and improved access to drug treatment and housing.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Alcoholism / complications*
  • Alcoholism / mortality
  • Cocaine-Related Disorders / complications
  • Cocaine-Related Disorders / mortality
  • Cohort Studies
  • Female
  • HIV Infections / complications*
  • HIV Infections / mortality*
  • Heroin Dependence / complications
  • Heroin Dependence / mortality
  • Homeless Persons*
  • Humans
  • Longitudinal Studies
  • Male
  • Proportional Hazards Models
  • Substance-Related Disorders / complications*
  • Substance-Related Disorders / mortality
  • Survival Analysis
  • Time Factors