16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

PERSISTENT CONTRIBUTION OF SUBSTANCE ABUSE TO EXCESS MORTALITY AMONG PERSONS WITH AIDS IN NEW YORK CITY, 1999 – 2003

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. ThAc0201

Pfeiffer M.R., Hanna D.B., Begier E.M., Sepkowitz K.A., Torian L.V., Sackoff J.E.
New York City Department of Health and Mental Hygiene, HIV/AIDS Prevention and Control, New York, United States

BACKGROUND: In New York City (NYC), injecting drug users (IDU) account for 30% of persons living with AIDS but 43% of deaths. While deaths continue to decline in all transmission risk groups, the death rate in IDU remains 2 – 3 times higher than in men who have sex with men (MSM). We examined contributing causes of death to determine reasons for excess deaths.

METHODS: Deaths during 1999 – 2003 among adult NYC residents reported with AIDS to the NYC population-based HIV/AIDS Surveillance System with a transmission risk of IDU or MSM were examined. Multiple causes of death were obtained from the NYC Vital Statistics Registry. We calculated overall proportions and trends in contributing causes of death in IDU compared with MSM.

RESULTS: During 1999 – 2003, there were 5,328 deaths in IDU and 1,548 in MSM in NYC. After unspecified HIV disease, the most frequent contributing cause of death in IDU was drug abuse, including overdose (21.5% versus 4.1% in MSM (p<.0001)). Liver disease contributed to 16.4% of deaths in IDU compared with 7.6% in MSM (p<.0001). The prevalence of these causes did not change significantly over the 5-year period among IDU, but hepatitis C (HCV), which contributed to 60.3% of liver disease deaths, was reported twice as often in 2003 (12.4%) as in 1999 (6.1%) (p trend<.0001). In contrast, among MSM, pneumonia (13.4%) and septicemia/shock (11.2%) were the most frequent contributing causes, and HCV increased only moderately (2.9% to 4.4%) (p=0.23).

CONCLUSIONS: IDU constitute a disproportionate share of deaths among persons with AIDS in NYC. Excess deaths were mainly due to substance abuse-related causes including overdose, HCV and other liver diseases. Mortality could be cut substantially by addressing these causes through substance abuse treatment, HCV treatment, and promotion of harm reduction strategies such as syringe exchange programs and naloxone distribution to treat accidental overdose.

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2006-08-13
ThAc0201

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