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Behavioral and biological factors may be among the reasons for this increased risk, according to the Rhode Island Hospital researchers. Drug overdose is a frequent cause of non-AIDS death among people with HIV.
The link between HIV infection and drug use is well documented, but the association between HIV and overdose has received less attention and was the focus of this study, which involved a review of 24 previous studies.
"Over the past 30 years, we have made impressive strides in caring for and prolonging the lives of people with HIV. Our study found that premature death by overdose is an issue that affects people with HIV disproportionately," study leader Traci Green, a researcher with Rhode Island Hospital and the Lifespan/Tufts/Brown Center for AIDS Research, said in a hospital news release.
"It is not entirely clear why the risk is greater, and few studies have endeavored to figure out why this might be happening," she added.
Biological factors may include clinical status, weakened immune systems, opportunistic infections and poorer physical health among HIV-infected drug users. Some research has suggested that hepatitis C infection and other conditions that affect metabolic ability may also increase the risk of overdose, according to the release.
Behavioral factors -- such as high-risk lifestyles and an increased rate of psychiatric conditions -- may also contribute to the higher risk of overdose among HIV-infected drug users, Green said.
Other possible factors could include homelessness and poverty, and poor access to medications and therapy used to treat opioid dependence, she suggested. Many HIV patients take opioid painkiller drugs as part of their treatment, while others use illegal opioids.
The study appears online in advance of print in the journal AIDS.
"Bringing overdose awareness and prevention into the HIV care setting is critical to reducing overdose deaths," Green said.
"Health care providers who treat HIV-infected patients with a history of substance abuse or who are taking opioid medications should consider counseling patients on how to reduce their risk of overdose. They may also consider prescribing naloxone (Narcan) to patients, or offering a referral to MAT (medication-assisted therapy) to reduce the risk of overdose," she advised.
Naloxone is a prescription medication that reverses an opioid overdose and has no abuse potential.
-- Robert Preidt
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