title: Recent drug use, homelessness and increased short-term mortality in HIV-infected persons with alcohol problems.
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.
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, USA. awalley@bu.edu
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Walley
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.forename: Howard
authors.initials: H
authors.lastname: Libman
authors.forename: David
authors.initials: D
authors.lastname: Nunes
authors.forename: C Robert
authors.initials: CR
authors.lastname: Horsburgh
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications* / Q000401:mortality; D019970:Cocaine-Related Disorders / Q000150:complications / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality*; D006556:Heroin Dependence / Q000150:complications / Q000401:mortality; D006703:Ill-Housed Persons; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D019966:Substance-Related Disorders / Q000150:complications* / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors