Excess mortality among HIV-infected patients diagnosed with substance use dependence or abuse receiving care in a fully integrated medical care program.
BACKGROUND
We examined the association between substance use (SU) disorder and mortality among HIV-infected patients in a large, private medical care program.


METHODS
In a retrospective cohort design, HIV-infected patients (≥14 years old) from a large health plan (Northern California) were studied to examine mortality associated with diagnosis of SU dependence or abuse over an 11-year period.


RESULTS
At study entry or during follow-up, 2,279 (25%) of 9,178 HIV-infected patients had received a diagnosis of SU disorder. Diagnoses were categorized as alcohol dependence/abuse only, illicit drugs only, or both. Cause of death differed by the category of SU diagnosis. Mortality rates ranged from 35.5 deaths per 1,000 person-years in patients with an SU disorder to 17.5 deaths among patients without an SU disorder. Regression results indicated mortality risk was significantly higher in all categories of SU disorder compared to no SU diagnosis (hazard ratios ranging from 1.65 to 1.67) after adjustment for SU treatment and confounders.


CONCLUSIONS
A diagnosis of SU dependence/abuse is associated with higher mortality among HIV-infected patients for whom access to medical services is not a significant factor.
Kaiser Permanente Medical Care Program, Oakland, California 94612, USA. gerald.n.delorenze@kp.org
Gerald N
GN
DeLorenze
Constance
C
Weisner
Ai-Lin
AL
Tsai
Derek D
DD
Satre
Charles P
CP
Quesenberry
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D006296:Health Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications* / Q000401:mortality*; D016896:Treatment Outcome