title: Examining non-AIDS mortality among people who inject drugs.
abstract: OBJECTIVE
  To systematically review and analyse data from cohorts of people who inject drugs (PWID) to improve existing estimates of non-AIDS mortality used to calculate mortality among PWID in the Spectrum Estimates and Projection Package.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  We conducted an update of an earlier systematic review of mortality among PWID, searching specifically for studies providing data on non-AIDS-related deaths. Random-effects meta-analyses were performed to derive pooled estimates of non-AIDS crude mortality rates across cohorts disaggregated by sex, HIV status and periods in and out of opioid substitution therapy (OST). Within each cohort, ratios of non-AIDS CMRs were calculated and then pooled across studies for the following paired sub-groups: HIV-negative versus HIV-positive PWID; male versus female PWID; periods in OST versus out of OST. For each analysis, pooled estimates by country income group and by geographic region were also calculated.
  
  
  RESULTS
  Thirty-seven eligible studies from high-income countries and five from low and middle-income countries were found. Non-AIDS mortality was significantly higher in low and middle-income countries [2.74 per 100 person-years; 95% confidence interval (CI) 1.76-3.72] than in high-income countries (1.56 per 100 person-years; 95% CI 1.38-1.74). Non-AIDS CMRs were 1.34 times greater among men than women (95% CI 1.14-1.57; N = 19 studies); 1.50 times greater among HIV-positive than HIV-negative PWID (95% CI 1.15, 1.96; N = 16 studies); and more than three times greater during periods out of OST than for periods on OST (N = 7 studies).
  
  
  CONCLUSIONS
  A comprehensive response to injecting drug must include efforts to reduce the high levels of non-AIDS mortality among PWID. Due to limitations of currently available data, including substantial heterogeneity between studies, estimates of non-AIDS mortality specific to geographic regions, country income level, or the availability of OST should be interpreted with caution.
authors.affiliation: aThe Kirby Institute for Infection and Immunity in Society, Faculty of Medicine bNational Drug and Alcohol Research Centre, University of New South Wales, Sydney cSchool of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Mathers
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
mesh_terms: D002423:Cause of Death; D015331:Cohort Studies; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D009026:Mortality; D058850:Opiate Substitution Treatment; D012737:Sex Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*