title: Mortality in HIV-Infected Alcohol and Drug Users in St. Petersburg, Russia.
abstract: In Russia, up to half of premature deaths are attributed to hazardous drinking. The respective roles of alcohol and drug use in premature death among people with HIV in Russia have not been described. Criminalization and stigmatization of substance use in Russia may also contribute to mortality. We explored whether alcohol, drug use and risk environment factors are associated with short-term mortality in HIV-infected Russians who use substances. Secondary analyses were conducted using prospective data collected at baseline, 6 and 12-months from HIV-infected people who use substances recruited between 2007-2010 from addiction and HIV care settings in a single urban setting of St. Petersburg, Russia. We used Cox proportional hazards models to explore associations between 30-day alcohol hazardous drinking, injection drug use, polysubstance use and environmental risk exposures (i.e. past incarceration, police involvement, selling sex, and HIV stigma) with mortality. Among 700 participants, 59% were male and the mean age was 30 years. There were 40 deaths after a median follow-up of 12 months (crude mortality rate 5.9 per 100 person-years). In adjusted analyses, 30-day NIAAA hazardous drinking was significantly associated with mortality compared to no drinking [adjusted Hazard Ratio (aHR) 2.60, 95% Confidence Interval (CI): 1.24-5.44] but moderate drinking was not (aHR 0.95, 95% CI: 0.35-2.59). No other factors were significantly associated with mortality. The high rates of short-term mortality and the strong association with hazardous drinking suggest a need to integrate evidence-based alcohol interventions into treatment strategies for HIV-infected Russians.
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Nadia S
authors.initials: NS
authors.lastname: Fairbairn
authors.affiliation: Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, United States of America.
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Walley
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Emily
authors.initials: E
authors.lastname: Quinn
authors.affiliation: Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, Massachusetts, United States of America.
authors.forename: Carly
authors.initials: C
authors.lastname: Bridden
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Christine
authors.initials: C
authors.lastname: Chaisson
authors.affiliation: First Pavlov State Medical University, St. Petersburg, Russian Federation.
authors.forename: Elena
authors.initials: E
authors.lastname: Blokhina
authors.affiliation: First Pavlov State Medical University, St. Petersburg, Russian Federation.|North-West Regional AIDS Center, St. Petersburg, Russian Federation.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Lioznov
authors.affiliation: First Pavlov State Medical University, St. Petersburg, Russian Federation.|Bekhterev Research Psychoneurological Institute, St. Petersburg, Russian Federation.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Krupitsky
authors.affiliation: Division of Global Public Health, University of California San Diego School of Medicine, La Jolla, California, United States of America.
authors.forename: Anita
authors.initials: A
authors.lastname: Raj
authors.affiliation: Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, United States of America.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000150:complications* / Q000401:mortality* / Q000523:psychology; D055030:Drug Users / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D012426:Russia; D057545:Social Stigma