title: Fatal and non-fatal overdose after narcology hospital discharge among Russians living with HIV/AIDS who inject drugs.
abstract: Among Russians living with HIV/AIDS who inject drugs, we examined the incidence of fatal and non-fatal overdoses following discharge from a narcology hospital and the associations with more advanced HIV infection.
  
  
  
  Prospective cohort study of data collected at baseline, 3 and 6 months from HIV-infected patients with a history of injection drug use who were not treated with anti-retroviral therapy. Participants were recruited between 2012-2014 from a narcology (addiction) hospital in St. Petersburg, Russia.
  
  
  
  Fatal overdose was determined based on contact reports to study staff in the year after discharge. Non-fatal overdose was self-reported at the 3- and 6-month assessments. The main independent variable for HIV severity was CD4 cell count at the baseline interview (<200cells/mm3≥200cells/mm3). Secondary analyses assessed time since HIV diagnosis and treated with anti-retroviral treatment (ART) prior to enrolment as independent variables. We fit Cox proportional hazards models to assess whether HIV severity is associated with either fatal or non-fatal overdose.
  
  
  
  Among 349 narcology patients, 18 participants died from overdose within one year after discharge (8.7%, 95% CI 3.4-14.2 by Kaplan-Meier); an estimated 51% [95% CI 34-68%] reported at least one non-fatal overdose within 6 months of discharge. HIV severity, time since HIV diagnosis and ever ART were not significantly associated with either fatal or non-fatal overdose events.
  
  
  
  Fatal and non-fatal overdose are common among Russians living with HIV/AIDS who inject drugs after narcology hospital discharge. Overdose prevention interventions are urgently warranted among Russian narcology patients with HIV infection.
authors.affiliation: Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA. Electronic address: awalley@bu.edu.
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Walley
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, USA.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, USA.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Quinn
authors.affiliation: First Pavlov State Medical University, St. Petersburg, Russian Federation.
authors.forename: Elena
authors.initials: E
authors.lastname: Blokhina
authors.affiliation: Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA.
authors.forename: Natalia
authors.initials: N
authors.lastname: Gnatienko
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, USA; Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, USA.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Chaisson
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: San Francisco Department of Public Health, San Francisco, CA 94102, USA; Division of HIV/AIDS, University of California San Francisco, San Francisco CA 94103, USA.
authors.forename: Philip O
authors.initials: PO
authors.lastname: Coffin
authors.affiliation: Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA; Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D062787:Drug Overdose / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D055815:Young Adult
keywords: HIV; Injection drug use; Mortality; Overdose; Russia