Prevalence and predictors of HIV among patients presenting to US emergency departments with opioid overdose.
Publication/Presentation Date
9-7-2024
Abstract
INTRODUCTION: Opioid overdose deaths in the U.S. have risen dramatically in the past decade, largely due to the surge in illicitly manufactured fentanyl. Injection drug use is a known risk factor for HIV, further complicating the long-term consequences of opioid use. The baseline prevalence of HIV among adults in the US is 0.46 %. The primary purpose of this study was to determine the prevalence and risk factors of HIV among patients presenting to the emergency departments (ED) with an acute opioid overdose.
METHODS: This study is a prospective observational cohort study from the ToxIC Fentalog Study group. Patients age 18 years of age or older are included if they present to one of 10 participating U.S. hospitals in 9 states between September 2020 and May 2023 with a suspected opioid overdose and had waste serum available after routine laboratory testing. Clinical data is collected from the medical record and patient serum is sent for comprehensive toxicologic analysis via liquid chromatography quadrupole time-of-flight mass spectroscopy to detect the presence of over 1200 substances including illicit opioids, novel synthetic opioids, medications, and adulterants. Logistic multivariable regression was performed to examine the association between demographic, behavioral, and serum toxicology data with risk factors and HIV status.
RESULTS: Among the total cohort (n=1690), 1062 cases had known HIV status (62.8 % of total sample). Among patients with a known HIV status, 60 (5.6 % [95 % CI: 4.2 %, 7.0 %]) were HIV positive. Patients with HIV reported stimulant use more frequently (13.3 %) than those without HIV (6.8 %; p=0.003). After controlling for confounding, bipolar psychiatric history was a significant independent predictor of HIV positivity (aOR: 1.08; 95 % CI: 1.02, 1.13) in this population.
CONCLUSIONS: In this large multicenter cohort, the prevalence of HIV for ED patients with illicit opioid overdose was 9 times higher than that expected by the general population. Bipolar disorder appears to be a novel risk factor for HIV positivity in this patient population.
Volume
264
First Page
112423
Last Page
112423
ISSN
1879-0046
Published In/Presented At
Levine, M., Culbreth, R., Amaducci, A., Calello, D. P., Shulman, J., Judge, B., Love, J., Hughes, A., Schwarz, E. S., Carpenter, J., Wax, P., Aldy, K., Krotulski, A. J., Logan, B. K., Buchanan, J., Brent, J., Meaden, C. W., Hendrickson, R. G., Abston, S., Li, S., … ToxIC Fentalog Study Group (2024). Prevalence and predictors of HIV among patients presenting to US emergency departments with opioid overdose. Drug and alcohol dependence, 264, 112423. Advance online publication. https://doi.org/10.1016/j.drugalcdep.2024.112423
Disciplines
Medicine and Health Sciences
PubMedID
39270332
Department(s)
Department of Emergency Medicine, Toxicology Division
Document Type
Article