CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Alcoholismwas the most diagnosed single SUD in the DC Cohort. SUDs disproportionately affected Blacks, Latinos, men, and risk groups other than MSM. Chronic HCV was highly prevalent among PLWH with SUDs and warrants closer attention to ensure successful treatment. SUD was associated with mortality but not VS, suggesting substance-related causes of death. 881 ACCIDENTAL OVERDOSE DEATHS AMONG HIV+ INDIVIDUALS IN WASHINGTON, DC, 2013-2016 Kerri Dorsey 1 , Jenevieve Opoku 2 , Rupali K. Doshi 1 1 George Washington University, Washington, DC, USA, 2 District of Columbia Department of Health, Washington, DC, USA Background: Drug overdose deaths in DC increased by 178% from 2014 to 2016 (DC Office of the Chief Medical Examiner), but the extent to which people living with HIV (PLWH) died of drug overdose is unknown. We compared the demographic profiles and markers of engagement in HIV care among PLWH in DC who died of accidental overdose (AOD) versus other causes of death (COD) from 2013 to 2016 using death certificate data. Methods: Deaths reported to the DC Department of Health among PLWH from 2013 to 2016 were evaluated. AOD included ICD-10 codes X40, X41, X42, X43, X44, and Y12 in any death cause position. Individuals were classified as having either AOD or other COD. Univariate analyses (Cochran-Mantel-Haenszel and Student’s t-test) and multivariate logistic regression were conducted to evaluate potential covariates, including age at HIV diagnosis, gender, race/ethnicity, mode of transmission, duration of HIV illness, and CD4 cell count, viral suppression (most recent viral load ≤ 200 copies per mL), and retention in care (at least 1 CD4 or VL) in the year prior to death. Results: From 2013 to 2016, 1125 deaths among PLWH were reported; of these, 6% (n=68) were AOD. AOD among PLWH increased by 182% from 2013 (n=11) to 2016 (n=31), and PLWH who died from exposure to narcotics (X41) increased by 156% from 2013 (n=9) to 2016 (n=23). Among PLWH with AOD, 40% (n=27) had history of injection drug use (IDU) at the time of HIV diagnosis vs. 26% among PLWH with other COD (p=0.03). Among PLWH with AOD, mean age of HIV diagnosis was 38 years vs 42 years for other COD (p-value = 0.01). No statistical difference was found between the mean duration of HIV (AOD 13.7 years vs. other COD 12.5 years, p-value=0.21). In unadjusted analyses, retention in care, viral suppression, and rates of missing lab data were similar between AOD and other COD (Table 1). Based on multivariable analysis, those who died of AOD (vs. other COD) were more likely to have a history of IDU (aOR: 2.3, 95% CI 1.0,5.1) and CD4 count ≥ 500 (aOR: 3.6 95% CI 1.6,8.1). Conclusion: AOD among PLWH in DC has increased substantially in recent years and was prominent among PLWH with history of IDU. CD4 was higher among PLWH with AOD, indicating HIV treatment success. Access to naloxone and opioid substitution therapy for PLWH should be enhanced, and provider awareness of IDU history and overdose potential should be increased, to address this rapidly increasing cause of mortality.

1 Harvard Medical School, Boston, MA, USA, 2 Yale University, New Haven, CT, USA, 3 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 4 Connecticut Department of Correction, Wethersfield, CT, USA Background: People with HIV (PWH) released from the criminal justice (CJ) system experience poor HIV outcomes and high mortality. In a cohort of PWH incarcerated in Connecticut and returned to communities, we have shown that the risk of death is 8.47 (standardized mortality ratio [SMR]; 95% CI: 7.25-9.69) times that of the general Connecticut population and 6.97 (95% CI: 5.96- 7.97) times that of the general US population. To guide future interventions, we aimed to identify demographic (age and race/ethnicity) disparities in comparative mortality. Methods: We linked pharmacy, custodial, death, case management, and HIV surveillance data from Connecticut Departments of Correction and Public Health to create a retrospective cohort of all adult PWH released from jails and prisons in Connecticut (2007-2014). We compared mortality in this cohort with the general US and Connecticut populations and with a cohort of PWH from North America (NA-ACCORD) using SMRs. We assessed differences in cause of death and time-to-death within the cohort, stratified by race/ethnicity and age (<45, ≥45 years of age). Results: Among 1,350 PWH released from CJ settings in Connecticut, median length of incarceration was 73 days (IQR=25-201). After stratifying by race/ ethnicity and age, released PWH had significantly higher adjusted mortality than individuals within the general US, CT, and PWH populations (See Table). Assessment of within cohort differences found that among younger, formerly incarcerated PWH, Whites had a shorter time-to-death than Blacks (p<0.0001). In older, formerly incarcerated PWH, time-to-death was shorter among Hispanics compared to Whites (p=0.032). The most frequent causes of death were HIV/AIDS complications (46%), drug overdose (15%), and liver disease including hepatitis C (10%). Causes of death differed by race/ethnicity for younger (p=0.025), but not older PWH (p=0.526), with younger Hispanics dying most commonly from HIV/AIDS (50%) or liver disease (19%), younger Blacks dying most frequently from HIV/AIDS (23%) or accidental injury/suicide (23%), and younger Whites dying most frequently from HIV/AIDS (50%) or drug overdose (25%). Conclusion: For PWH, release from the CJ is associated with markedly elevated risk for death relative to general and PWH populations in North America. To reduce mortality, linkage and retention in care post-release and expanded treatment provision for substance use disorders and other chronic conditions in prison are critically important.

Poster Abstracts

882 RELEASED TO DIE: ELEVATED MORTALITY IN PEOPLE WITH HIV AFTER INCARCERATION Katherine M. Rich 1 , Kelsey B. Loeliger 2 , Divya K. Chandra 2 , Dharushana Muthulingam 2 , Keri N. Althoff 3 , Colleen Gallagher 4 , Jaimie P. Meyer 2 , Frederick Altice 2

883 HIV AND OVERDOSE AMONG PEOPLE WHO INJECT DRUGS IN A COMMUNITY-BASED COHORT

Becky L. Genberg , Jacquie Astemborski, Jing Sun, Gregory D. Kirk, Shruti H. Mehta

CROI 2019 343