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Drug Alcohol Depend. 2018 Aug 29. pii: S0376-8716(18)30421-6. doi: 10.1016/j.drugalcdep.2018.06.036. [Epub ahead of print]

Speed kills: Associations between methamphetamine use, HIV infection, tobacco use, and accelerated mortality among gay and bisexual men in Los Angeles, CA 20years after methamphetamine dependence treatment.

Author information

1
College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN, 38163, USA; South American Program in HIV Prevention Research, UCLA Department of Medicine, Division of Infectious Diseases, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA. Electronic address: ryan.c.passaro@vanderbilt.edu.
2
South American Program in HIV Prevention Research, UCLA Department of Medicine, Division of Infectious Diseases, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA
3
UCLA Center for Behavioral and Addiction Medicine, 10880 Wilshire Blvd., Ste. 1800, Los Angeles, CA, 90024, USA
4
National Institute on Drug Abuse, Office of Science Policy and Communications, Public Information and Liaison Branch, 6001 Executive Blvd., Room 5213, MSC 9561,Bethesda, MD, 20892, USA
5
Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Av. Alameda San Marcos s/n, Chorrillos (Lima 09), Lima, Peru
6
McGovern Medical School at UTHealth, Department of Internal Medicine, Division of Infectious Diseases, 6341 Fannin St., MSB2.112, Houston, TX, 77030, USA
7
Friends Research Institute, 11835 Olympic Blvd., #775E, Los Angeles, CA, 90064, USA
8
UCLA Center for HIV Identification, Prevention, and Treatment Services, 10880 Wilshire Blvd., Ste. 1800, Los Angeles, CA, 90024, USA

Abstract

BACKGROUND:

To better characterize mortality among methamphetamine users, we estimated rates of all-cause mortality by HIV serostatus and smoking history in gay and bisexual men (GBM) treated for methamphetamine dependence, and explored associated clinical and socio-behavioral characteristics.

METHODS:

We searched public records to identify deaths among men screened between 1998-2000 for a trial of outpatient therapy for GBM with methamphetamine dependence. Crude mortality rates (CMRs) were calculated, and standardized mortality ratios (SMRs) estimated, comparing data with historical information from CDC WONDER. Associations of mortality with HIV infection, tobacco use, and other factors were explored using Kaplan-Meier survival analysis and Cox proportional hazards models.

RESULTS:

Of 191 methamphetamine-dependent GBM (median age 35 years; majority Caucasian), 62.8% had HIV infection, and 31.4% smoked tobacco at baseline. During the 20-year follow-up period, 12.6% died. Relative to controls, methamphetamine-dependent GBM had a three-fold higher 20-year SMR: 3.39, 95% CI: 2.69-4.09. Especially high mortality was observed among participants reporting tobacco use (adjusted HR 3.48, 95% CI: 1.54-7.89), club drug use prior to starting methamphetamine (2.63, 1.15-6.00), or other clinical diagnoses at baseline (3.89, 1.15-13.22). At 20 years, the CMR for HIV infected participants (7.7 per 1000 PY) was 1.5 times that for men without HIV (5.2 per 1000 PY; p = 0.22) and there was a 5-fold difference in CMRs for HIV infected tobacco smokers (16.9 per 1000 PY) compared to non-smokers (3.4 per 1000 PY; p < 0.01).

CONCLUSION:

In our sample of methamphetamine-dependent GBM, concomitant HIV infection and tobacco use were associated with dramatic increases in mortality.

KEYWORDS:

Gay and bisexual men (GBM); Human immunodeficiency virus (HIV); Methamphetamine; Mortality; Survival; Tobacco

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