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.

Is substance use associated with HIV cascade outcomes in Latin America?

“…With that said, under-reporting of mortality among those LTFU could still be an issue. In Russia and in the Veterans Aging Cohort Study, hazardous alcohol use increased overall mortality among HIV-infected substance users [ 36 , 37 ], and substance users lost to follow up may have a higher chance of being dead than non-users. There was insufficient follow-up in our study to investigate any association between substance use and mortality; additional studies with longer follow up periods are necessary.…”

Stigma, Coping, and Alcohol Use Severity Among People Living With HIV: A Prospective Analysis of Bidirectional and Mediated Associations

“…For example, alcohol consumption has been linked with risky sexual behaviors that may increase the likelihood of HIV transmission [15][16][17]. Also, people living with HIV who use alcohol are approximately 50%-60% less likely to be adherent to antiretroviral therapy than abstainers [18], and heavy drinking is related to increased risk of detectable viral load, impaired liver function, and death [19][20][21]. Thus, a better understanding of the link between HIV-related stigma and alcohol use is necessary to curb their negative impact on the health and well-being of people living with HIV.…”

HIV Stigma and Unhealthy Alcohol Use Among People Living with HIV in Russia

“…Another Russian study, among PLWH, reported that hospitalized, alcohol-dependent patients consumed a mean of 28 g of alcohol per day (the equivalent of 2 standard drinks per NIAAA definition) in the past month [28]. Excessive alcohol consumption is widespread in Russia and is closely linked with excess mortality particularly among Russian men [29], but also among PWID [30]. We assume that even in an environment where drinking is normative, excessive alcohol use might be associated with self-stigma [31], especially when alcohol consumption is disorderly and apparent to others, such as among people with more severe alcohol use disorders [32].…”