Trends in HIV and opioid misuse

Rising misuse of opioids in the United States has contributed to many adverse health outcomes over the past 10 to 15 years. One health concern related to opioid misuse is an increase in injection drug use and greater risk of HIV infection. Patterns of HIV infection associated with injection drug use have changed over the past decade, with more diagnoses in younger, white and rural Americans. However, it is unclear how trends in HIV and opioid misuse have changed nationwide over that time span.

In a new study, the Southwest Rural Health Research Center at the Texas A&M University School of Public Health investigated factors like rurality, insurance coverage and demographics, and their relationship with co-occurring HIV and opioid-related hospitalizations—hospitalizations for which patients had both an HIV-related diagnosis and an opioid use disorder-related diagnosis. The study, published in the journal Preventive Medicine Reports, used the National Inpatient Database (NIS), a nationally representative database that captures hospital admissions in the United States. The researchers pooled NIS data from 2009 to 2017 to determine the likelihood of hospitalizations due to HIV and opioid misuse and to identify potential risk factors.

“In identifying people who are at greatest risk of HIV infection due to opioid misuse-related injection drug use, policymakers and health providers can create targeted public health interventions and promote more impactful use of resources to address the opioid epidemic,” said Alva O. Ferdinand, DrPH, JD, director of the Southwest Rural Health Research Center and interim department head of Health Policy and Management.

The researchers queried the database for hospital discharges containing diagnosis codes for both HIV-related and opioid-related conditions. They also created variables where discharges had only one of the two conditions. As possible risk factors, researchers extracted data on whether patients lived in rural or urban areas as well as age, race and ethnicity, insurance status, income level and region of the country in which the patients lived.

Rural versus urban status was the research team’s main variable of interest as studies have found that rural areas have been disproportionately affected by opioid misuse over the study period.

Although opioid misuse has been growing in recent years, the researchers did not find a significant change in hospitalizations for co-occurring HIV and opioid misuse diagnoses during the study period. The analysis also showed that most of the hospitalizations occurred in large, northeastern cities and that those in rural areas were less likely to be hospitalized for both HIV and opioid-related reasons. The researchers noted that rural hospital closures could play some role in this.

In addition, the analysis showed that Black and white patients had about the same likelihood of being hospitalized for both HIV and opioid-related diagnoses. This highlights the need for interventions that focus on prevention and treatment that are culturally relevant for various demographic groups. Lastly, researchers found that although the South accounted for more than half of the new HIV diagnoses in the United States in recent years, there is a need for efforts targeting HIV and opioid misuse in the Northeast, as well, due to this region having the most co-occurring hospitalizations.

“As states and localities explore avenues for greater access to medication-assisted treatment for opioid use disorders and determine best strategies for utilizing and disbursing billions of dollars from opioid-related lawsuits, this study can be useful for stakeholders who are hoping to use evidence to develop transparent and inclusive decision-making processes for improving prevention, equity and the saving of lives,” Ferdinand said.

The findings of this study shed light on factors associated with hospitalizations due to HIV and opioid misuse in the United States and highlight a need for interventions tailored to different groups to reduce hospitalizations. Opioid misuse is expected to grow in the future, so having information that can reduce some of the harms associated with this issue would be beneficial.