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

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.

Figure 1.

Kaplan-Meier (K-M) Survival Curves for GBM Treated for Methamphetamine Dependence in Los Angeles, CA between 1998–2000, stratified by HIV status, versus Age-Matched Control Population of HIV-Negative Men Who do Not Use Methamphetamine from Urban California; N = 382. Short-dashed line = Control group (No HIV infection, No methamphetamine use); Dash-dot line = GBM treated for meth use (No HIV infection); Solid line = GBM with HIV infection treated for meth use.

Figure 2.

Kaplan-Meier (K-M) Survival Curves for GBM Treated for Methamphetamine Dependence in Los Angeles, CA between 1998–2000, stratified by HIV status and Tobacco Use; N = 191. Short-dashed line = HIV infection, but no tobacco use; Dashed line = No HIV infection of tobacco use; Dash-dot line = Tobacco use, but no HIV infection; Solid line = Concomitant HIV infection and tobacco use.