HIV Infection Linked to Injection Use of Oxymorphone in Indiana, 2014-2015.
Philip J Peters1, Pamela Pontones1, Karen W Hoover1
1From the Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta (P.J.P., K.W.H., M.R.P., R.R.G., M.W.S., W.M.S., Y.K., S.M.O., V.M., P.J.W., D.B., T.S., J.M., J.T.B.); and the Indiana State Department of Health (P.P., S.J.B., C.C., J.G., E.C., J.C.R., J.W., J.M.D.), Indiana University School of Medicine (J.W.), and Indiana University Richard M. Fairbanks School of Public Health (J.M.D.), Indianapolis, Clark County Health Department, Jeffersonville (J.S., D.W.), and Scott County Health Department, Scottsburg (B.C.) - all in Indiana.
Injection drug use of extended-release oxymorphone fueled a rapid HIV outbreak in Indiana. Public health interventions, including a syringe service program, were implemented to control the spread.
Area of Science:
- Epidemiology
- Public Health
- Infectious Disease
Background:
- An outbreak of 11 new human immunodeficiency virus (HIV) diagnoses in Indiana in January 2015 prompted an investigation.
- The study aimed to determine the extent, cause, and control measures for the HIV outbreak.
Purpose of the Study:
- To investigate the cause and extent of a human immunodeficiency virus (HIV) outbreak in Indiana.
- To implement control measures and understand transmission dynamics.
Main Methods:
- Identified outbreak cases diagnosed after October 1, 2014, residing in Scott County, Indiana, or linked through partnerships.
- Conducted phylogenetic analysis of HIV polymerase (pol) gene sequences and ascertained risk factors.
- Performed contact tracing to identify, assess, test, and link individuals to care.
Main Results:
- 181 HIV cases were diagnosed between November 2014 and November 2015.
- 87.8% of patients reported injecting extended-release oxymorphone; 92.3% were coinfected with hepatitis C virus.
- Phylogenetic analysis revealed highly related HIV sequences; syringe-sharing was significantly associated with HIV infection risk (aRR=1.9).
Conclusions:
- Injection drug use of extended-release oxymorphone facilitated the introduction and rapid transmission of HIV within a drug-using network.
- The outbreak led to the declaration of a public health emergency and the establishment of Indiana's first syringe-service program.
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