Outbreak of HIV Infection Among Injection-Drug Users in Indiana

Summary and Comment |
April 27, 2015

Outbreak of HIV Infection Among Injection-Drug Users in Indiana

  1. Carlos del Rio, MD

HIV infection was diagnosed in about 3% of the population of one rural county; hepatitis C virus coinfection was diagnosed in 84% of those affected.

  1. Carlos del Rio, MD

In early 2015, the Indiana State Department of Health received a report of 11 confirmed HIV cases occurring among injection-drug users in a rural county in southeastern Indiana, an area where fewer than 5 cases had been reported per year in the past. The new cases were linked to needle sharing and injection of the prescription opioid oxymorphone. As of April 21, HIV infection had been diagnosed in 135 people in this community of 4200 (about 3 per 100 population), with hepatitis C virus coinfection identified in 84% of them. The patients (55% of whom were male) had a mean age of 35; they reported 4 to 15 injections per day with 1 to 6 injection partners each time.

Comment

This outbreak, occurring in an area historically not known to have many HIV cases but where unemployment, poverty, and poor access to healthcare have been compounded by the rapid emergence of injection-drug use with a highly addictive opioid, highlights how rapidly infectious diseases can spread within a population. There is an ongoing state and federal effort to control this outbreak, but without a comprehensive strategy of harm reduction and without addressing social determinants of health such as poverty in underserved areas, we can expect similar outbreaks in the future.

The time has come to implement comprehensive strategies to decrease the risk for HIV infection among injection-drug users, including lifting the federal ban on funding needle-exchange programs, improving access to substance-abuse treatment, and implementing pre-exposure prophylaxis.

Editor Disclosures at Time of Publication

  • Disclosures for Carlos del Rio, MD at time of publication Consultant / Advisory board InnaVirVax Grant / Research support National Institutes of Health (NIH); NIH/National Institute of Allergy and Infectious Diseases; Centers for Disease Control and Prevention; NIH/National Institute on Drug Abuse; Addis Ababa University Editorial boards AIDS Research and Human Retroviruses; Journal of AIDS Leadership positions in professional societies HIV Medicine Association (Board of Directors); International Antiviral Society–USA (Board of Directors)

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