April 24, 2015
2 min read

HIV infections surge in Indiana

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INDIANA — Indiana Gov. Mike Pence issued a second 30-day public health disaster emergency today as state and federal health care agencies attempt to contain a major HIV outbreak in Scott County.

The outbreak, which has been traced primarily to IV drug use of Opana (oxymorphone, Endo Pharmaceuticals), has swelled to 136 confirmed cases and six preliminary cases since being identified in February.

“We literally have new cases being reported every day, literally on an hourly basis,” Indiana State Health Commissioner Jerome M. Adams, MD, MPH, said today at a press conference attended by state and federal health officials. “To put this in further perspective, from 2009 to 2013 the county only reported three new cases of HIV.”

The majority of cases were linked to syringe-sharing partners in a rural community in Scott County with a population of 4,200, according to the CDC. Adams said the state health department also had traced contacts to neighboring Jackson County that were related to the Scott County outbreak.

“We feel confident we have adequately captured the contacts in Jackson County and gotten those people appropriately referred for treatment,” he said.

Jonathan Mermin

Jonathan Mermin

Jonathan Mermin, MD, MPH, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said his organization issued a health alert advisory today “to health departments and health care providers nationwide with recommendations for identifying and preventing HIV and hepatitis C infections among people who inject drugs.”

According to MMWR, also released today, coinfection with HCV has been diagnosed in 84.4% of the Scott County HIV outbreak patients.

The advisory encourages health care departments to review the most recent sources of data on HIV diagnoses, HCV diagnoses (acute as well as past or present), overdose deaths, admissions for drug treatment, and drug arrests, among other recommendations. Health care providers were urged to:

  • ensure all persons diagnosed with HCV infection are tested for HIV infection, and that all persons diagnosed with HIV infection are tested for HCV infection;
  • ensure persons receiving treatment for HIV and/or HCV infection adhere to prescribed therapy and are engaged in ongoing care;
  • encourage HIV and HCV testing of syringe-sharing and sexual partners of persons diagnosed with either infection; and
  • note that long-term opioid therapy is not associated with reduced chronic pain.

“There are sharp increases in inappropriate opioid pain reliever prescribing that has created and continues to fuel sharp rises in prescription opioid addictions, overdoses and has led to increased infections,” Mermin said.

According to the report, there were many socioeconomic factors that may have contributed to the outbreak.

“The outbreak highlights the vulnerability of many rural, resource-poor populations to drug use, misuse and addiction, in the context of a high prevalence of unaddressed comorbid conditions,” the researchers said “The county has substantial unemployment (8.9%), a high proportion of adults who have not completed high school (21.3%), a substantial proportion of the population living in poverty (19%), and limited access to health care,” the researchers wrote. “Injection drug use in this community is a multigenerational activity, with as many as three generations of a family and multiple community members injecting together.”

Patients interviewed reported an average of nine syringe-sharing partners, sex partners or other social contacts who might be at risk for HIV infection, according to the report.

The Indiana State Department of Health is working with local health officials, the CDC, drug treatment facilities, local medical providers and other state agencies to contain the outbreak and place individuals with HIV into treatment. The department also has created a public awareness campaign called “You Are Not Alone,” focusing on drug abuse, safe sex, needle disposal and HIV testing and treatment. – by David Jwanier

Disclosure: The researchers report no relevant financial disclosures.