Indiana HIV outbreak linked to injection use of oxymorphone




The 2014-2015 HIV infection outbreak in Indiana was associated with the injection-drug use of extended-release oxymorphone, according to a study published in the New England Journal of Medicine.

The study examined 181 HIV-1 infections diagnosed in patients in Scott County, Ind., from Nov. 18, 2014, to Nov. 1, 2015. Of these outbreak-related cases, a total of 159 patients (87.8%) reported injecting the extended-release formulation of the prescription opioid oxymorphone in the previous 12 months. In addition, 173 of the 181 patients reported other injection-drug use, including 47 (27.2%) who reported occasionally injecting heroin, 40 (23.1%) who reported injecting methamphetamine, 15 (8.7%) who reported injecting cocaine, and 2 (1.2%) who reported injecting oxycodone.


Researchers noted that the first three HIV cases in the patient network were detected during routine HIV screening, while eight more cases were diagnosed in syringe-sharing partners of these case patients. All 11 of these HIV-infected persons reported having injected oxymorphone, and a subsequent public health investigation that included contact tracing and phylogenetic analyses of HIV and hepatitis C virus (HCV) sequences revealed the extent of the outbreak. Ultimately, 167 case patients (92.3%) were coinfected with HCV before and during the outbreak.

“Although the proactive deployment of interventions for HIV prevention among persons who inject drugs is challenging in rural areas that have a low incidence of HIV but are at risk for an outbreak, the implementation of HIV testing and treatment, syringe-service programs, and medication-assisted treatment are necessary to help prevent a similar outbreak in the future,” the researchers concluded.

Read the full study here (doi:10.1056/NEJMoa1515195).

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