The surge of HIV and hepatitis C virus (HCV) infections in southeastern Indiana, mostly among people who inject dissolved oxymorphone tablets, has prompted the Centers for Disease Control and Prevention (CDC) to put clinicians and public health authorities nationwide on high alert.
"Urgent action is needed to prevent further HIV and HCV transmission in this area and to investigate and control any similar outbreaks in other communities," the CDC said in a health advisory today.
For clinicians, urgent action means testing all patients diagnosed with HIV for HCV, and vice versa, according to the CDC. The agency also recommends that, with pain-management patients, clinicians should discuss the risks and benefits of all treatment options, and not just prescription analgesics.
"Note that long-term opioid therapy is not associated with reduced chronic pain," the CDC said.
Since last November, 142 individuals in Indiana's Scott and Jackson counties have tested positive for HIV either on a confirmed or preliminary basis, the Indiana State Department of Health announced today. The vast majority live in Scott County, where fewer than five HIV cases per year are the norm.
"We likely haven't reached the peak of this outbreak, but we hope to soon through the continued comprehensive response made possible by the joint efforts of so many people and organizations," said Indiana State Health Commissioner Jerome Adams, MD, MPH, in a news release.
To stem the tide of infections, Indiana Governor Mike Pence last month authorized a needle exchange program for Scott County so injection drug users can swap used needles for sterile ones.
The CDC reported that of 135 individuals in southeastern Indiana with newly diagnosed HIV infections, 84% tested positive for HCV. And of 112 individuals with HIV who were interviewed, 96% injected drugs. "All reported dissolving and injecting tablets of the prescription-type opioid oxymorphone using shared drug preparation and injection equipment," the agency stated.
The CDC advises health departments to watch for spikes in HCV infections, especially among individuals aged 35 years or younger, and in HIV infections attributed to injection drug use. These departments should make sure that all contacts of people with newly diagnosed HIV infections are tracked down and tested for HIV and HCV.
The CDC also recommends that clinicians encourage patients to get tested for HIV and HCV if they have sex or share syringes with others diagnosed with either infection.
Today's health advisory from the CDC is available on the agency's website.
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Cite this: CDC Warns of HIV, HCV Outbreaks Among Injection Drug Users - Medscape - Apr 24, 2015.