HIV Infection Linked to Injection Use of Oxymorphone in Indiana, 2014-2015

被引：491

作者：

Peters, Philip J. ^{[1
]}

Pontones, Pamela ^{[2
]}

Hoover, Karen W. ^{[1
]}

Patel, Monita R. ^{[1
]}

Galang, Romeo R. ^{[1
]}

Shields, Jessica ^{[4
]}

Blosser, Sara J. ^{[2
]}

Spiller, Michael W. ^{[1
]}

Combs, Brittany ^{[5
]}

Switzer, William M. ^{[1
]}

Conrad, Caitlin ^{[2
]}

Gentry, Jessica ^{[2
]}

Khudyakov, Yury ^{[1
]}

Waterhouse, Dorothy ^{[4
]}

Owen, S. Michele ^{[1
]}

Chapman, Erika ^{[2
]}

Roseberry, Jeremy C. ^{[2
]}

McCants, Veronica ^{[1
]}

Weidle, Paul J. ^{[1
]}

Broz, Dita ^{[1
]}

Samandari, Taraz ^{[1
]}

Mermin, Jonathan ^{[1
]}

Walthall, Jennifer ^{[2
]}

Brooks, John T. ^{[1
]}

Duwve, Joan M. ^{[2
,3
]}

机构：

[1] Ctr Dis Control & Prevent, Div HIV AIDS Prevent, Natl Ctr HIV Viral Hepatitis STD & TB Prevent, Atlanta, GA USA

[2] Indiana Univ Sch Med, Indiana State Dept Hlth, Indianapolis, IN 46202 USA

[3] Indiana Univ, Richard M Fairbanks Sch Publ Hlth, Indianapolis, IN 46204 USA

[4] Clark Cty Hlth Dept, Jeffersonville, IN USA

[5] Scott Cty Hlth Dept, Scottsburg, IN USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2016年 / 375卷 / 03期

关键词：

C VIRUS-INFECTION; UNITED-STATES; RISK BEHAVIORS; YOUNG-ADULTS; HEROIN USE; DRUG USE; NEW-YORK; EPIDEMIC; TRANSMISSION; INCREASES;

D O I：

10.1056/NEJMoa1515195

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND In January 2015, a total of 11 new diagnoses of human immunodeficiency virus (HIV) infection were reported in a small community in Indiana. We investigated the extent and cause of the outbreak and implemented control measures. METHODS We identified an outbreak-related case as laboratory-confirmed HIV infection newly diagnosed after October 1, 2014, in a person who either resided in Scott County, Indiana, or was named by another case patient as a syringe-sharing or sexual partner. HIV polymerase (pol) sequences from case patients were phylogenetically analyzed, and potential risk factors associated with HIV infection were ascertained. RESULTS From November 18, 2014, to November 1, 2015, HIV infection was diagnosed in 181 case patients. Most of these patients (87.8%) reported having injected the extended-release formulation of the prescription opioid oxymorphone, and 92.3% were coinfected with hepatitis C virus. Among 159 case patients who had an HIV type 1 pol gene sequence, 157 (98.7%) had sequences that were highly related, as determined by phylogenetic analyses. Contact tracing investigations led to the identification of 536 persons who were named as contacts of case patients; 468 of these contacts (87.3%) were located, assessed for risk, tested for HIV, and, if infected, linked to care. The number of times a contact was named as a syringe-sharing partner by a case patient was significantly associated with the risk of HIV infection (adjusted risk ratio for each time named, 1.9; P< 0.001). In response to this outbreak, a public health emergency was declared on March 26, 2015, and a syringe-service program in Indiana was established for the first time. CONCLUSIONS Injection-drug use of extended-release oxymorphone within a network of persons who inject drugs in Indiana led to the introduction and rapid transmission of HIV. ( Funded by the state government of Indiana and others.)

引用

页码：229 / 239

页数：11

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