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Many US communities vulnerable to HIV outbreak due to unsafe injecting of prescription opioids
Michael Carter, 2016-06-21 07:50:00
in the online edition of the Journal of
Acquired Immune Deficiency Syndromes has identified the jurisdictions in
the United States especially vulnerable to the rapid spread of HIV or HCV due
to unsafe injecting drug use. A total of 220 countries in 26 states had a high
level of vulnerability, with factors associated with unsafe injecting including
high rates of death due to drug overdose, unemployment and poverty.
“We have developed
a model to identify US counties potentially vulnerable to rapid spread of HIV,
if introduced, and new or continuing high numbers of HCV infections among PWID
[people who inject drugs],” comment the authors. “Jurisdictions identified as
at-risk might use potentially informative local data that were not available
nationally and take action.”
There has been a
massive increase in opioid use in the United States over the past decade. This
has fuelled an increase in unsafe drug injecting, leading to new HCV
infections, especially in non-urban communities.
In late 2014,
injection of prescription opioids was implicated in an outbreak of HIV in a
rural US community (Austin in Scott County, Indiana). Almost all (92%) of those infected with HIV during this outbreak were also infected with HCV. Health
officials were concerned about the potential for similar outbreaks in other communities.
They therefore designed a model to identify the jurisdictions potentially
vulnerable to the rapid spread of HIV, if the infection were introduced into
groups illicitly injecting drugs.
infections were used as a proxy for illicit unsafe injecting.
Data on the number
of acute HCV infections reported in 2012 (n = 1,710) and 2013 (n = 2,074) were
included in investigators’ analyses. The county-level factors possibly
associated with use of unsterilised injecting equipment were identified. For
each vulnerable jurisdiction, the authors assessed the likelihood that HIV
might be introduced into a network of people who inject drugs. This calculation
took into account local HIV prevalence.
A total of 2,970
counties reported acute HCV infections in the study period.
were associated with the rate of new HCV infections:
- Drug overdose deaths per
100,000 population (p < 0.0001).
- Prescription opioid sales per
10,000 population (p = 0.012).
- Higher percentage of white,
non-Hispanic population (p < 0.0001).
- Lower per-capita income (p <
- Higher rate of adult
unemployment (p = 0.0095)
- Buprenorphine prescription for opioid substitution treatment per
identified 220 counties in 26 states that were especially vulnerable to an HIV
outbreak spread by injecting drug use.
identified in our analysis were overwhelmingly rural,” note the authors. “Since
2006, rates of acute HCV infection have increased faster in rural than in urban
areas consistent with introduction and spread of this infection into
populations made newly vulnerable by the expansion of IDU in rural America.”
poverty were important risk factors for acute HCV infection. “It has been
hypothesized that financial stressors increase vulnerability to drug use so
that young adults in economically deprived areas may accumulate risk factors
for drug use and be likely to establish drug dependencies at a younger age than
persons in more economically privileged areas,” write the researchers.
prevalence rates ranged between 0.9 to 38 per 10,000 population, and with one
exception, the vulnerable counties had a prevalence rate below the national
prevalence of 29 per 10,000 population.
“All health officials can review these results
along with the most recent sources of data on HIV and acute HCV diagnoses
available to them. Additional local insights may be gained by examining data
sources associated with IDU that were not available for inclusion in our
analysis,” conclude the authors. “To reduce vulnerability, targeted
interventions in accordance with efforts to prevent and treat substance use
disorder and to reduce risk of infectious complications of IDU are warranted.”