As Opioid Use Increases, Cases of HIV Infection May Follow Suit

A commentary on the relationship between America's opioid abuse epidemic and the number of human immunodeficiency virus (HIV) infections was recently published in the Journal of the American Academy of Physician Assistants. In the commentary, author Kevin Michael O’Hara, MMSc, MS, PA-C, assistant professor in the physician assistants program at the Yale School of Medicine, described the alarming nature of this relationship, provided examples to support what he described as a "potential public health crisis", and explained the importance of "harm reduction" as a preventative strategy.

Mr. O’Hara, MMSc, MS, PA-C, noted that the number of new HIV cases in the United States has remained stable at around 50,000 per year over the past 10 years. Although this is a disappointing number given the concerted efforts of clinicians, researchers, and other key stake holders, it may be heading for a dramatic increase due, at least in part, to an ever growing population of opioid dependent injection drug abusers.

There can be little doubt that the United States is in the midst of an opioid dependence epidemic. While this is a tragedy in and of itself, the tendency of injection drug abusers to share needles provides fertile ground for the transmission of HIV. Mr. O’Hara states that, "Meaningful incorporation of innovation, understanding, and collaboration into our practice is necessary to curtail this emerging public health threat."

Mr. O’Hara includes findings from a recent case report from rural Indiana as support for the existence of this growing threat. In 2015, one rural county experienced a significant HIV outbreak, with a roughly 27-fold increase over the historical yearly number of new cases. When the newly diagnosed patients were examined, it was revealed that many admitted to sharing needles to inject and abuse opioids. In light of these statistics, the author asks, "How should clinicians and communities caring for patients abusing opioids, or at high risk for abuse, respond to this potential public health crisis?"

According to the author the answer is simple: employ "harm reduction" strategies. As the term implies, the goal of such initiatives is to limit negative consequences without attacking the core sources of a health-related problem. For example, needle and syringe exchange programs and over-the-counter availability of clean syringes would be considered harm reduction strategies for the spread of HIV in opioid dependent injection drug abusers. "Harm reduction is another example of how understanding the challenges of addiction can result in effective prevention strategies." states O’Hara.

Unfortunately, despite proven effectiveness in reducing the spread of infectious diseases or provoking increased drug abuse, these harm reduction tactics remain controversial in some quarters.

In addition to the traditional harm reduction approaches, the author describes a newer, pharmacotherapeutic technique referred to as preexposure prophylaxis (PrEP). This is a biochemically-based, proactive strategy focused on the use of antiviral medications in high-risk populations. The goal of PrEP is reduced transmission of HIV, and it has been shown to be effective. Of course, clinicians would need training on the safe use of PrEP, as well as communication techniques designed to inform and educate those at highest risk.

The combination of pharmacologic and non-pharmacologic strategies will have the highest likelihood of success. The author himself remarks "PrEP and needle and syringe exchange programs are HIV prevention options with demonstrated efficacy."

O’Hara concludes that increased opioid abuse will lead to the spread of HIV, which can best be combated by employing harm reduction methods, both traditional and new.

William Perlman, PhD, CMPP is a former research scientist currently working as a medical/scientific content development specialist. He earned his BA in Psychology from Johns Hopkins University, his PhD in Neuroscience at UCLA, and completed three years of postdoctoral fellowship in the Neuropathology Section of the Clinical Brain Disorders Branch of the National Institute of Mental Health.