Ongoing Opioid Abuse in US Likely Culprit Behind HIV Clusters

Collateral damage from the ongoing opioid abuse epidemic in the United States continues to plague many rural communities across the country, with recent reports suggesting it is likely behind clusters of HIV cases in these areas.

A Centers for Disease Control and Prevention (CDC) analysis, accepted for publication by the Journal of Acquired Immune Deficiency Syndromes, identified 220 counties in the United States that are “potentially vulnerable” to HIV and hepatitis C virus (HCV) infections “among people who inject drugs within the context of the national opioid epidemic.” The findings follow on the heels of an alarming cluster of 194 HIV cases reported in the rural community of Austin, Indiana in 2015.

In addition to the health implications for those in the affected areas, government officials are concerned about the care costs associated with treating these vulnerable populations. The CDC estimates that the lifetime healthcare costs for the patients in Indiana alone will exceed $100 million.

“Our main goal was to prevent this from happening again, and this is one way we think we can help jurisdictions,” John Brooks, senior medical adviser for the CDC’s Division of HIV/AIDS Prevention and lead author of the report, told the Wall Street Journal. “[But] that doesn’t mean these are the only places that have a problem.”

The 220 counties (there are slightly more than 3,100 counties in the United States) are all deemed to be in the 95^th percentile for HIV/HCV outbreak risk, according to the CDC. In all, 26 states have counties deemed to be at high risk, but 56% of the at-risk counties are in 3 states: Kentucky, Tennessee, and West Virginia. The Appalachia region has been particularly hard hit by the opioid abuse epidemic.

Maine, Missouri, and Arizona are other states with a large number of at-risk counties.

The CDC researchers used data such as pharmacy sales of prescription opioids, overdose deaths, and unemployment figures to determine the counties with the highest numbers of injection drug users, per capita, and thus at greatest risk for HIV/HCV outbreaks. Injection drug use, of course, has long been linked with both diseases.

Interestingly, though, the findings come at a time when HIV infections linked with injection drug use are in sharp decline nationally. According to the CDC, in 1995, 30% of all new HIV cases in the United States were attributed to injection drug use. That number fell to 6% in 2014, the last year for which data are available.

A report issued by Castlight Health, a large health benefits platform provider, in April found that some 4.5% of those who receive a prescription for opioid pain relievers in the United States are “abusers.” In an earlier interview, Karen Leggett Dugosh, PhD, a senior research scientist at Treatment Research Institute, a substance abuse research center in Philadelphia, told Contagion that issues such as the increasing prevalence of HIV and/or HCV cases are another example of the “devastating affects” of the opioid abuse epidemic on “individuals, families, and society.”

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.