HIV Infection Linked to Injection Use of Oxymorphone in Indiana, 2014-2015
HIV Infection Linked to Injection Use of Oxymorphone in Indiana, 2014-2015
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DOI：
10.1056/nejmoa1515195
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发表时间：
2016-07-21
影响因子：
158.5
通讯作者：
Duwve, Joan M.
中科院分区：
文献类型：
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作者：
Peters, Philip J.;Pontones, Pamela;Duwve, Joan M.
2015年1月，印第安纳州的一个小社区共报告了11例新的人类免疫缺陷病毒（HIV）感染诊断。我们调查了疫情的程度和原因，并实施了控制措施。METHODSWe确定了一个与疫情相关的病例，该病例为2014年10月1日之后新诊断的实验室确认的HIV感染，该病例发生在一个居住在印第安纳州斯科特县的人，或者被另一个病例患者命名为共享伴侣或性伴侣。方法：对2014年11月18日至2015年11月1日期间确诊的181例HIV感染者进行HIV聚合酶（polymerase，pol）基因序列分析，并分析其与HIV感染相关的潜在危险因素。这些患者中的大多数（87.8%）报告注射了处方阿片类药物羟吗啡酮的缓释制剂，92.3%合并感染了丙型肝炎病毒。在159例有HIV 1型pol基因序列的患者中，157例（98.7%）具有高度相关的序列，通过系统发育分析确定。通过接触者追踪调查，确定了536名被列为病例患者接触者的人;其中468名接触者（87.3%）已被找到，进行了风险评估，进行了艾滋病毒检测，如果感染，则与护理有关。一个接触者被一个病例患者命名为共享性伴侣的次数与HIV感染的风险显著相关（每次命名的校正风险比为1.9; P< 0.001）。为了应对这一爆发，2015年3月26日宣布了公共卫生紧急状态，并在印第安纳州的一个注射服务计划成立了第一次。CONCLUSIONSSINJECTION注射药物使用延长释放羟吗啡酮在网络内的人谁注射毒品在印第安纳州导致艾滋病毒的引进和快速传播。（由印第安纳州和其他州政府资助。）
BACKGROUNDIn 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.METHODSWe 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.RESULTSFrom 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.CONCLUSIONSInjection-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.)