HIV Infection Linked to Injection Use of Oxymorphone

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Oct 17, 2012
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HIV Infection Linked to Injection Use of Oxymorphone in Indiana, 2014–2015
Philip J. Peters, M.D., Pamela Pontones, M.A., Karen W. Hoover, M.D., M.P.H., Monita R. Patel, Ph.D., M.P.H., Romeo R. Galang, M.D., M.P.H., Jessica Shields, B.S., Sara J. Blosser, Ph.D., Michael W. Spiller, Ph.D., Brittany Combs, R.N., William M. Switzer, M.P.H., Caitlin Conrad, B.S., Jessica Gentry, M.A., Yury Khudyakov, Ph.D., Dorothy Waterhouse, B.S., S. Michele Owen, Ph.D., Erika Chapman, M.P.H., Jeremy C. Roseberry, M.A., Veronica McCants, M.S.A., Paul J. Weidle, Pharm.D., M.P.H., Dita Broz, Ph.D., M.P.H., Taraz Samandari, M.D., Ph.D., Jonathan Mermin, M.D., M.P.H., Jennifer Walthall, M.D., M.P.H., John T. Brooks, M.D., and Joan M. Duwve, M.D., M.P.H., for the Indiana HIV Outbreak Investigation Team*



N Engl J Med 2016; 375:229-239July 21, 2016DOI: 10.1056/NEJMoa1515195

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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 1pol 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.)
 
Ngeli tatizo kubwa nimesoma hadi njaa imeniuma. Miss ungekuwa unatusaidia kutafsiri kidogo
Ngeli tatizo kubwa nimesoma hadi njaa imeniuma. Miss ungekuwa unatusaidia kutafsiri kidogo
Oxmorphine ni dawa ya maumivu, ni mpaka upate prescription ya doctor kuitumia kwa wale wenye (cronic pain) maumivu makali ya muda mrefu kama cancer au baada ya ajali matatizo ya uti wa mgongo na kadhalika. Ukishaelekezwa jinsi ya kuitumia unaenda nayo nyumbani hivyo huna haja ya kumsumbua mtaalamu wa afya aje akuchome sindano.
Research hiyo inaonyesha watu waliomainiwa kutumia dawa hiyo wamekuwa na maambukizi ya HIV, Hepatitis C na kadhalika. Walivyofuatilia wamegundua kuwa wanaazimana sindano, sasa wameweka wazi kuwa ni moja ya public health issue kuwa si watu wa methadone tu wanashare sindano hata hawa wanaoaminika kwa matumizi ya oxmorphine pia wako hatarini kwa maambukizi.

Kama nimekosea nisahihishwe.
 
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