HIV infection among persons who inject drugs

Abstract

AIDS among persons who inject drugs, first identified in December 1981, has become a global epidemic. Injecting drug use has been reported in 148 countries and HIV infection has been seen among persons who inject drugs in 61 countries. Many locations have experienced outbreaks of HIV infection among persons who inject drugs, under specific conditions that promote very rapid spread of the virus. In response to these HIV outbreaks, specific interventions for persons who inject drugs include needle/syringe exchange programs, medicated assisted treatment (with methadone or buprenorphine) and antiretroviral therapy. Through a “combined prevention” approach, these interventions significantly reduced new HIV infections among persons who inject drugs in several locations including New York City, Vancouver and France. The efforts effectively ended the local HIV epidemic among persons who inject drugs in those locations. This review examines possible processes through which combined prevention programs may lead to ending HIV epidemics. However, notable outbreaks of HIV among persons who inject drugs have recently occurred in several countries, including in Athens, Greece, Tel-Aviv, Israel, Dublin Ireland, as well as in Scott County, Indiana USA. This review also considers different factors that may have led to these outbreaks. We conclude with addressing the remaining challenges for reducing HIV infection among persons who inject drugs.

HIV infection among persons who inject drugs

“…This is the same estimated incidence that we used in our article [2], and that led us to conclude that the HIV epidemic among PWID in France has ‘ended’.…”

Racial Inequities in HIV Prevalence and Composition of Risk Networks Among People Who Inject Drugs in HIV Prevention Trial Network 037

“…Lessons learned from the 2015 HIV outbreak in rural Indiana, where 135 individuals acquired HIV from injection of prescription opioid oxymorphone, show that when high-risk sex and drug practices occur in somewhat closed networks, rapid HIV transmission takes place. 31 Statistics from the Centers for Disease Control and the 2016 U.S. Surgeon General’s report on addiction show that opioid injection is expanding in the United States to reach an alarming epidemic proportion: during 2002–2013, heroin overdose death rates nearly quadrupled, from 0.7 deaths to 2.7 deaths per 100,000 population.…”

Acute HIV infection transmission among people who inject drugs in a mature epidemic setting

“…Despite this relatively modest portion of the world population, PWID account for about 10% of incident HIV infections annually [3]. Many settings with mature PWID epidemics (e.g., New York City (NYC), France, and Vancouver) have provided examples of how to achieve stark reductions in HIV incidence [4]. One of the prominent features of these settings has been the expansion of highly active antiretroviral therapy (HAART) among PWID [4, 5], utilizing the principle of treatment as prevention (TasP) to decrease HIV transmission [6].…”

“…Many settings with mature PWID epidemics (e.g., New York City (NYC), France, and Vancouver) have provided examples of how to achieve stark reductions in HIV incidence [4]. One of the prominent features of these settings has been the expansion of highly active antiretroviral therapy (HAART) among PWID [4, 5], utilizing the principle of treatment as prevention (TasP) to decrease HIV transmission [6]. Prevention strategies based on TasP have played a key role in reducing HIV incidence among PWID in settings that encourage HIV testing, linkage to HIV care, and harm reduction services [5, 7].…”

“…For the purposes of our analysis, we define a mature epidemic setting as a setting with on-going, endemic HIV transmission within the PWID population, and with evidence of either stable or previously peaked HIV prevalence among PWID, many of which have been previously described [4]. …”