HIV infection linked to injection use of oxymorphone in Indiana, 2014-2015

Philip J. Peters, Pamela Pontones, Karen W. Hoover, Monita R. Patel, Romeo R. Galang, Jessica Shields, Sara J. Blosser, Michael W. Spiller, Brittany Combs, William M. Switzer, Caitlin Conrad, Jessica Gentry, Yury Khudyakov, Dorothy Waterhouse, S. Michele Owen, Erika Chapman, Jeremy C. Roseberry, Veronica McCants, Paul J. Weidle, Dita BrozTaraz Samandari, Jonathan Mermin, Jennifer Walthall, John T. Brooks, Joan M. Duwve

Research output: Contribution to journalArticle

250 Scopus citations


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 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 syringesharing 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.

Original languageEnglish (US)
Pages (from-to)229-239
Number of pages11
JournalNew England Journal of Medicine
Issue number3
StatePublished - Jul 21 2016

ASJC Scopus subject areas

  • Medicine(all)

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    Peters, P. J., Pontones, P., Hoover, K. W., Patel, M. R., Galang, R. R., Shields, J., Blosser, S. J., Spiller, M. W., Combs, B., Switzer, W. M., Conrad, C., Gentry, J., Khudyakov, Y., Waterhouse, D., Owen, S. M., Chapman, E., Roseberry, J. C., McCants, V., Weidle, P. J., ... Duwve, J. M. (2016). HIV infection linked to injection use of oxymorphone in Indiana, 2014-2015. New England Journal of Medicine, 375(3), 229-239.