NKY, Cincinnati see sharp rise in HIV cases linked to injected drug use; CDC to assist NKY

The people at the forefront of the heroin epidemic in Northern Kentucky predicted that a surge in HIV would follow. They were right.

HIV cases linked to injection drug use swung up in Northern Kentucky and Cincinnati last year, public health officials say.

Northern Kentucky Health Department saw 18 cases of HIV-positive people to date in 2017 who identified injection drug use as a risk factor. (The count isn't finalized.)

That's three times the number of such cases in years 2009-2016 when zero to five such cases were reported each year. 

The national Centers for Disease Control and Prevention has been notified of Northern Kentucky's situation and is assisting with genetic testing to determine if cases are connected, health officials confirmed Monday.

While Hamilton County Public Health did not immediately provide HIV numbers, the Cincinnati Health Department also reported an upswing in HIV cases for those who'd identified injection drug use as a risk factor. 

New HIV cases reported for Cincinnati residents in 2017 was just over 40 percent higher than the number in 2016 (129 compared to 91), said Sharon Hutchins, supervising epidemiologist for the communicable disease unit of Cincinnati health. Cases linked to injection drug use increased nearly 250 percent from 2016 to last year, she said. 

Northern Kentucky and Kentucky state health officials will provide more detail about the upswing in HIV and their response at a public meeting Tuesday at the Northern Kentucky Health Department in Edgewood.

The unwelcome news is no surprise to health officials who've battled the heroin epidemic. HIV can be treated but not cured with expensive drugs, which can prevent retransmission of the virus in many patients. If left untreated, people with the HIV virus develop AIDS, resulting in a range of opportunistic infections and death.

"The realization hit the treatment field over four years ago that we stood on a threshold of an epidemic within an epidemic: HIV, as a consequence of our opioid epidemic," said Dr. Mina "Mike" Kalfas, an addiction expert who treats more than 200 heroin-addicted patients in Northern Kentucky.

HIV outbreaks tied to injected drugs have occurred in recent years in places as disparate as Boston and rural Indiana.

Health officials aren't sure whether any of the cases in Northern Kentucky are connected at this point. 

Those who inject drugs are at risk of contracting HIV because the virus can stay on a used needle or other injection equipment, and people with addiction often share that equipment.

Anyone who works in public safety and emergency healthcare is also at risk if they work with people who inject drugs. Paramedics in Greater Cincinnati and Northern Kentucky have treated many overdosed people with a needle still in their arm or near their body, and hospital caregivers have found needles buried in the clothing of those who've overdosed and are brought to hospitals.

Experts reassert case for needle exchange

A national harm reduction strategist who helped Northern Kentucky when it began efforts to attack the heroin epidemic was disappointed to hear about the HIV surge.

"What's so frustrating is that Northern Kentucky had the opportunity to get in front of this," said Daniel Raymond, policy director for the National Harm Reduction Coalition in New York City.

But regardless of a push by Northern Kentucky Health Department District Director Dr. Lynne Saddler and community advocates, syringe exchange development stopped almost right after it started.

The CDC and area public health officials support the exchanges, where sterile needles and other injection equipment are available to people who inject drugs. Programs also offer HIV and hepatitis testing and a pathway to drug treatment.

Northern Kentucky has one syringe exchange, which opened in 2016 in the health department's Williamstown office, in Grant County. It's funded with private grant money, which is also available for other counties.

See previous coverage: Launching a syringe exchange 

Still, the three biggest counties, Boone, Campbell and Kenton, have resisted starting exchange operations.

All three were stopped by elected officials, who either balked at approving an exchange or made demands for operation. Covington, for example, wanted a neighboring county also has a syringe exchange operation before the city would approve one of its own.

Cincinnati and Hamilton County have approved public funding for needle exchange operations for this year, a first in their history.

They did so because of an upswing in hepatitis C, which also is raging in Northern Kentucky, and concerns about other communicable diseases such as HIV.

Just last week, a public health collaborative including Hamilton County and Cincinnati health departments started operating The Exchange Project, a needle exchange that they say will continue to grow and is sustainable through $325,000 per year in public funds and a grant. The program replaces The Cincinnati Exchange Project, with UC School of Medicine remaining a partner.

CDC cautioned in '17 of HIV threat here

Last year, the CDC warned of HIV, noting that 54 Kentucky counties and 11 in Ohio were under threat of HIV outbreaks because of high hepatitis C rates.

Tiny, rural Scott County in Indiana was the crucial red flag that spurred the disease experts to make the analysis.

That county experienced a quick and vicious HIV outbreak in 2014 and 2015. More than 188 IV drug users were infected. About 90 percent also tested positive for hepatitis C. Infectious disease specialists learned that those afflicted were IV opioid drug users, with the prescription painkiller Opana as their main choice to crush and inject.

Kalfas, who has seen more HIV cases in the last year, called the spike in cases "the sum of my fears. He added, "But it's not as bad as it can get.… There's still prevention to be done."

Raymond said prevention hinges on quick action by public health officials.

"This has got to be an alarm signal for those communities that there's no time to waste," he said.

The Enquirer will update this story.

Earlier coverage on heroin, HIV and needle exchanges

Seven days of heroin: This is what an epidemic looks like

CDC warns Tristate that HIV may follow heroin

Why isn't this solution to hep C used in NKY?

Rural Indiana county added exchange after outbreak

Cincinnati, Hamilton County hit reset on needle exchange