A New Outbreak of HIV in Rural America Likely Related to Opioid Epidemic

The outbreak of HIV in Scott County, Indiana, in 2014–15 was the first but certainly not the last HIV outbreak to occur in the U.S. as a result of the opioid epidemic (NEJM JW Infect Dis Jun 2015 and MMWR Morb Mortal Wkly Rep 2015; 64:1). Now investigators have documented a cluster encompassing 15 counties in West Virginia. The investigation identified 57 persons, 40 of them diagnosed in 2017 and 17 diagnosed before. Most were men (89%), white (75%), and younger than 30 years (49%). In at least 60% of the cases the mode of transmission was thought to be male-to-male sexual contact, but injection drug use was involved in at least 8 cases; in 13 the risk factor was unknown. The involved counties had high prevalences of drug overdose deaths, p…