Archives

  • 2018-07
  • 2018-10
  • 2018-11
  • 2019-04
  • 2019-05
  • 2019-06
  • 2019-07
  • 2019-08
  • 2019-09
  • 2019-10
  • 2019-11
  • 2019-12
  • 2020-01
  • 2020-02
  • 2020-03
  • 2020-04
  • 2020-05
  • 2020-06
  • 2020-07
  • 2020-08
  • 2020-09
  • 2020-10
  • 2020-11
  • 2020-12
  • 2021-01
  • 2021-02
  • 2021-03
  • 2021-04
  • 2021-05
  • 2021-06
  • 2021-07
  • 2021-08
  • 2021-09
  • 2021-10
  • 2021-11
  • 2021-12
  • 2022-01
  • 2022-02
  • 2022-03
  • 2022-04
  • 2022-05
  • 2022-06
  • 2022-07
  • 2022-08
  • 2022-09
  • 2022-10
  • 2022-11
  • 2022-12
  • 2023-01
  • 2023-02
  • 2023-03
  • 2023-04
  • 2023-05
  • 2023-06
  • 2023-08
  • 2023-09
  • 2023-10
  • 2023-11
  • 2023-12
  • 2024-01
  • 2024-02
  • 2024-03
  • 2024-04

    • Figure shows the network of the

    2022-05-16

    Figure 2 shows the network of the 47 persons with diagnosed HIV and their 192 contacts. Of the contacts, 149 (78%) were first-generation contacts and 43 (22%) were second-generation contacts. Color and shape combinations used for network nodes (i.e., persons) allow one to simultaneously discern past 12-month IDU behavior and HIV case status (persons with HIV diagnosed in 2017 and pre-2017 are shown separately in orange and red, respectively). The network diagram was built from persons with HIV diagnosed in 2017 and included 14/47 (30%) persons who were either not interviewed (n = 8) or did not list any contacts (n = 6); these nodes are shown in the diagram as singletons. There are 245 connections between nodes. The average degree (i.e., number of direct links or connections) for all nodes in the network is 2.1. Among persons with HIV diagnosed in 2017, 10 (21%) had only one contact, 8 (17%) had 2–3 contacts, and 15 (32%) had at least four contacts. Figure 3 shows potential for onward HIV transmission from persons with 2017 diagnoses in terms of viral suppression status, number of sexual or IDU contacts with a discordant HIV status (negative or unknown HIV status), and risk behaviors during the past 12 months. There were 19 persons with HIV diagnosed in 2017 who were not virally suppressed and were interviewed by DIS about their partners and risk behaviors. Of these, nine (47%) had at least one sexual or IDU contact with a negative or unknown HIV status. Further, among those nine, one reported having injected drugs and shared needles or equipment, and two others had at least one discordant partner who injected drugs and shared needles or equipment during the past 12 months. An additional two persons of the nine with HIV diagnosed in 2017, who were not virally suppressed and had discordant partners reported anal or vaginal condomless sex in the past 12 months (data not shown).
    Discussion An in-depth network investigation of persons diagnosed with HIV in 2017 in 15 West Virginia counties revealed that Rose Bengal most HIV infections were likely transmitted by male-to-male sexual contact. However, interviewed persons reported moderately high levels of IDU behavior—13% of persons with a recent HIV diagnosis injected drugs in the past year, as did 21% of their interviewed contacts. In comparison, the prevalence of past-year PWID was estimated to be 0.3% in the United States [11], and 9% of persons diagnosed with HIV in the United States in 2017 reported injection drug use as their transmission category [12]. As expected, most drugs injected were opioids. Bridging of HIV risk from MSM to PWID is present, although we did not find a dense network of PWID with rapidly disseminating HIV as was documented in Scott County, Indiana [8]. However, any needle or equipment-sharing behavior among PWID in an area with high rates of opioid use and even a few HIV infections warrants serious public health concern. Persons with HIV diagnosed in Rose Bengal 2017 in the 15 counties of interest were demographically similar to those with recent diagnoses throughout the state. West Virginia reported 78 HIV diagnoses in 2017; at a rate of 4.3 diagnoses per 100,000 population, it had the 11th lowest HIV diagnosis rate nationally [12]. Among persons with HIV diagnosed in West Virginia during 2012–2016, 80% were male, 47% were aged younger than 35 years, 72% were non-Hispanic white, and 54% likely acquired HIV through male-to-male sexual contact, whereas 13% had some lifetime IDU risk. The demographic characteristics of persons with diagnosed HIV in West Virginia have remained relatively stable since reporting began in 1989 [13]. Rapid dissemination of HIV would overtax West Virginia's public health system given historically low, stable background HIV prevalence. The population is widely dispersed throughout the state with few urban areas, and infectious disease physicians or other health care providers trained to care for persons living with HIV are in short supply [9]. At the time of this investigation, some key HIV surveillance data, including contact tracing and risk behavior data, were not digitized and therefore unavailable for rapid analysis. In addition, there were only three DIS working across the 15 counties, and they had many other notifiable disease responsibilities. At the current rate of HIV diagnoses, these issues are somewhat manageable, as evidenced by our finding that 50% of persons with 2017 diagnoses were already virally suppressed by early 2018, with another 36% linked to care but not yet virally suppressed. However, these infrastructural and human resources constraints do not have quick fixes and would make rapid response to an HIV outbreak challenging and resource intensive.