The US Centers for Disease Control and Prevention has agreed to assist the Massachusetts Department of Public Health (DPH) with investigating a large cluster of new HIV infections in the northeast region of the state among people who inject drugs and/or experience homelessness. After seeing the increase in new HIV cases last year in Lawrence and Lowell among people who inject drugs, DPH requested formal assistance from the CDC.

Public domain photo/Psychonaught
Public domain photo/Psychonaught

Although Massachusetts as a whole has not seen an overall increase in the number of new HIV diagnoses, the number of new diagnoses attributed to people who inject drugs has increased in recent years, most notably in the cities of Lawrence and Lowell. DPH’s preliminary data shows 52 new HIV cases in 2017 in the northeast region among injection drug users, compared to 23 in 2016.

“We have seen an increase in the number of newly diagnosed cases of hepatitis C related to injection drug use in people under the age of 30 over the past several years and have been concerned about the potential for HIV infection following a similar course,” said Dr. Al DeMaria, infectious disease medical director and state epidemiologist at DPH. “In order to fully characterize what is going on and what would be required to effectively prevent further spread of infection, we have asked for assistance from CDC. This assistance can allow a more rapid investigation by putting more investigators in the field and making further use of the capacity of CDC for advanced laboratory methods and their expertise acquired in other investigations. The sooner we can discover why these infections are happening now, the sooner we can use the most effective prevention interventions based on the evidence.”

DPH’s request included asking for CDC support with the epidemiologic investigation, assistance in determining the underlying causes of these clusters of infection, and why this is happening now, after a decade of increasing injection drug use related to the opioid epidemic without evidence of significant transmission.

The Department also is seeking assistance in the field interviewing infected individuals and needle-sharing and sexual partners, aid with ethnographic studies, support for epidemiologic analysis, and the performance and interpretation of viral genetic sequencing results. This additional assistance from the CDC is expected to begin late this month.

After seeing the first spike in 2016 in HIV cases in the northeast region, DPH expanded its screening outreach among injection drug users, quadrupled the number of its needle exchange programs across the state, and deployed mobile outreach units to homeless shelters and programs serving people at risk.

Last November, the Department issued a clinical advisory to notify health-care workers of the increase in newly diagnosed and acute HIV infections among people who inject drugs.