Public health officials are scrambling to contain a new cluster of HIV cases among people who inject drugs, this time based in Boston and involving six people so far.
The new cluster follows an HIV outbreak in Lawrence and Lowell that involved 153 cases from 2015 through 2018. Boston and state officials expressed optimism that the deadly virus can be stopped before the Boston outbreak spreads.
The six people in Boston were diagnosed since Nov. 1, most in January. During the same period the previous year, there were no new HIV cases in Boston.
The renewed fight against HIV transmission, which until 2015 had been declining among intravenous drug users in Massachusetts, stands as another grim side effect of the state’s continuing epidemic of opioid addiction. The virus is spread through the blood, and people can contract it when they share needles.
“Another hot spot in the Boston area tells us we’re confronting an increase that wasn’t isolated to one neighborhood,” said Carl Sciortino, vice president for government and community relations at Fenway Health, which offers testing and treatment for HIV. “The perfect storm that led to the outbreak in Lawrence is present in communities across the state. It’s not going to stop in Boston and Lawrence.”
On Friday the Massachusetts Department of Public Health and the Boston Public Health Commission sent an alert to Boston health care providers, informing them of the new cases and urging them to ask patients about risky behaviors, test them for HIV, and link them to antiviral treatment if they are infected.
“I hope that what we are seeing is the universe of exposed individuals and no more,” said Dr. Jenifer Leaf Jaeger, director of the infectious disease bureau at the Boston Public Health Commission.
Kevin Cranston, the state health department’s assistant commissioner and director of its Bureau of Infectious Disease and Laboratory Sciences, said the six people were tested at different sites around the city. Heightened attention to HIV since the Lawrence outbreak led health officials to connect the cases and notice the unusual cluster, he said.
The state’s expanded team of field epidemiologists — recently doubled from nine to 18 with federal funding — will contact the infected people and connect them with HIV treatment, which can enable a normal life and also suppress the virus to the point that it can no longer be spread. They will also conduct interviews to identify others who had sexual contact or shared needles with the infected people, and reach out to those contacts to coax them into testing and treatment.
“I’m hopeful we’re able to actually contain this outbreak,” Cranston said.
The US Centers for Disease Control and Prevention will conduct molecular testing to see whether the cases are related to each other, or to the previous outbreak.
The Lawrence outbreak has abated, but it’s not yet clear that it’s over, Cranston said. Since August, the number of new HIV diagnoses among people who inject drugs in the region has been in the single digits, he said.
As recently as 2014, throughout Massachusetts, only 30 new HIV cases were diagnosed among people who inject drugs. In 2017, that number jumped to 105. Data for 2018 were not available.
Meanwhile, HIV has declined in other at-risk populations, such as men who have sex with men. The proportion of new HIV infections attributed to intravenous drug use increased from 5 percent in 2014 to 17 percent in 2017. As a result, a long decline in new HIV cases has started to level off, Cranston said.
“It’s clearly very alarming to see a reversal in what had been 15 years of progress,” Sciortino said. The group’s drug user health program diagnosed three new HIV cases since July 1, Sciortino said. In the previous 12 months, the program saw no cases at all.
Fentanyl, now common in the illicit drug supply, wears off quickly, prompting users to inject more frequently and thus increase their risk of infection. Homelessness and incarceration also make matters worse by limiting access to treatment, according to the conclusions of a federal team that investigated the Lawrence and Lowell outbreak last year.
Additionally, health officials have said that the current opioid epidemic involves younger people who have not learned the dangers of sharing needles and how to avoid spreading infections.
Programs that provide clean needles and instructions in safe injecting play an important role in controlling the spread of HIV, and those programs have proliferated in Massachusetts in recent years. Currently 25 are in operation and six more have been approved and will open soon.
Sciortino said that safe injection sites — where drug users can inject while being monitored in case they overdose — also prevent HIV infection by providing clean supplies and instruction in preventing infections. A state commission is weighing the feasibility of opening such a site in Massachusetts, but the idea has proven controversial.