HUNTINGTON — Cabell County’s active HIV cluster is now at 44 confirmed cases — up from 28 in March — according to the West Virginia Bureau for Public Health.
The disease has spread primarily among the county’s population of intravenous drug users. There are an estimated 1,800 active IV drug users in Cabell County, according to a recent survey by Johns Hopkins University.
Cabell County’s is currently the only HIV cluster in West Virginia, though the state Department of Health and Human Resources is now calling for increased HIV testing statewide.
The cluster, tracked from January 2018 to the present, represents a sharp uptick from the baseline average of eight cases annually over the past five years.
This is also the first notable HIV cluster in West Virginia where intravenous drug use is identified as the main risk factor.
In Appalachia, HIV is typically a rare diagnosis compared with coastal cities. This latest cluster represents a continuing shift in how HIV is most often spread, from men having risky sexual contact with other men to intravenous drug users.
HIV has, however, been on the minds of public health officials for years as it relates to the opioid epidemic. If HIV were to be introduced among IV drug users, the virus could spread uncontrollably with a devastating human and economic cost.
A true-life, worst-case scenario was lived out around 250 miles down the Ohio River in 2015, when rural Scott County, Indiana, suffered an HIV outbreak infecting 181 people among a close network of residents sharing needles to inject opioids.
Preventing HIV, along with hepatitis and other bloodborne diseases, is the major purpose of syringe exchange programs, which offer clean syringes in exchange for used ones. The Cabell-Huntington Health Department has operated a syringe exchange since 2015.
On Wednesday, the health department voted to begin prescribing antiviral medication for those most at risk of the virus. Known as pre-exposure prophylaxis (PrEP), the daily pill is given to those who do not have HIV but are at high risk for contracting the virus.
The situation is still defined as a cluster rather than a full outbreak. The West Virginia Bureau for Public Health characterizes a cluster as being confined to a certain population — in this case, IV drug users — where it may be able to be controlled with minimal risk to the general public.
An outbreak would indicate the disease is spreading beyond that initial group.