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Growth of Cabell County HIV cluster slows

HUNTINGTON — Cabell County’s current HIV cluster is now at 53 cases, the West Virginia Department of Health and Human Resources confirmed this week.

The total has crawled upward by four new cases over the past four weeks (49 as of May 22) and nine cases over the past nine weeks (44 as of April 28). The cluster has spread primarily among the county’s intravenous drug-using population, of which there are an estimated 1,800 active in Cabell County.

“We can’t relax based on any slowing,” said Dr. Michael Kilkenny, physician director of the Cabell-Huntington Health Department. “We need to consistently and strategically test as many people as we possibly can and link to care in every case — the ultimate goal being to stop the spread of HIV.”

HIV isn’t as easy to track as other diseases because of how difficult it is to transmit. Unlike hepatitis A, which is passed through the fecal-oral route, HIV is bloodborne and not shared through casual contact.

Because of that, HIV doesn’t “spread” in a predictable fashion, but rather “pops up” independently. The epidemiological curve — the sloping up and down from a peak — therefore isn’t as easy to follow as hepatitis A or other viruses like influenza.

With that in mind, Kilkenny expressed caution in marking where Cabell County is on the cluster’s progression.

“We can’t tell where we are, and we can’t tell how far we need to go,” Kilkenny said. “So we’re just continuing to keep pushing ahead to make sure.”

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. Cabell County’s is currently the only active HIV cluster in West Virginia, though a new handful have cropped up along the Ohio River Valley in the wake of the nationwide opioid epidemic.

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.

The most potent tool available to contain the spread of HIV, Kilkenny said, is the department’s syringe exchange program.

The purpose of a syringe exchange is ideally to provide clean syringes to IV drug users to control the spread of bloodborne diseases through needle sharing. Cabell-Huntington’s syringe exchange has operated since 2015.

While the HIV cluster occurred well after the program was established, Kilkenny said providing clean syringes is now minimizing the spread.

“If we didn’t have a harm reduction program now, we would be building one,” he added.

But the program is not without public detraction, chiefly from those arguing that the free syringes it provides may find themselves littered in the public. Earlier this month, Cabell County Commissioner Kelli Sobonya requested an audit of the needle exchange program.

But data provided by the health department indicates the department still receives more syringes than it dispenses, a trend stretching back into 2018.

The department received back nearly twice as many syringes as it gave out between August and December 2018, according to department data. From January to March 2019, 30 percent more syringes were returned to the department than were given out.

“We’re happy to be accountable to our community, and we’re always ready to be responsive to their concerns,” Kilkenny said. “Right now, our focus is stopping the spread of HIV in our community, and that’s where our energy is directed.”

The request for an audit is currently under consideration by the state Department of Health and Human Resources.

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