An outbreak of HIV infections in Indiana has been linked to injection drug use of extended-release oxymorphone within a network of people who inject drugs, according to a study published in the New England Journal of Medicine.

In response to the outbreak, Indiana declared a public health emergency and established its first syringe-service program.

The study, led by Philip J. Peters, MD, DTM&H, a medical officer in the division of HIV/AIDS prevention for the CDC, included laboratory-confirmed HIV infections diagnosed after October 1, 2014, in people who either lived in Scott County, Indiana, or were a syringe-sharing or sexual partner of a case patient.

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From November 18, 2014, to November 1, 2015, 181 case patients living in Scott County were diagnosed with HIV infection. The majority of these patients (87.8%) reported injecting extended-release oxymorphone. Hepatitis C coinfections were present in 92.3% of patients. From the 159 patients with an HIV type 1 pol gene sequence, 157 (98.7%) had highly related sequences, determined by phylogenetic analyses.

The researchers investigated 536 people who were identified as contacts of case patients, locating and testing 468 of these contacts for HIV. Each time a contact was named as a syringe-sharing partner by a case patient, the risk of HIV infection significantly increased (adjust risk ratio, 1.9).


  1. Peters PJ, Pontones P, Hoover KW, et al. HIV infection linked to injection use of oxymorphone in Indiana, 2014-2015. N Engl J Med. 2016; 375:229-239.