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HIV in Indiana Called Public Health Crisis

INDIANAPOLIS (CN) - Indiana Gov. Mike Pence on Thursday declared a public health emergency in Scott County, saying a recent outbreak of HIV has reached "epidemic proportions."

The Indiana State Department of Health has confirmed 70 new cases originating in the southern Indiana county, which typically sees around five new HIV-related cases annually.

Pence said the outbreak stems from needle injection drug abuse, and is likely related to use of the prescription painkiller Opana. He said Indiana will support a short-term needle exchange program lasting 30 days to quell the spread of the disease.

Pence said he refuses to support needle exchange programs in general, but has temporarily reconsidered in the case of Scott County, as "this is a public health emergency" that affects the whole state.

"Scott County is facing an epidemic of HIV, but this is not a Scott County problem; this is an Indiana problem," Pence said.

The state health department will set up an incident command center for HIV and substance abuse treatment in the county.

"The people of Scott County are working hard to address this crisis, and with additional state resources and new tools provided by this emergency declaration, I am confident that together we will stop this HIV outbreak in its tracks, Pence said.

The health department first identified the outbreak at the end of January and has worked to contain it while continuing to treat those infected. On March 23 a medical team from the Centers for Disease Control arrived in the county this month to help identify people who may have come into contract with those infected. More CDC workers are expected next week.

Over time, HIV, also known as the human immunodeficiency virus, can destroy so many of an infected person's white blood cells that their bodies can no longer fight disease or infections. AIDS is the final stage of HIV infection, but not everyone who has HIV advances to this stage.

With a population of around 24,000, a slow economy and comparatively high unemployment and high school drop out rates, Scott County has struggled drug addiction for years.

In addition to its immediate response, the state health department is launching "You Are Not Alone," a public awareness campaign targeting Scott County residents that focuses on drug treatment, infection prevention, safe sex, needle disposal and HIV testing and treatment to combat the region's drug addiction problem.

Governor Pence's declaration of a public health emergency in Scott County comes as the National Institute of Health released findings that show HIV can genetically evolve and independently replicate in patients' brains early in the illness process.

During the study, researchers funded by Division of AIDS Research of the NIH's National Institute of Mental Health analyzed cerebral spinal fluid and found that for a subset of HIV patients, the virus started replicating within the brain within the first months of infection. They also found that about 30 percent of their study subjects showed early signs of inflammation, suggesting that viral replication occurs within two years of infection.

Prior to the study, it was known that HIV readily penetrates the brain and can trigger neurological problems and eventually cause dementia over the course of the infection. Yet there was little evidence about how quickly it can take hold and thrive there. Nor was it clear to what extent the brain serves as a hard-to-reach hideout from which the virus might re-infect the body - even if it is eliminated from peripheral blood and lymph node tissue by treatment.

The evidence suggests that in most patients peripheral forms of the virus infect immune cells that spread to the brain via blood. Yet in some patients, genetic versions of the virus not found in blood evolve in the brain environment. So it could become an independent, compartmentalized viral reservoir, capable of generating treatment-resistant mutant forms that could break out and re-infect the rest of the body after seemingly successful treatment, the researchers said.

Whether the potential brain damage caused by early HIV replication and inflammation might be reversible with antiviral therapy awaits further research, the NIH said.

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