HUNTINGTON - Cabell County's ongoing HIV cluster, still the only one known in West Virginia, continues to grow at a consistent pace with now 73 confirmed cases, according to the West Virginia Department of Health and Human Resources.
The total crept, slowly but steadily, by an average two additional new cases each week over the past 10 weeks. This indicates a marginal rise in the frequency cases are now being diagnosed. In the prior nine weeks (April 28 through June 21), Cabell County averaged one new case each week.
One death, in June, has been associated with the Cabell County cluster, DHHR confirmed.
The sharp spike in HIV cases, in a region not accustomed to it, has triggered a "complex, multiagency response" jointly by the Cabell-Huntington Health Department, the West Virginia Bureau for Public Health and the Centers for Disease Control and Prevention, said Dr. Michael Kilkenny, CHHD physician director, in an interview Wednesday morning.
Plans have been pieced together since the cluster was first tracked in January 2018, and have become over the past six months more ardent with the addition of state and federal expertise.
Locally, the health department's prime objective is to curtail the spread of HIV in Cabell County, Kilkenny said. That has called for greatly expanding its HIV testing capacity to points in the community where those at risk frequent, keeping a physical outreach at areas were those at risk gather, promoting the use of pre-exposure and post-exposure prophylaxes (prescriptions that drive down an infected person's viral load), and bolstering the community's capacity to treat substance use disorder.
According to Kilkenny, the most effective tool to stop the spread of HIV is the department's harm reduction program, which includes its syringe exchange program.
"Nobody wants intravenous drug use in our community, but we cannot pretend it doesn't happen in our community," Kilkenny said. "We can't wave a magic wand and make it go away; we need to refer people to appropriate treatment and get it taken care of."
An early and effective harm reduction program could have prevented nearly all the damage caused by an HIV outbreak in Scott County, Indiana, between 2011 and 2015, which cost the state roughly $100 million to abate and treat, according to a study published last year by Yale School of Public Health. The county did not begin a public health response until 2015, as the virus was already on the decline. Had the county acted during the peak in 2013, the study estimates the outbreak would have been limited to 56 cases or fewer.
Kilkenny has said that if Cabell County did not already have a harm reduction program, they would be creating one right now.
"Whether you like harm reduction or whether you don't, no community can stop the transmission without a vital harm reduction program," Kilkenny said. "We've done so much work already, but we can't rest and we can't be derailed if we're going to stop this."
While the Cabell County cluster is currently contained to IV drug users and is predominantly spread through sharing dirty needles, officials are concerned the disease could spread to non-drug users through unprotected sex, Kilkenny said. Like clean syringes, condoms are cheap and effective physical components to stopping the spread of HIV.
In response to the current cluster, more Huntington area medical providers are stocking and prescribing pre-exposure and post-exposure prophylaxes for those at risk, Kilkenny said.
Pre-exposure prophylaxis is taken by those who have not contracted the disease but are at risk for it, such as those whose sexual partners have HIV or regular IV drug users. Post-exposure prophylaxis is taken by those who already have HIV to drive down their viral load to levels low enough to not transmit the disease.
Both are oral prescription regiments taken daily. For sexual contact, the pill is 99% effective in stopping transmission. For intravenous drug use, the pill is an estimated 92% effective.
DHHR posts weekly updates on Cabell County's HIV totals each Monday at oeps.wv.gov/hiv-aids.