HUMAN IMMUNODEFICIENCY VIRUS (HIV) AND ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)

Outbreak of Human Immunodeficiency Virus (HIV) Linked to Injection Drug Use

Since January 2018, the West Virginia Bureau for Public Health (WV BPH) has been monitoring increased diagnoses of HIV across the state, especially among people who inject drugs (PWID). In 2019, Cabell County was the epi center for a large HIV cluster, however, since then, HIV cases have been increasing in other areas of the state (for more information, please see Health Advisory 162: HIV Infections Among People Who Inject Drugs – Additional Area Seeing Increase, Others Vulnerable). Currently, this increase is most significant in Kanawha County.

PWID are often a mobile population and seek services within multiple counties, however, persons newly diagnosed with HIV are reported according to their county of residence at the time of HIV diagnosis.

Statewide HIV case counts will be updated bi-monthly. This will include HIV cases in all WV counties, however, data will be suppressed for counties with 1-4 diagnoses of HIV.

Clusters of Human Immunodeficiency Virus (HIV) Linked to Persons Who Inject Drugs (PWID)

The West Virginia Bureau for Public Health (WVBPH) has been monitoring a rise in HIV diagnoses statewide since 2018, particularly among PWID. While Cabell County had a significant outbreak in 2019, cases are now increasing elsewhere. For more information, see Health Advisory 162: HIV Infections Among People Who Inject Drugs - Aditional Area Seeing Increase, Others Vulnerable.

It's important to note that while PWID often seek services across county lines, new diagnoses are recorded based on the individual's county of residence at the time of diagnosis.

Cabell County HIV Cluster

In January 2019, the WVBPH noticed a spike in new HIV cases among PWID in Cabell County. The WVBPH worked with the Cabell-Huntington Health Department (CHHD) to request assistance from the Centers for Disease Control and Prevention (CDC) in April 2019. The CDC provided surge capacity and support for the public health investigation and response through their Epi-Aid program. Although the CDC Epi-Aid concluded in September 2019, the WVBPH, CHHD, and community partners continue collaborating on the response.

Response to a Large HIV Outbreak, Cabell County, West Virginia, 2018-2019

Notes from the Field: Outbreak of Human Immunodeficiency Virus Infection Among Persons Who Inject Drugs - Cabell County, West Virginia, 2018-2019 | MMWR

Kanawha County HIV Cluster

In January 2021, WVBPH surveillance Staff identified a surge in new HIV diagnoses among PWID in Kanawha County. In response to this outbreak, WVBPH and the Kanawha Charleston Health Department (KCHD) jointly requested CDC Epi-Aid support in April 2021. The CDC Epi-Aid investigation concluded in August 2021, but WVBPH, KCHD, and community partners remain committed to collaborative response efforts.

Notes from the Field: HIV Outbreak During the COVID-19 Pandemic Among Persons Who Inject Drugs - Kanawha County, West Virginia, 2019-2021 | MMWR

Epi-Aid

• CDC Preliminary Findings and Recommendations
• CDC Preliminary Epi-Aid Report
• CDC West Virginia Epi-Aid Closeout Meeting:Preliminary Findings

HIV Taskforce

• August 16, 2022 Kanawha HIV Taskforce Meeting
• June 14, 2022 Kanawha HIV Taskforce Meeting
• April 12, 2022 Kanawha HIV Taskforce Meeting
• February 08, 2022 Kanawha HIV Taskforce Meeting
• January 11, 2022 Kanawha HIV Taskforce Meeting
• December 14, 2021 Kanawha HIV Taskforce Meeting
• October 19, 2021 Kanawha HIV Taskforce Meeting
• September 14, 2021 Kanawha HIV Taskforce Meeting

Monongalia County HIV Cluster

Since May 2023, there has been an increase in new HIV diagnoses among men who have sex with men in Monongalia County. WVBPH, the Monongalia County Health Department, and community partners are actively responding to thise outbreak.

Community

• About HIV/AIDS
• Transmission
• Prevention
• HIV & Injection Drug Use
• Testing
• Living with HIV
• Resources
• STD and HIV Resources Directory

Healthcare Professionals

The inclusion of links to sites not produced by one of the listed agencies does not mean the content of these sites has been reviewed, approved, or validated by the agencies. The links are provided as a convenience for users of this site who must use their own judgment concerning the information contained on the linked sites.

• Federal Partners and Resources

  • Centers for Disease Control and Prevention (CDC) HIV
  • CDC National Center for HIV, Viral Hepatitis, STD, and TB Prevention
  • National Institute of Allergy and Infectious Diseases Division of AIDS
  • Johns Hopkins HIV Guide

• Screening for HIV

  • Screening for HIV | Clinicians
  • Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings
  • Recommendation: Human Immunodeficiency Virus (HIV) Infection: Screening | United States Preventive Services Taskforce
  • Screening for HIV in Health Care Settings: A Guidance Statement From the American College of Physicians and HIV Medicine Association
  • CDC HIV Testing Algorithm and HIV Lab Interpretation

• Perinatal HIV

  • Maternal HIV Testing and Identification of Perinatal HIV Exposure | NIH
  • Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection
  • Pregnant People | HIV by Group
  • Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States
  • WV HAN 217: Perinatal HIV Case in WV
  • Perinatal HIV Consultation and Referral Services (Perinatal HIV Hotline): 888-HIV-8765

• HIV Self-Testing

  • Self Testing | CDC

• HIV Stigma

  • Standing Up To HIV Stigma
  • Ways to Stop HIV Stigma and Discrimination | CDC
  • HIV Stigma and Discrimination Persist, Even in Health Care | Journal of Ethics | American Medical Association

• HIV Treatment

  • Clinical Info HIV
  • HIV Treatment and Care | Clinicians
  • Recommendations for HIV prevention with adults and adolescents with HIV in the United States, 2014
  • Evidence of HIV Treatment and Viral Suppression in Preventing the Sexual Transmission of HIV Transmission | CDC
  • Adult and Adolescent ARV - What's New in the Guidelines

• PrEP

  • PrEP | HIV Basics | HIV/AIDS | CDC
  • Preexposure Prophylaxis for the Prevention of HIV Infection in the United States – 2021 Update
  • Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV—United States, 2016
  • National Clinician Consultation Center: (855) HIV-PrEP

• HIV and Persons who Inject Drugs

  • HIV Among People Who Inject Drugs | CDC
  • WV HAN 158: Recommendations for Routine HIV Testing and Available Resources

• Education and Training Opporunities

  • MidAtlantic AIDS Education and Training Center
  • WV Academic Mentoring Partnership
  • WV HIV Academic Mentoring Partnership
  • Free Continuing Education Opportunities | Clinicians | HIV | CDC

HIV/AIDS Reporting

Diagnoses, laboratory reports, initial care events, and perinatal exposure of HIV infection and AIDS are reportable conditions in accordance with the Bureau for Public Health’s rule, Reportable Diseases, Events, and Conditions 64CSR7 and pursuant to WV Legislative Rule 64 CSR 64.

Reporting Forms

• Adult HIV/AIDS Confidential Case Report Form: Static | Fillable
• Pediatric HIV/AIDS Confidential Case Report Form: Static | Fillable
• Laboratory Reporting of Positive Tests for Human Immunodeficiency Virus (HIV) Static | Fillable
• Laboratory Reporting of Positive Tests for Human Immunodeficiency Virus (HIV) Example
• HIV Test Form (Updated 2019)
• HIV Testing Manual/Instructions

HIV Reporting Fact Sheets

• HIV Reporting for Providers and Healthcare Facilities Fact Sheet
• HIV Reporting for Recovery and Behavioral Health Facilities Fact Sheet

What is Reportable?

All diagnostic and prognostic test results are reportable for HIV-positive persons.

• New diagnoses of HIV infection.
• Persons new to a provider/facility.
• Any and all CD4+ T-lymphocyte counts and percentages, and viral load test results.
• Perinatal exposures of HIV (child born to HIV-infected mother).

Who is Responsible for Reporting

• Healthcare Providers/Facilities:
  • New diagnoses of HIV infection: All positive/reactive diagnostic test results for persons newly diagnosed with HIV are to be reported accompanied by an Adult Case Report Form (for persons at least 13 years old). The Pediatric Case Report Form should be used for persons less than 13 years old.
  • Patients new to a facility/provider: An Adult Case Report Form (for persons at least 13 years old) should be completed for any person being seen by a provider/facility for the first time, regardless of when or where the person was initially diagnosed with HIV (i.e., in another state, or at a different facility). The Pediatric Case Report Form should be used for persons less than 13 years old.
  • Subsequent follow-up test results of persons living with HIV: Any and all lab results for HIV tests (e.g., CD4 counts and percentages and viral loads) performed on HIV-positive persons to monitor the progression of HIV disease or efficacy of HIV treatment.
    • Subsequent follow-up test results may be reported by the performing laboratory, provided the provider/facility has ensured the performing laboratory is reporting results and case report forms are completed and reported by the provider/f​acility for persons newly diagnosed with HIV and any person initiating care with the provider/facility, regardless of when or where the person was initially diagnosed with HIV.
  • Perinatal exposures: Every instance of perinatal exposure and ​any and all subsequent test results on the exposed child until either HIV infection or negative serostatus is confirmed, must be submitted using the Pediatric Case Report Form .
• CDC-Funded Organizations: Health Departments (HDs) and Community-Based Organizations (CBOs) funded by the Centers for Disease Control and Prevention (CDC) to provide HIV counseling, testing, and referral (CTR) services are required to collect data about ​HIV prevention activities. ALL HIV test results, including negative/non-reactive test results, must be submitted using the HIV Test Form .
  • HIV Test Form Completion: HIV Test Forms must be completed entirely. Do not leave fields blank or unanswered. Please do not mark “Declined to Answer”. If unsure of the correct response, mark “Unknown/Client does not know/I don’t know.”​
    
• Laboratories:
  • The initial positive/reactive HIV antibody (e.g., HIV-1/2 EIA) and/or combination HIV antibody/antigen test result (e.g., HIV-1/2 Ag/Ab Combo) and the corresponding supplemental test results used as part of a multi-test algorithm to verify HIV infection, unless the overall final result interpretation of the multitest diagnostic algorithm resolves to negative/nonreactive;
  • A positive/reactive result on an HIV antigen test (e.g., HIV-1 p24 antigen);
  • A positive/reactive qualitative HIV nucleic acid amplification test (NAAT or NAT) (e.g., HIV-1 RNA or DNA, HIV-2 RNA or DNA, HIV polymerase chain reaction [PCR]);
  • A quantitative HIV nucleic acid amplification test (i.e., viral load), including resulting copies/ML and log values for both detectable and undetectable results;
  • A nucleotide sequence from an HIV genotype test;
  • CD4+ T-lymphocyte counts and percentages of all values unless the patient is not known to have HIV infection.

Laboratories are encouraged to report electronically. More information can be found here . Please note that even if laboratories report electronically, the provider/facility must complete and report the case report form for individuals newly diagnosed with HIV and any individuals new to a provider/facility, regardless of when or where the person was initially diagnosed with HIV.

Supervisors of all laboratories in West Virginia that perform serologic or other tests for or related to HIV/AIDS shall make a report on the first and fifteenth days of each month of all laboratory tests that are indicative of HIV infection using the Laboratory Reporting of Positive Tests for Human Immunodeficiency Virus (HIV) form (also known as the "purple form").

Reporting Time Frames:

• Health care providers (e.g. physicians, in- and outpatient facilities, medical clinics, community-based organizations): are to report no later than 7 days from the date of diagnosis or specimen collection date, whichever is later.
• For instances of perinatal exposure to HIV, reports are to be made no later than 7 days from the date of the infant’s birth.
• HIV Test Forms should be completed and reported within 7 days from the test date for all positive results, and within 30 days from the test date for negative results.
• Laboratory supervisory report ("purple form") is due monthly on the 1st and 15th days of the following month.

How Do I Report?

• To report by confidential fax line:
  HIV (secure): (304) 957-7753
  STD: (304) 558-6478
  Hepatitis: (304) 558-6478
  ​
  
• To report by mail, please place report forms (available above) inside a sealed envelope marked "confidential" and address to:
  Office of Epidemiology and Prevention Services
  Attn: DSHHT Surveillance
  350 Capitol Street, Room 125
  Charleston, WV 25301

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CLICK HERE to see all new HIV diagnoses by county

HIV and Hepatitis C Elimination Plan

• 2022-2026 WV HIV & Hepatitis C Elimination Plan

HIV Epidemiologic Profile

• 2017
• 2008

HIV Surveillance Summary

• 2017
• 2016
• 2015
• 2014
• 2013
• 2011
• 2009

Fact Sheets

• HIV Among Persons Who Inject Drugs, 2018-2022

Vulnerability Studies

• County-Level Vulnerability Assessment for Rapid Dissemination of HIV or HCV Infections among Persons who Inject Drugs, United States
• West Virginia County-Level Vulnerability to Rapid Transmission of HIV and Hepatitis C
• West Virginia County-Level Vulnerability to Overdose Deaths