A Recent Human Immunodeficiency Virus Outbreak Among People Who Inject Drugs in Munich, Germany, Is Associated With Consumption of Synthetic Cathinones

Kirsten Hanke; Stefan Fiedler; Christina Grumann; Oliver Ratmann; Andrea Hauser; Patrycja Klink; Karolin Meixenberger; Britta Altmann; Ruth Zimmermann; Ulrich Marcus; Viviane Bremer; Volker Auwärter; Norbert Bannert

doi:10.1093/ofid/ofaa192

A Recent Human Immunodeficiency Virus Outbreak Among People Who Inject Drugs in Munich, Germany, Is Associated With Consumption of Synthetic Cathinones

Open Forum Infect Dis. 2020 May 27;7(6):ofaa192. doi: 10.1093/ofid/ofaa192. eCollection 2020 Jun.

Authors

Affiliations

¹ Division of HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany.
² Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
³ Hermann Staudinger Graduate School, University of Freiburg, Freiburg, Germany.
⁴ Department of Mathematics, Imperial College London, London, United Kingdom.
⁵ Division of HIV/AIDS, STI, and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.
⁶ Institute of Virology, Charité Universitätsmedizin Berlin, Berlin, Germany.

Abstract

Background: Needle and syringe sharing among people who inject drugs (PWID) can result in a rapid regional spread of a human immunodeficiency virus (HIV) variant. Such outbreaks have been identified recently in several countries and have raised public health attention because of an association with new psychoactive substances (NPS).

Methods: Dried serum spots from approximately 60% of newly diagnosed HIV cases in Germany in 2013-2018 were received together with statutory notification data. Samples were sequenced in the pol-region, genotyped, and viral phylogenies were analyzed. For selected samples, the hepatitis C virus (HCV) status and the presence of NPS were determined.

Results: An outbreak of closely related 27 subtype C infections with a core of 11 cases with almost identical sequences was identified using phylogenetic analyses. The first case of the outbreak was diagnosed in 2015, and the last one was in 2018. With exception of 3 infections, all were reported from Munich, the capital of the federal state of Bavaria. Of 26 analyzed outbreak members, 24 (92.3%) had a resolved or viremic HCV coinfection. In 8 of 18 (44%) cases, α-pyrrolidinopentiothiophenone and/or the related substance α-pyrrolidinoheptiophenone was identified.

Conclusions: Despite harm reduction services in place, HIV outbreaks of considerable size can occur in PWID. The establishment of a real-time molecular surveillance is advised to rapidly identify outbreaks and target prevention measures.

Keywords: HIV-1 outbreak; dried serum spots; new psychoactive substances; people who inject drugs; synthetic cathinones.