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January 14, 2019

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  • Be aware that the number of HIV infections diagnosed among heterosexuals who inject drugs in King County, WA has dramatically increased over the last year. This increase has been particularly pronounced among persons who inject drugs and who are living homeless.

  • Emergency departments and other medical providers should ask all patients if they have injected drugs in the last year and should perform HIV tests on all patients who report injection drug use if they have not tested in the prior 6 months.

  • Providers should also perform HIV tests on persons who inject drugs (PWID) who present with symptoms or signs consistent with acute HIV (e.g. fever, fatigue, pharyngitis, diarrhea), a sexually transmitted infection (STI) or STI syndrome or any illness associated with immunosuppression (e.g. zoster, pneumonia, thrush or wasting).

  • Providers should recommend that patients who exchange sex, particularly those who are living homeless and/or inject drugs, initiate HIV pre-exposure prophylaxis (PrEP). Patients can access PrEP at the PHSKC STD Clinic at Harborview Medical Center and from other medical providers listed on the Public Health website: www.kingcounty.gov/prep

The HIV epidemic in King County, WA has traditionally been highly concentrated in men who have sex with men (MSM). However, between 2017 and 2018, the number of new HIV diagnoses among heterosexuals who inject drugs increased over 300%, from 7 cases in 2017 to 30 cases in 2018. Seventy percent of newly diagnosed PWID were living homeless, half were women and, among the women, two-thirds had exchanged sex for money, drugs or other things of value.

Although this increase was originally identified as an outbreak among PWID living in north Seattle, fewer than half of the 30 cases identified among PWID in 2018 are clearly associated with this geographically defined outbreak. Thus, recommendations to test PWID for HIV apply to all of King County.

Since 2006, CDC has recommended HIV testing be a part of routine clinical care in all health-care settings including hospital EDs. Laboratories in Washington State are legally required to report all positive HIV test results to Public Health – Seattle & King County (PHSKC), and health department staff follow-up on all persons with newly diagnosed HIV infection to assure their linkage to HIV medical care. This system is very effective and will ensure that persons testing HIV positive in emergency rooms receive their results and are linked to care. No one in King County goes without HIV medical care because of lack of insurance or inability to pay for medical care.