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Health officials say needle exchange can help stop the surge of HIV cases in Northern Kentucky and Cincinnati. Terry DeMio

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EDGEWOOD, Ky. — The number of HIV cases linked to injection-drug use in Northern Kentucky and Southwest Ohio increased dramatically last year, according to public health officials.

Now the federal Centers for Disease Control and Prevention is assisting with genetic testing to determine if the cases are connected.

"The realization hit the treatment field over four years ago that we stood on a threshold of an epidemic within an epidemic: HIV, as a consequence of our opioid epidemic," said Dr. Mina "Mike" Kalfas of Fort Wright, Ky., an addiction expert who treats more than 200 heroin-addicted patients in Northern Kentucky.

HIV outbreaks tied to injected drugs have occurred in recent years in places as disparate as Boston and rural Indiana.

► Nov. 8: More than overdoses, IV opioid users' diseases overwhelm hospitals
► Oct. 26: Trump orders public health emergency for opioids
► Oct. 26: What Trump's opioid emergency declaration does — and doesn't — do

HIV can be treated but not cured with expensive drugs, which can prevent retransmission of the virus in many patients. But if left untreated, people with the HIV virus develop AIDS, resulting in a range of opportunistic infections and death.

The Northern Kentucky Health Department in this Cincinnati suburb saw 18 cases of HIV-positive people in 2017 who identified injection drug use as a risk factor. The preliminary total is three times the number of such cases from 2009 to 2016 when zero to five cases were reported each year.

Cincinnati residents reported 40% higher rates of HIV than 2016, said Sharon Hutchins, supervising epidemiologist for the city health department's communicable disease unit. Cases linked to injection-drug use increased nearly 250% from 2016 to last year.

Those who inject drugs are at risk of contracting HIV because the virus can stay on a used needle or other injection equipment, and people with addiction often share that equipment.

Anyone who works in public safety and emergency health care is also at risk if they work with people who inject drugs. Paramedics in Greater Cincinnati and Northern Kentucky have treated many overdosed people with a needle still in their arm or near their body, and hospital caregivers have found needles buried in the clothing of those who have overdosed and are brought to hospitals.

"What's so frustrating is that Northern Kentucky had the opportunity to get in front of this," said Daniel Raymond, policy director for the National Harm Reduction Coalition in New York City who helped Northern Kentucky officials when they began efforts to attack the heroin epidemic.

Elected officials in Northern Kentucky's largest counties — Boone, Campbell and Kenton — have resisted needle-exchange operations.

► July 2016: Indiana's HIV outbreak was avoidable, study says
► April 2016: 190 people in this Indiana town were diagnosed with HIV

Farther south, Grant County, Ky., has one syringe exchange in the county health department's Williamstown office. Private grant money pays for the program.

Cincinnati and Hamilton County in Ohio have approved public money for needle-exchange programs for this year, a first in their history. They did so because of an upswing in hepatitis C, which also is raging in Northern Kentucky, and concerns about other communicable diseases such as HIV.

Last year, the CDC warned that 54 Kentucky counties and 11 in Ohio were under threat of HIV outbreaks because of high hepatitis C rates.

► October 2015: Needle-sharing dropped among addicts using Indiana exchange
► September 2015: Needle-exchange policy prevented HIV

Rural Scott County in Indiana was the crucial red flag that spurred disease experts to do the analysis. That county experienced a quick and vicious HIV outbreak in 2014 and 2015.

More than 188 IV drug users were infected. About 90% also tested positive for hepatitis C.

Infectious disease specialists learned that those afflicted were intravenous opioid drug users with the prescription painkiller Opana as their main choice to crush and inject.

► May 2015: Indiana HIV outbreak may be peaking, officials say
► March 2015: Indiana OKs clean needle exchange amid HIV outbreak

Kalfas, who has seen more HIV cases in the past year, called the spike in cases "the sum of my fears."

"But it's not as bad as it can get," he said. "There's still prevention to be done."

Prevention hinges on public health officials' quick action, Raymond said.

"This has got to be an alarm signal for those communities that there's no time to waste," he said.

Follow Terry DeMio on Twitter: @tdemio

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