London, Canada experienced an HIV outbreak among persons who inject drugs (PWID) despite widespread distribution of harm reduction equipment. Hydromorphone controlled-release (HMC) is the local opioid of choice. Injection drug preparation equipment (IDPE; i.e., cookers, filters) are often shared and reused due to the perception that there is residual HMC in the IDPE after use. The purpose of this study was to investigate the mechanisms of HIV transmission in this context.
Residual hydromorphone, (controlled-release or immediate-release), remaining in the IDPE, was measured with liquid chromatography–tandem mass spectrometry, in conditions replicating PWID use. HIV was added to IDPE in the presence HMC, hydromorphone immediate-release, or microcrystalline cellulose (an HMC drug excipient). HIV viral persistence was measured by reverse transcriptase activity and infectivity of indicator Tzm-bl cells.
45% of HMC remained in the IDPE following the first aspiration of solution, with no change after heating. HIV persistence and infectivity were preserved in the presence of HMC, and less so with microcrystalline cellulose. Heating the IDPE rapidly inactivated HIV.
Sharing of IDPE is a potential means of HIV transmission. HMC encourages IDPE sharing due to the residual drug in the IDPE, and the HMC excipients preserve HIV viability. Heating IDPE prior to aspiration of the opioid may be a harm reduction strategy.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
1Department of Medicine, Western University, B3 414, St. Joseph’s Health Care London, PO Box 5777, Stn B, London, Ontario, Canada N6A 4V2
2Department of Microbiology and Immunology, Western University, DSB, Room 3014, 1151 Richmond Street, London, Ontario, Canada N6A 5C1
3Department of Epidemiology and Biostatistics, Western University, Kresge Building, Room K201B, London, Ontario, Canada N6A 5C1
4Department of Family Medicine, The Western Centre for Public Health and Family Medicine, 1st floor, Schulich School of Medicine & Dentistry, Western University 1465 Richmond St., London, ON, Canada N6G 2M1
Corresponding author: Michael Silverman, MD, FACP, FRCP Division of Infectious Diseases Western University London, Ontario, Canada Michael.Silverman@sjhc.london.on.ca
The authors have no relevant conflicts of interest.
# contributed equally to the research
* co-corresponding authors