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

Abstract

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). Dried Serum Spots (DSS) from about 60% of newly diagnosed German HIV cases in 2013-2018 were received together with statutory notification data. Samples were sequenced in the pol-region, genotyped and viral phylogenies analyzed. For selected samples the Hepatitis C Virus (HCV) status and the presence of NPS were determined. 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 in 2018. With exception of three 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 co-infection. In 8/18 (44%) cases α-pyrrolidinopentiothiophenone (α–PVT) and/or the related substance α-pyrrolidinoheptiophenone (PV8) was identified. 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 in order to rapidly identify outbreaks and target prevention measures.