Researchers test new HIV transmission method among injecting drug users and effective prevention technique

LONDON, ON – New studies from the Lawson Health Research Institute and Western University have revealed for the first time that HIV can be transmitted by sharing equipment used to prepare drugs before injection and that a simple intervention – heating the equipment with a cigarette lighter for 10 seconds – can destroy the HIV virus, preventing its transmission. The results, used to inform a public health campaign called "Cook Your Wash," reduced HIV transmission rates in London, Ontario.

The two studies published in Journal of Acquired Immune Deficiency Syndrome (JAIDS) were launched in 2016 to address a public health emergency in London, Ontario, when HIV rates among injecting drug users have more than doubled.

"This outbreak occurred while London was benefiting from Canada's largest per capita sterile needle and syringe program, an opioid substitution treatment program, and an HIV clinic. multidisciplinary, "says Dr. Michael Silverman, Associate Scientist at Lawson and Chair / Head of Infectious Diseases at Schulich. School of Medicine & Dentistry, Western University, London Health Sciences Center and St. Joseph's London Health Care. "We knew that there had to be a new method of transmitting HIV at play."

Between August 2016 and June 2017, the research team interviewed 119 injecting drug users to understand their injecting behaviors and their risk of contracting HIV. They found that those who shared the material used to prepare the drugs for injection were 22 times more likely to contract HIV than those who did not share it, even though they did not share needles or syringes.

The equipment includes a metal "cooker" used to dissolve the drugs in water and a filter used to suck the mixture, called "wash" in the syringe. Injection drug users reported using the equipment again when they were using controlled release hydromorphone, one of the most commonly injected opioids.

"The controlled release hydromorphone is expensive and difficult to dissolve.After the first wash, there are still large amounts of medicine in the equipment that is then saved, shared or sold for future use," says the Dr. Sharon Koivu, Associate Scientist at Lawson. Associate Professor at Schulich Medicine & Dentistry. "Although people know that they do not share the needles, some use their own needle several times, which can contaminate the material."

The team reported his findings to the research laboratory. They confirmed that on average 45% of the drug remained in the equipment after the first wash. Not only did they confirm that the HIV virus could be transmitted between needles, stoves and filters, but they also discovered that controlled release hydromorphone had properties that promote virus survival.

"The slow release properties of the drug can unfortunately stabilize the HIV virus," says Eric Arts, PhD, director of the department of microbiology and immunology at Schulich Medicine & Dentistry. "For the first time, we were able to demonstrate that equipment sharing could lead to the type of HIV epidemic we have seen in the community."

The team discovered that when the stove is heated with a lighter for about 10 seconds or until the wash boils, the virus is destroyed. They called the technique "cook your laundry".

They also confirmed that the stove's heating had no impact on the drug concentration. "We had to make sure that cooking your laundry would not change the amount of medicine drawn into the syringe," says Dr. Silverman. "If too much drug was released, it could lead to an overdose.If a drug was burned or lost, the intervention would not be accepted by injecting drug users."

In partnership with local community organizations such as Middlebad-London Health Unit and Regional HIV / AIDS Connection, "Cook Your Wash" was launched as a public health campaign.

"The Cook Your Wash campaign is one of the most exciting things happening in our community," said Dr. Koivu. "We learned from injecting drug users that we learned in the lab to develop a solution, and that this solution was brought back to the community in record time."

Dr. Silverman adds that local rates of new HIV cases have dropped significantly after the launch of the campaign. "This was not the only reason for the reduction in HIV rates because other interventions had also been introduced, but the timing suggests that this was part of the solution."

Studies build on previous research showing that equipment sharing can lead to the transmission of hepatitis C and that controlled release hydromorphone can promote the survival of bacteria that can cause endocarditis, heart valve infection.

The team hopes that this research can be used to inform understanding and interventions in other centers facing HIV epidemics among injecting drug users. "We hope our results can be used to further reduce the incidence of HIV transmission and that one day society will be free of HIV," said Dr. Silverman.

###

The video of researchers discussing their work is available here: https: //youtu.be/VQK3SQFzxTQ.

MEDIA CONTACT: Robert DeLaet, Communications and External Relations, Lawson Health Research Institute, t. 519.685.8500 ext. 75664, c. 519.619.3872, [email protected]

As a research institute of the London Health Sciences Center and St. Joseph's Health Care London and in partnership with Western University, the Lawson Health Research Institute is committed to making advance scientific knowledge to advance health care around the world.

Western University offers an unrivaled academic experience. Since 1878, The Western Experience has combined academic excellence with opportunities for intellectual, social and cultural growth to better serve our communities. Our excellence in research expands knowledge and promotes discovery with concrete applications. Western attracts people with a broad worldview, who seek to study, influence and lead the international community.

The Schulich School of Medicine and Dentistry at Western University is one of the largest medical and dental schools in Canada. Founded in 1881, this school is one of the founding schools of Western University. It is known to be the cradle of family medicine in Canada. For more than 130 years, the school has demonstrated its commitment to academic excellence and its pbadion for scientific discovery.