OBJECTIVES: Hepatitis C virus (HCV) and HIV transmission in the United States may increase as a result of increasing rates of opioid use disorder (OUD) and associated injection drug use (IDU). Epidemiologic trends among American Indian/Alaska Native (AI/AN) persons are not well known. METHODS: We analyzed 2010-2014 Indian Health Service data on health care encounters to assess regional and temporal trends in IDU indicators among adults aged >/=18 years. IDU indicators included acute or chronic HCV infection (only among adults aged 18-35 years), arm cellulitis and abscess, OUD, and opioid-related overdose. We calculated rates per 10 000 AI/AN adults for each IDU indicator overall and stratified by sex, age group, and region and evaluated rate ratios and trends by using Poisson regression analysis. RESULTS: Rates of HCV infection among adults aged 18-35 increased 9.4% per year, and rates of OUD among all adults increased 13.3% per year from 2010 to 2014. The rate of HCV infection among young women was approximately 1.3 times that among young men. Rates of opioid-related overdose among adults aged <50 years were approximately 1.4 times the rates among adults aged >/=50 years. Among young adults with HCV infection, 25.6% had concurrent OUD. Among all adults with arm cellulitis and abscess, 5.6% had concurrent OUD. CONCLUSIONS: Rates of HCV infection and OUD increased significantly in the AI/AN population. Strengthened public health efforts could ensure that AI/AN communities can address increasing needs for culturally appropriate interventions, including comprehensive syringe services programs, medication-assisted treatment, and opioid-related overdose prevention and can meet the growing need for treatment of HCV infection.

OBJECTIVES: To describe trends in HIV diagnoses and prevalence among persons who inject drugs (PWID), and trend variations by jurisdiction. METHODS: We used National HIV Surveillance System data to estimate the number of HIV diagnoses made during 2008 through 2013, and measured trends by estimated annual percent change; and persons living with diagnosed HIV infection at year-end 2008 to 2012, and measured trends in prevalence by the 2012-2008 arithmetic difference. RESULTS: During 2008 through 2013, the number of HIV diagnoses was stable among all persons (< 2% per year), and decreased among PWID (> 10% per year) overall and in 10 jurisdictions. The Black-to-White PWID diagnosis ratio was 2 to 1. During 2008 through 2012, the number of persons living with diagnosed HIV infection increased overall, was stable among PWID, and decreased in 14 jurisdictions. CONCLUSIONS: Had the rate of decrease in diagnoses of HIV infection among PWID equaled that of all persons, an additional 1500 diagnoses would have occurred between 2008 and 2013. Prevalence was stable among PWID, and increased overall among all persons living with HIV infection. Pronounced racial inequities persist, particularly for Blacks, and appear to be diminishing. (Am J Public Health. Published online ahead of print September 15, 2016: e1-e8. doi:10.2105/AJPH.2016.303380).