INDIANAPOLIS (AP) — State health officials say the largest HIV outbreak in Indiana history has now topped 180 cases.

The State Department of Health said Friday the southern Indiana outbreak has reached 181 cases, with 177 confirmed cases and four preliminary positives.

The outbreak had 175 cases in late July. The six new cases were reported during the past two weeks among individuals linked to people previously infected in the outbreak.

Nearly all of the cases have occurred in Scott County, about 30 miles north of Louisville, Kentucky. The outbreak has been largely driven by needle-sharing among people injecting a liquefied form of the painkiller Opana.

State health Commissioner Dr. Jerome Adams says that while every case of HIV that’s diagnosed is troubling “this disease isn’t the death sentence it once was.”