Related Experiment Videos
Hepatitis B and hepatitis C in emergency department patients
G D Kelen1, G B Green, R H Purcell
1Division of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus type 1 (HIV-1) are highly prevalent in inner-city emergency departments. Routine HIV-1 screening alone misses many patients with HBV and HCV infections.
Area of Science:
- Infectious Diseases
- Public Health
- Epidemiology
Background:
- Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus type 1 (HIV-1) infections are common in inner-city populations.
- The frequency and interrelations of these viral infections are not well established in this demographic.
Purpose of the Study:
- To determine the prevalence and interrelations of HBV, HCV, and HIV-1 infections in an inner-city emergency department population.
- To evaluate the effectiveness of screening strategies for these viral infections.
Main Methods:
- Serum samples were collected from adult patients presenting to an inner-city emergency department over a six-week period.
- Samples were tested for hepatitis B surface antigen (HBsAg) and antibodies to HCV and HIV-1.
- Information on risk factors was collected for all patients.
Main Results:
- Of 2523 patients tested, 24% were infected with at least one virus: 5% for HBV, 18% for HCV, and 6% for HIV-1.
- HCV was highly prevalent in intravenous drug users (83%) and black men aged 35-44 (51%).
- Screening for HIV-1 alone would miss 87% of HBV and 80% of HCV infections.
Conclusions:
- HBV, HCV, and HIV-1 are highly prevalent in inner-city emergency room patients.
- Routine screening for HIV-1 alone is insufficient to identify the majority of patients with significant viral infections.
- Comprehensive screening is necessary to protect healthcare providers from potential exposure to HBV and HCV.
Background:
Infections with hepatitis B virus (HBV), hepatitis C virus (HCV), and the human immunodeficiency virus type 1 (HIV-1) are common in inner-city populations, but their frequency and interrelations are not well established.
Methods:
During a six-week period, excess serum samples were collected, along with information on risk factors, from all adult patients presenting to an inner-city emergency department. The samples were assayed for hepatitis B surface antigen (HBsAg) and antibodies to HCV and HIV-1.
Results:
Of the 2523 patients tested, 612 (24 percent) were infected with at least one of the three viruses. Five percent were seropositive for HBV, 18 percent for HCV, and 6 percent for HIV-1. HCV was found in 145 of the 175 intravenous drug users (83 percent), 36 of the 171 transfusion recipients (21 percent), and 5 of the 24 homosexual men (21 percent). Among black men 35 to 44 years of age, the seroprevalence of HCV was 51 percent. HBsAg was present in 9 percent of those whose only identifiable risk was possible heterosexual exposure. At least one viral marker was found in about 30 percent of the patients who were actively bleeding or in whom procedures were performed. Testing for HIV-1 alone would have failed to identify 87 percent of the patients infected with HBV and 80 percent of those infected with HCV.
Conclusions:
In a population of patients in an inner-city emergency room, HBV, HCV, and HIV-1 are all highly prevalent. However, routine screening for HIV-1 alone would identify only a small fraction of the patients who pose risks of severe viral infections, including HBV and HCV, to providers.