Seroprevalence of parenterally transmitted viruses (HIV-1, HBV, HCV, and HTLV-I/II) in forensic autopsy cases

HIV, HBV, HCV, and HTLV show similar modes of transmission and infection is frequently identified in certain population groups. The seroprevalence of these infectious agents and interrelation in forensic autopsy populations are described here. A total of 414 serum samples were collected sequentially from autopsy cases at the Office of the Chief Medical Examiner for the State of Maryland. All samples were tested for the presence of antibodies to HIV-1, HCV, HTLV-I/II, and hepatitis B core antigen, using Enzyme-linked Immunosorbent Assays (ELISA). Samples yielding repeatedly reactive results were confirmed by Western Blots (WB) for HIV-1 and HTLV-I/II, while for HCV confirmation, the second generation recombinant immunoblot (RIBA-2) was used. Of the 414 cases, 32.6% (135/414) were infected with at least one of the four viruses. 5.6% were seropositive for HIV-1, 23.2% for HBV, 19.1% for HCV, and 1.0% for HTLV-I/II. Intravenous drug users (IVDU) showed significant increased prevalences of HIV-1, HBV, and HCV. 83.6% of the IVDU were infected with at least one of the three viruses, 25.5% with HIV-1, and 47.3% with both HBV and HCV. The data indicate that the overall prevalence of HIV, HBV, and HCV seropositivity in the autopsy population of an inner city medical examiner office is much higher than that of the general population. Routine testing only for HIV-1 would have missed 86% of the infections with HCV or HBV. Universal precautions should be strictly employed by all personnel working in this environment.