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Sentinel surveillance of HIV and hepatitis C virus in two urban emergency departments

Published online by Cambridge University Press:  21 May 2015

Stan Houston ,
Brian H. Rowe ,
Laura Mashinter ,
Jutta Preiksaitis ,
Mark Joffe ,
Duncan Mackey ,
John Galbraith  and
Natasha Wiebe
Stan Houston*
Affiliation:
Division of Infectious Diseases, Capital Health; and Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
Brian H. Rowe
Affiliation:
Division of Emergency Medicine, Capital Health; and Faculty of Medicine and Dentistry, University of Alberta
Laura Mashinter
Affiliation:
Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta
Jutta Preiksaitis
Affiliation:
Public Health Laboratory for Northern Alberta, Alberta Health and Wellness, Edmonton, Alta
Mark Joffe
Affiliation:
Division of Infectious Diseases, Capital Health; and Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
Duncan Mackey
Affiliation:
Division of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta; and Lethbridge Regional Hospital, Lethbridge, Alta
John Galbraith
Affiliation:
Dynacare Kasper Medical Laboratories, Edmonton, Alta
Natasha Wiebe
Affiliation:
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta
*
Division of Emergency Medicine, University of Alberta, Rm. 1G1.43 WMC, 8440–112 St., Edmonton AB T6G 2B7; 780 407–6707, fax 780 407–3982, [email protected]

Abstract

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Objectives:

This study was designed to determine the prevalence of HIV and hepatitis C virus (HCV) in a specific population, and to distinguish between known and previously unrecognized infections in the emergency department (ED) setting.

Methods:

Consecutive patients aged 15 to 54 years who had presented to the EDs of 2 urban hospitals during a 6-week period were enrolled in a prospective cross-sectional study if a complete blood count had been obtained as part of their care. The study patients were initially cross-referenced against local databases of known HIV and HCV seropositive patients. After removal of all personal identifiers, the study patients’ leftover blood was serotested for HIV and HCV, and seroprevalences were calculated. Univariate and multivariate analyses were performed to identify factors associated with HIV and HCV infection.

Results:

Of 3057 individuals whose files were analyzed, 1457 (48%) were male and 7% (213) were Aboriginal. Overall, 302 patients (10%; 95% confidence interval [CI], 9%–11%) were seropositive for HCV and, of these, only 132 (44%) were previously known to be. HCV seropositivity was associated with Aboriginal status, age, male gender, hospital site and HIV infection (all p < 0.001). In contrast, 39 patients (1%; 95% CI, 1%–2%) were HIV seropositive. Of these, 32 (82%) were previously known to be HIV positive, and 27 (69%) were HCV seropositive. HIV seropositivity was only associated with HCV infection (p < 0.001).

Conclusions:

The rate of previously undetected infections was relatively low for HIV but high for HCV. Emergency physicians in urban settings will frequently encounter patients not known to be HCV positive and not identified as such. These results emphasize the need for more effective preventive measures in the community and the importance of observing standard (universal) precautions in ED practice.

Keywords

seroprevalenceHIVhepatitis Cemergency departmentsurveillance
Type
EM Advances • Innovations En MU
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 2 , March 2004 , pp. 89 - 96
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

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