Parallel declines in HIV and hepatitis C virus prevalence, but not in herpes simplex virus type 2 infection: A 10-year, serial cross-sectional study in an inner-city emergency department

Abstract

Background The Johns Hopkins Hospital Emergency Department (JHHED) has served as an observational window on the HIV epidemic in a socioeconomically depressed, urban population. We previously reported that HIV incidence among JHHED patients is decreasing and that prevalence has declined from 11.4% in 2003 to 5.6% in 2013. Objectives This study sought to observe temporal trends in hepatitis C virus (HCV) and herpes simplex virus type 2 (HSV-2) seroprevalence, which are surrogate markers for parenteral and sexual risk behavior, respectively. Study Design Identity unlinked-serosurveys were conducted over 6–8 weeks in the adult JHHED in 2003, 2007, and 2013. Excess sera from 10,274 patients, previously tested for HIV, were assayed for HSV-2 and HCV antibodies. Results Overall HCV seroprevalence declined steadily from 22.0% in 2003 to 13.8% in 2013 (Ptrend<0.01), and was significant by all gender and race strata. Overall HSV-2 prevalence declined from 55.3% in 2003 to 50.0% in 2013 (Ptrend<0.01), but was non-significant after adjustment for demographics. Among HIV+ individuals <45 years of age, there was a significant decrease in the proportion of individuals with HCV co-infection [without HSV-2] (Ptrend=0.02) from 2003 to 2013, however, there was an increase in individuals with HSV-2 co-infection [without HCV] (Ptrend<0.01). Discussion Little change in age-specific HSV-2 prevalence suggests the decrease in HIV prevalence was likely not associated with changes in sexual risk behavior. In addition to clinical interventions, strategies to address sexual health disparities and continued parenteral harm-reduction efforts are needed to further drive the decline in HIV.

Demographic and clinical correlates of acute and convalescent SARS-CoV-2 infection among patients of a U.S. emergency department

“…Emergency Departments (EDs) are potentially unique sites for conducting SARS-CoV-2 serosurveillance, providing a ‘window’ into the community. Historically EDs have played a critical role in prior public health epidemics and pandemics, including HIV, hepatitis C, HSV-2 and influenza H1N1 [ [12] , [13] , [14] ], and more recently, in detecting racial/ethnic disparities for COVID-19 [ 15 ].…”

Differential Performance of CoronaCHEK SARS-CoV-2 Lateral Flow Antibody Assay by Geographic Origin of Samples

“…The copyright holder for this preprint this version posted April 19, 2021. ; https://doi.org/10.1101/2021.04.12.21255284 doi: medRxiv preprint infections, as demonstrated by a seroprevalence of 6%, 12% and 50% for HIV, HCV and HSV-2 respectively (18).…”

“…The pre-pandemic samples from Baltimore were not matched to those from Uganda based on symptomology, though historically, individuals attending the ED in the United States have a high prevalence of fever and viral infections (17). Samples from the JHH ED do have a high burden of chronic viral infections, as demonstrated by a seroprevalence of 6%, 12% and 50% for HIV, HCV and HSV-2 respectively (18).…”

Differentiation of SARS-CoV-2 naturally infected and vaccinated individuals in an inner-city emergency department

“…By providing data on symptomatic infection rates, emergency departments (EDs) have historically played a critical role in prior epidemics and pandemics and thus present a rich opportunity for conducting SARS-CoV-2 serosurveillance [15][16][17] . Although case-reporting can provide an estimate of population-level seroprevalence, relying on case-reporting alone may underestimate the burden of infection, emphasizing the need for accurate serologic assessment of seroprevalence 18 .…”