Hepatitis B and Hepatitis C in Emergency Department Patients

Abstract

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. 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. 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. In a population of patients in an innercity 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. (N Engl J Med 1992;326:1399–404.), IN addition to human immunodeficiency virus type 1 (HIV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV) are major sources of public health concern. Approximately 25 percent of adults infected with HBV become ill with jaundice, and of the 6 to 10 percent with acute infections who become carriers, about a quarter progress to chronic active hepatitis. 1 In a substantial proportion cirrhosis or primary hepatocellular carcinoma develops. HCV is considered to be the chief etiologic agent for both parenterally transmitted 2 3 4 and sporadic 5 6 7 non-A, non-B hepatitis. Although HCV infection is usually not severe and is often asymptomatic, chronic hepatitis develops… © 1992, Massachusetts Medical Society. All rights reserved.