Seroprevalence Rates of Human Immunodeficiency Virus Infection at Sentinel Hospitals in the United States

Abstract

BACKGROUND AND METHODS: To evaluate the epidemiology of infection with human immunodeficiency virus type 1 (HIV-1) in selected urban communities in the United States, we instituted active surveillance at sentinel hospitals by anonymous testing of samples of blood specimens for HIV-1 antibody. To reflect better the rates of HIV-1 seroprevalence in the communities served by the sentinel hospitals, we excluded specimens from all patients with diagnoses that are often associated with HIV infection. RESULTS: From January 1988 to June 1989, 89,547 specimens were tested at 26 hospitals in 21 cities. The overall rate of HIV-1 seroprevalence was 1.3 percent, but it ranged from 0.1 to 7.8 percent according to hospital (median, 0.7 percent). The age distribution of persons seropositive for HIV-1 was similar across hospitals and closely paralleled that of persons with the acquired immunodeficiency syndrome (AIDS). In areas of low seroprevalence, HIV-1 infections were highly concentrated among men. However, the male-to-female ratio (median, 7.0) decreased steadily with an increasing overall rate of seroprevalence (P less than 0.001); at the five hospitals with the highest rates of seroprevalence, the median male-to-female ratio was only 2.9. The median black-to-white ratio of HIV-1 seroprevalence was 1.8, but at hospitals with low rates of seroprevalence the rates in blacks and whites were nearly equal. At two hospitals in the communities with the highest prevalence of AIDS, 1.1 to 3.8 percent of adolescents 15 to 19 years old and 18 to 22 percent of all men 25 to 44 years old were seropositive for HIV-1. CONCLUSIONS: In these sentinel, urban populations there is tremendous variation in the rate of HIV-1 infection (over 70-fold). The very high seroprevalence at some sentinel hospitals indicates the need for routine screening for HIV-1 infection among some groups of patients, regardless of clinical presentation.