Hepatitis C (HCV) and HIV remain prevalent infections in the United States partially because many individuals are unaware that they are infected. Indeed, this is the reason behind many recent social media campaigns encouraging individuals to #KnowYourStatus or be #HepAware.
To learn even more about how many individuals are unaware of their status, Lucia V. Torian, PhD, of the New York City Department of Health and Mental Hygiene, and colleagues studied individuals who presented to a busy NYC emergency room (ER) to discover how many were unaware of their status. The findings of their study were recently presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2017) in Seattle, Washington.
Dr. Torian and her team gathered data from remnant serum of patients who visited the Bronx ER between March 8, 2015 and May 8, 2015. Blood was drawn from 63% of ER presenters, which was unusually high, according to the researchers. (The researchers noted that the study was blinded. Participants did not give consent in order to avoid patients’ bias due to perceived risk. In addition, all patient identifiers were permanently removed from the database.)
After drawing the blood, “the first consecutive 5,004 specimens appearing to have sufficient remnant serum to complete the two- or three-step testing algorithm for HIV or HCV were selected and transferred to the laboratory,” Dr. Torian and her team explained.
HIV diagnoses were screened using the fourth generation combination Antigen-Antibody immunoassay (Architect HIV Ag/Ab Combo) and confirmed with the second generation rapid HIV-1/HIV-2 differentiation assay (BioRad Multispot HIV-1/HIV-2 Rapid Test).
The Vitros Anti-HCV Immunodiagnostic Test screened for HCV with a reactive result being signal-to-cutoff ratio of >1.0. Infection was confirmed with the HCV RNA Polymerase Chain Reaction (PCR), with a positive result being >15 copies of HCV RNA/mL.
Out of the 4,990 completed tests for HIV, 308 patients were repeatedly reactive on screening. Two hundred and forty-eight patients were reactive with supplemental testing and two patients had antibody-negative/RNA positive acute HIV infections—bringing the total to 250 HIV-positive ER visitors (5%). The researchers found that only 12 of the 250 individuals who tested positive were undiagnosed (seven males, five females). Seven of the undiagnosed patients were ages 40 to 59. The researchers found anti-HCV antibody in 372 of 4,989 participants (7.5%) with completed results. The confirmatory test showed HCV RNA positive in 196 individuals—38 of which (19.2%) of which were undiagnosed.
The researchers also found a substantial number of coinfections in the cohort of patients. Of HIV-positive individuals, 32% had anti-HCV antibody; 21% of those who were anti-HCV positive had HIV. In addition, 16% of those with HIV were HCV RNA positive; 19% of HCV RNA positive also had HIV.
According to the researchers, the prevalence of HIV and the number of undiagnosed cases were actually the lowest in the history of serosurveys conducted in NYC ERs. The prevalence of HCV and the number of undiagnosed cases, however, were higher in this serosurvey than what officials estimated city-wide. Those individuals from the baby boomer generation (those born between 1945 and 1965) had the highest HCV prevalence in the study. According to the Centers for Disease Control and Prevention (CDC
), “national prevalence data show that people born during these years are five times more likely than other adults to be infected.” The researchers found that individuals aged 40 to 59 years and 70 to 89 years also had high rates of HCV.
Although this study shows the number of undiagnosed patients on a localized scale, the CDC estimates that on a larger scale, 13% of individuals infected with HIV and 50% of individuals infected with HCV are not aware of their positive status.
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