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. 2022 Mar 16;9(5):ofac130.
doi: 10.1093/ofid/ofac130. eCollection 2022 May.

A Tale of 3 Pandemics: Severe Acute Respiratory Syndrome Coronavirus 2, Hepatitis C Virus, and Human Immunodeficiency Virus in an Urban Emergency Department in Baltimore, Maryland

Yu-Hsiang Hsieh  1 , Richard E Rothman  1   2 , Sunil S Solomon  2   3 , Mark Anderson  4 , Michael Stec  4 , Oliver Laeyendecker  2   3   5 , Isabel V Lake  1 , Reinaldo E Fernandez  2 , Gaby Dashler  1 , Radhika Mehta  1 , Thomas Kickler  6 , Gabor D Kelen  1 , Shruti H Mehta  3 , Gavin A Cloherty  4 , Thomas C Quinn  2   3   5 ; Johns Hopkins COVID-19 Emergency Medicine Investigators
Collaborators, Affiliations

A Tale of 3 Pandemics: Severe Acute Respiratory Syndrome Coronavirus 2, Hepatitis C Virus, and Human Immunodeficiency Virus in an Urban Emergency Department in Baltimore, Maryland

Yu-Hsiang Hsieh et al. Open Forum Infect Dis. .

Abstract

Background: We sought to determine the prevalence and sociodemographic and clinical correlates of acute and convalescent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections among emergency department (ED) patients in Baltimore.

Methods: Remnant blood samples from 7450 unique patients were collected over 4 months in 2020 for SARS-CoV-2 antibody (Ab), HCV Ab, and HIV-1/2 antigen and Ab. Among them, 5012 patients were tested by polymerase chain reaction for SARS-CoV-2 based on clinical suspicion. Sociodemographics, ED clinical presentations, and outcomes associated with coinfections were assessed.

Results: Overall, 729 (9.8%) patients had SARS-CoV-2 (acute or convalescent), 934 (12.5%) HCV, 372 (5.0%) HIV infection, and 211 patients (2.8%) had evidence of any coinfection (HCV/HIV, 1.5%; SARS-CoV-2/HCV, 0.7%; SARS-CoV-2/HIV, 0.3%; SARS-CoV-2/HCV/HIV, 0.3%). The prevalence of SARS-CoV-2 (acute or convalescent) was significantly higher in those with HCV or HIV vs those without (13.6% vs 9.1%, P < .001). Key sociodemographic disparities (race, ethnicity, and poverty) and specific ED clinical characteristics were significantly correlated with having any coinfections vs no infection or individual monoinfection. Among those with HCV or HIV, aged 18-34 years, Black race, Hispanic ethnicity, and a cardiovascular-related chief complaint had a significantly higher odds of having SARS-CoV-2 (prevalence ratios: 2.02, 2.37, 5.81, and 2.07, respectively).

Conclusions: The burden of SARS-CoV-2, HCV, and HIV co-pandemics and their associations with specific sociodemographic disparities, clinical presentations, and outcomes suggest that urban EDs should consider implementing integrated screening and linkage-to-care programs for these 3 infections.

Keywords: HCV; HIV; SARS-CoV-2; coinfection; emergency department.

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Figures

Figure 1.
Figure 1.
Results of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G, SARS-CoV-2 reverse-transcription polymerase chain reaction, human immunodeficiency virus (HIV)–1/2 antigen/antibody, HIV RNA load, hepatitis C virus (HCV) antibody, and HCV RNA load in 7450 patients of an urban emergency department in Baltimore, Maryland, 1 May 2020—9 November 2020. Abbreviations: Ab, antibody; Ag, antigen; ED, emergency department; HCV, hepatitis C virus; HIV, human immunodeficiency virus; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 2.
Figure 2.
Prevalence of severe acute respiratory syndrome coronavirus 2, hepatitis C virus, and human immunodeficiency virus infection among 7450 patients who presented to an urban emergency department in Baltimore, Maryland, 1 May 2020–9 November 2020. Abbreviations: Ab, antibody; Ag, antigen; HCV, hepatitis C virus; HIV, human immunodeficiency virus; IgG, immunoglobulin G; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
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