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; Richard E Rothman; Sunil S Solomon; Mark Anderson; Michael Stec; Oliver Laeyendecker; Isabel V Lake; Reinaldo E Fernandez; Gaby Dashler; Radhika Mehta; Thomas Kickler; Gabor D Kelen; Shruti H Mehta; Gavin A Cloherty; Thomas C Quinn; Johns Hopkins COVID-19 Emergency Medicine Investigators

doi:10.1093/ofid/ofac130

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

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

Authors

Yu-Hsiang Hsieh¹, Richard E Rothman^{1

2}, Sunil S Solomon^{2

3}, Mark Anderson⁴, Michael Stec⁴, Oliver Laeyendecker^{2

3

5}, Isabel V Lake¹, Reinaldo E Fernandez², Gaby Dashler¹, Radhika Mehta¹, Thomas Kickler⁶, Gabor D Kelen¹, Shruti H Mehta³, Gavin A Cloherty⁴, Thomas C Quinn^{2

3

5}; Johns Hopkins COVID-19 Emergency Medicine Investigators

Collaborators

Johns Hopkins COVID-19 Emergency Medicine Investigators:
Evan J Beck, Sharada Saraf, Owen R Baker, Richard Wang, Erin P Ricketts, Danna Anderson, Jennifer Hurley

Affiliations

¹ Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
² Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁴ Abbott Laboratories, Abbott Park, Illinois, USA.
⁵ Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA.
⁶ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

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.