HUMAN-IMMUNODEFICIENCY-VIRUS AND HEPATITIS-B VIRUS SEROPREVALENCE IN AN URBAN TRAUMA POPULATION

Objective: To determine the seroprevalence of the human immunodeficien cy virus (HIV) and the hepatitis B virus (HBV) in patients of an urban level I trauma center. Design: Prospective, blinded point prevalence study of serum HIV and HBV antibody and antigen. Setting: An urban lev el I trauma center that participates in a trauma system serving three million people. Patients: The study included 994 (94.8%) of 1049 conse cutive trauma service patients treated between June 6, 1988 and Septem ber 22, 1988. The patients were 82.2% male and 73.1% black, with a mea n age of 28.8 +/- 12.3 years. Blunt trauma was seen in 65.4% of patien ts, 5.2% were in shock, and 96.2% survived their trauma. Main Outcome Measures: HIV and HBV seroprevalence, using both antibody and antigen testing. Results: HIV infection was seen in 43 patients (4.3%); 41 (95 .3%) were HIV Ab+ and two (4.7%) were HIV Ab-MTV Ag+. Infection with t he HBsAg was seen in 31 patients (3.1%). Infection with either virus w as seen in 70 patients (7%); four patients (0.4%) were infectious for both viruses. Infection was related to age 20 to 49 years, IV drug use , a hepatitis or sexually transmitted disease history, prior HIV testi ng, shock, and death (p < 0.05). Penetrating trauma was not predictive of infection. In a logistic regression model, IV drug use was the sin gle significant predictor of infection (p < 0.05). Conclusions: Young urban trauma patients, because of drug-related intentional violence, a re 15.3 to 17.6 times more likely to be HIV infected and 3.9 to 7.9 ti mes more likely to be infectious for HIV or HBV than the trauma popula tion overall. The 12 to 21% infection rates in critically injured pati ents who require shock resuscitation and/or die reinforces the need fo r mandated universal precautions and for clear policies which govern t he performance of procedures by physicians in training. Primary HIV in fection in critically injured patients may worsen their outcome and ma y adversely affect the exposed health care worker. Emergency departmen ts and trauma units should develop a referral system to HIV primary ca re services (HIV counselling and testing) for high risk patients and f or adversely exposed health care workers.