2015 年纽约市急诊部门未确诊的 HIV 和 HCV 感染。
Undiagnosed HIV and HCV Infection in a New York City Emergency Department, 2015.
机构信息
Lucia V. Torian, Qiang Xia, Lisa A. Forgione, Howard Doo, and Sarah L. Braunstein are with the New York City Department of Health and Mental Hygiene (DOHMH), HIV Epidemiology and Field Services Program, New York, NY. Fabienne Laraque, Eric J. Rude, and Angelica Bocour are with DOHMH, Viral Hepatitis Program. Demetre C. Daskalakis is with DOHMH, Division of Disease Control. Uriel R. Felsen and Barry S. Zingman are with the Division of Infectious Diseases, Montefiore Medical Center, Bronx, NY. Herbert Rose and Adam Cole are with the Division of Laboratory Services, Montefiore Medical Center. Gary J. Williams and Robert F. Bridgforth are with Quest Diagnostics, San Clemente, CA.
出版信息
Am J Public Health. 2018 May;108(5):652-658. doi: 10.2105/AJPH.2018.304321. Epub 2018 Mar 22.
OBJECTIVES
To measure undiagnosed HIV and HCV in a New York City emergency department (ED).
METHODS
We conducted a blinded cross-sectional serosurvey with remnant serum from specimens originally drawn for clinical indications in the ED. Serum was deduplicated and matched to (1) the hospital's electronic medical record and (2) the New York City HIV and HCV surveillance registries for evidence of previous diagnosis before being deidentified and tested for HIV and HCV.
RESULTS
The overall prevalence of HIV was 5.0% (250/4990; 95% confidence interval [CI] = 4.4%, 5.7%); the prevalence of undiagnosed HIV was 0.2% (12/4990; 95% CI = 0.1%, 0.4%); and the proportion of undiagnosed HIV was 4.8% (12/250; 95% CI = 2.5%, 8.2%). The overall prevalence of HCV (HCV RNA ≥ 15 international units per milliliter) was 3.9% (196/4989; 95% CI = 2.8%, 5.1%); the prevalence of undiagnosed HCV was 0.8% (38/4989; 95% CI = 0.3%, 1.3%); and the proportion of undiagnosed HCV was 19.2% (38/196; 95% CI = 11.4%, 27.0%).
CONCLUSIONS
Undiagnosed HCV was more prevalent than undiagnosed HIV in this population, suggesting that aggressive testing initiatives similar to those directed toward HIV should be mounted to improve HCV diagnosis.
目的
测量纽约市急诊部（ED）中未确诊的 HIV 和 HCV。
方法
我们对 ED 中因临床指征采集的标本进行了盲法横断面血清学调查。血清标本经过去重处理，并与（1）医院的电子病历和（2）纽约市 HIV 和 HCV 监测登记处进行匹配，以确认之前是否有诊断记录，随后对这些血清标本进行 HIV 和 HCV 检测，检测前将血清标本去标识化。
结果
HIV 的总体流行率为 5.0%（250/4990；95%置信区间 [CI] = 4.4%，5.7%）；未确诊 HIV 的流行率为 0.2%（12/4990；95% CI = 0.1%，0.4%）；未确诊 HIV 的比例为 4.8%（12/250；95% CI = 2.5%，8.2%）。HCV（HCV RNA ≥ 15 国际单位/毫升）的总体流行率为 3.9%（196/4989；95% CI = 2.8%，5.1%）；未确诊 HCV 的流行率为 0.8%（38/4989；95% CI = 0.3%，1.3%）；未确诊 HCV 的比例为 19.2%（38/196；95% CI = 11.4%，27.0%）。
结论
在该人群中，未确诊 HCV 比未确诊 HIV 更为常见，这表明应采取类似于针对 HIV 的积极检测措施，以提高 HCV 的诊断率。
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