title: Parallel declines in HIV and hepatitis C virus prevalence, but not in herpes simplex virus type 2 infection: A 10-year, serial cross-sectional study in an inner-city emergency department.
abstract: The Johns Hopkins Hospital Emergency Department (JHHED) has served as an observational window on the HIV epidemic in a socioeconomically depressed, urban population. We previously reported that HIV incidence among JHHED patients is decreasing and that prevalence has declined from 11.4% in 2003-5.6% in 2013.
  
  
  
  This study sought to observe temporal trends in hepatitis C virus (HCV) and herpes simplex virus type 2 (HSV-2) seroprevalence, which are surrogate markers for parenteral and sexual risk behavior, respectively.
  
  
  
  Identity unlinked-serosurveys were conducted over 6-8 weeks in the adult JHHED in 2003, 2007, and 2013. Excess sera from 10,274 patients, previously tested for HIV, were assayed for HSV-2 and HCV antibodies.
  
  
  
  Overall HCV seroprevalence declined steadily from 22.0% in 2003-13.8% in 2013 (Ptrend<0.01), and was significant by all gender and race strata. Overall HSV-2 prevalence declined from 55.3% in 2003-50.0% in 2013 (Ptrend<0.01), but was non-significant after adjustment for demographics. Among HIV+ individuals<45years of age, there was a significant decrease in the proportion of individuals with HCV co-infection [without HSV-2] (Ptrend=0.02) from 2003 to 2013, however, there was an increase in individuals with HSV-2 co-infection [without HCV] (Ptrend < 0.01).
  
  
  
  Little change in age-specific HSV-2 prevalence suggests the decrease in HIV prevalence was likely not associated with changes in sexual risk behavior. In addition to clinical interventions, strategies to address sexual health disparities and continued parenteral harm-reduction efforts are needed to further drive the decline in HIV.
authors.affiliation: Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, MD, USA.
authors.forename: Eshan U
authors.initials: EU
authors.lastname: Patel
authors.affiliation: Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, MD, USA.
authors.forename: Oliver
authors.initials: O
authors.lastname: Laeyendecker
authors.affiliation: Dept. of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
authors.affiliation: Dept. of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rothman
authors.affiliation: Dept. of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Gabor D
authors.initials: GD
authors.lastname: Kelen
authors.affiliation: Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, MD, USA. Electronic address: tquinn2@jhmi.edu.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000378:metabolism; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000276:immunology; D016174:Hepacivirus / Q000276:immunology*; D006526:Hepatitis C / Q000453:epidemiology* / Q000276:immunology; D006558:Herpes Genitalis / Q000453:epidemiology* / Q000276:immunology; D018258:Herpesvirus 2, Human / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016036:Seroepidemiologic Studies; D012725:Sexual Behavior; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral
keywords: Emergency department; HCV; HIV; HSV-2; Hepatitis C; Herpes