Background:  We wanted to determine the temporal trends in HIV prevalence, incidence, and associated risk behaviors in adults attending the Johns Hopkins Hospital Emergency Department (JHH ED) from 1988 to 2003.

Methods:  Identity-unlinked sero-survey studies were performed in 1988, 1992, 2000, 2001, and 2003 at the JHH ED.  A median of 1577 (range 986 to 2544) patients was surveyed at each time point.  Excess blood was tested for the presence of HIV antibody by EIA, confirmed by Western blot, and assessed for HIV viral load by Roche Amplicor.  Additionally HIV⁺ samples from the 2000, 2001, and 2003 study were tested by the STARHS assay to estimate HIV incidence.

Results:  The prevalence of HIV for patients attending the JHH ED initially increased from 6% in 1988 to 11% in 1992 and has subsequently remained stable at 11%. There was a significant trend in the percentage of patients who knew their HIV status, from 27% in 1988 to 81% in 2003 (p <0.05). The estimated HIV incidence rate in 2000, 2001, and 2003 was determined to be approximately 1%. From the 2001 study, newly infected individuals had a higher viral load (median 2.7 x 105 copies/mL) than chronically untreated infected individuals (4.6 x 104 copies/mL) (p = 0.05). A greater percentage of HIV-infected individuals in 2003 admitted to IV drug use (47%) than HIV-infected individuals in 1988 (23%). Additionally there was a decrease in the percentage of HIV-infected men who acknowledge to having sex with other men from 1988 to 2003 (47% vs 1.3%). 

Conclusions:  Inner city emergency departments may provide an opportunity to identify previously unrecognized HIV infection and provide education for an at risk population. The trends in risk behavior seen at the JHH ED reflect national trends with a decrease in MSM and increases in IDU.  HIV incidence at the JHH ED has remained stable at 1% from 2000 to 2003.

Keywords: HIV trends