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Objective: To determine the seroprevalence and epidemiologic features of human T-lymphotropic virus (HTLV I-II) among an emergency department patient population with a high rate of human immunodeficiency virus (HIV-1) infection., Design: Prospective survey using identity-unlinked consecutive sampling during a 6-week period in 1988., Setting: Inner-city teaching hospital., Patients: Sequential sample of 2544 adult patients with sufficient excess sera for analysis., Measurements and Main Results: Twenty-eight (1.1%) (95% CI, 0.7% to 1.5%) serum samples were seropositive for HTLV I-II whereas 152 (6.0%) (CI, 5.1% to 6.9%) were seropositive for HIV-1. The age distribution of HTLV I-II was similar to the study population while HIV-1 was concentrated among younger (25 to 44 years) age groups (P less than 0.05). Only 16 (57.1%) HTLV I-II infected patients had identified risk factors; 11 were intravenous drug users, 4 received transfusions, and 1 had heterosexual exposure to a high-risk partner. None of 39 identified homosexual men had HTLV I-II antibodies although 29 (74.3%) were HIV-1 seropositive., Conclusion: HTLV I-II infection may be more prevalent among certain segments of the U.S. population than previously realized and appears to have a different demographic distribution than HIV-1 infection. Although HTLV I-II may represent a nosocomial risk to health care providers, the risk of occupational transmission is probably less than for hepatitis B virus and even HIV-1. Adherence to universal precautions should minimize the risk.

Increasing numbers of patients with diagnosed HIV infection are presenting to inner-city emergency departments. Unfortunately, there is little information available on the characteristics and emergency clinical problems of HIV-infected patients to guide physicians in patient care and strategies for resource use. Preliminary data from an on-going investigation revealed that there were 254 emergency visits (1.8% of total) by 164 patients with known HIV infection during the four-month period of March to June 1988. Only 171 visits (62%) were likely related to patients' underlying HIV infection. Nine percent of IV drug users (IVDUs) carried a diagnosis of AIDS before presentation compared with 68% of patients who were homosexual or bisexual. Fifty-five patients (21.7%) presented with their first known complication of HIV. Among the 140 risks from patients previously considered asymptomatic, those with homosexual or bisexual risk were 3.6-fold more likely to present with a first-time complication of HIV than were IVDUs. HIV-infected patients were twice as likely to have inadequate insurance compared with a sample of ED seronegative controls. Of the 130 risks by IVDUs, 85% were without adequate insurance coverage compared with 56% of the 91 patient risks from homosexual or bisexuals (P less than .05). Generally, patient presentations did not imply an obvious diagnosis; vague constitutional complaints were the most common (42%). Preliminary interpretation of the data is that IVDUs use emergency services as a routine source of care. Because IVDUs probably represent those with more recent infection and HIV infection continues to spread unabated in this risk group, we can expect increasing numbers of patients to present to EDs with symptomatic HIV infection in the future.(ABSTRACT TRUNCATED AT 250 WORDS)