Cross-sectional assessment of bloodborne viruses and liver disease severity in a population with serious mental illness.

Background and Aim: People with serious mental illness have high rates of bloodborne viruses (BBVs) but often have poor access to medical care. We sought to define the burden of hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV in a long-stay inpatient cohort with serious mental illness. Emphasis was placed on elucidating BBV prevalence, risk factors, and access to care. Method(s): We prospectively approached all patients (n = 46) admitted to a long-stay mental health admission unit at a tertiary referring hospital over a 2-week period and invited each person to complete a BBV risk factor survey, opt-out BBV screening, and liver assessment using transient elastography and other non-invasive liver stiffness assays. This was part of a quality assurance initiative. Result(s): Baseline demographics showed a young cohort (median age, 39.5 years), with a male preponderance (71.7%). The primary psychiatric diagnoses were schizophrenia and schizoaffective disorders (95.7%). Almost two-thirds (63%) had a secondary diagnosis of substance-misuse disorders. Serology was obtained for 31 patients (67.4%). Of those screened for HBV, 15 (53.3%) were unvaccinated, four (13.3%) had previous HBV exposure, and 10 (33.3%) were vaccinated. No cases of HBV viremia were identified. HCV serology was positive (HCV antibody positive) in 11 patients (36.7%). Each had a history of intravenous drug use. Importantly, seven patients (23.3%) had successfully been treated for HCV and one (3.3%) had active viremia. The remaining cases likely reflected spontaneous clearance. To assess disease severity, transient elastography and the aspartate aminotransferase to platelet ratio index (APRI) were used as validated markers of liver fibrosis. APRI showed higher rates of fibrosis in the HCV antibody positive cohort, but this was not statistically significant compared with the HCV-naive cohort. Liver stiffness measurement conducted in the HCV antibody positive study group was similar and showed two