Researchers seek best methods for screening and counting HIV in the hospital

May 22, 2014 by Katy Cosse

The fight against HIV remains a top priority for physicians across the country—and includes questions on how best to understand its prevalence and when to test patients for the virus.

University of Cincinnati researchers presented results of two studies on HIV at this year's Society for Academic Emergency Medicine annual conference, held May 13-17 in Dallas. Both were led by assistant professor of emergency medicine Michael Lyons, MD, MPH, who focuses his research on HIV screening in emergency departments and directs UC's HIV Early Intervention Program.

Selective Screening Works

In the first study, Lyons and collaborators found that more limited screening by trained testing counselors in the emergency department (ED) was just as effective at identifying new cases as was a more large-scale and broad-based screening effort.

While universal HIV screening is recommended, many are still uncertain about the best criteria for patient selection or the best way to conduct screening programs.

"It would be helpful to understand how to conduct screening in the most effective and least costly way," says the study's first author, Lucia Derks, MD, a first-year resident in emergency medicine, "but the most efficient methods to identify undetected cases of HIV remain unknown."

In their review, researchers focused on three distinct time periods within the counseling and HIV testing program at University of Cincinnati Medical Center.

Each time period used identical program methods, but differed in the level of available staff. For the first and third time periods, there was a single testing counselor for the entire emergency department. For the second period, staffing was sufficient to approach all at-risk patients for HIV screening.

Reviewing the records, the team found that a greater proportion of screened patients tested positive for HIV during the first and third time periods.

"When we attempted to implement the screening fully," says Lyons, "we found that the number of cases detected fell dramatically. This suggests that screening may perform better when it's implemented on a selected basis, and that provider judgment should be further studied as a way to increase the number of patients diagnosed with HIV while decreasing the number who need to be tested."

Estimating Prevalence Two Ways

In another study also presented at SAEM, researchers investigated the best way to estimate prevalence of HIV in a community, using either blood tests in the or unused laboratory samples.

"It's important to know how many people have a disease (prevalence) in a given setting, as that guides many types of planning and intervention efforts," says the study's first author, Joshua Denney, MD, a second-year resident in . "Just knowing how many cases are diagnosed isn't sufficient, because often many cases aren't diagnosed."

He says it is possible to estimate HIV prevalence by obtaining unidentified blood samples from the hospital laboratory—a convenient method, but one that excludes patients who did not get blood tests as part of their treatment. Another option is to obtain samples directly from patients during their ED care.

Though laboratory samples may provide a reasonable estimate of how many people are affected by a disease, he says it may not be sufficient because 1) less than half of ED have blood drawn as part of their care and, 2) many people who do not have blood drawn have an undiagnosed disease.

In a comparison of both methods, researchers found an almost equal number of positive cases among both.

"In the case of HIV, this means that programs that only test people who are already having blood drawn are missing approximately half of the undiagnosed cases," says Lyons.

Explore further: Trial finds more support for universal HIV screening in emergency departments

More information: "Yield Of Screening In The ED: Effectiveness Versus Efficacy," Kimberly Hart, Andrew Ruffner, MPH, D.B. Wayne, Christopher Lindsell, PhD, Matthew Sperling, Alexander Trott and Carl Fichtenbaum, MD.

"Differences in Prevalence Assessment Using Prospective Enrollment Versus Collection of Discarded Laboratory Remnants," Joshua Denney, Kimberly Hart, Matthew Sperling, Andrew Ruffner, MPH, D.B. Wayne, Alexander Trott, Christopher Lindsell, PhD, and Carl Fichtenbaum, MD. 

Related Stories

Trial finds more support for universal HIV screening in emergency departments

August 6, 2013
Screening everyone for HIV in the emergency department may be superior to testing only those with apparent risk, when trying to identify patients with undiagnosed HIV infection, according to a new results by researchers at ...

Study shows missed opportunities for HIV diagnosis in emergency departments

July 29, 2011
New University of Cincinnati (UC) research on HIV testing at local emergency departments shows that hospitals miss opportunities to diagnose patients who do not know they are infected with HIV, even when a regular testing ...

Peer-referral programs can increase HIV-testing in emergency departments

May 17, 2013
Researchers at the University of Cincinnati (UC) have found that incorporating a peer-referral program for HIV testing into emergency departments can reach new groups of high-risk patients and brings more patients into the ...

Screening new inmates for HIV may not reveal many new undetected cases, study shows

November 26, 2013
More than 90 percent of HIV-infected inmates entering prison in North Carolina had previously tested positive for the virus, according to a study published in the November 27 issue of the Journal of the American Medical Association.

Researchers use computer simulations to find true cost of HIV screenings

November 19, 2012
Introducing HIV screenings into the nation's emergency departments (EDs) leaves some doctors worrying about longer wait times, disrupted operations, and possible interference with necessary emergency services. Are their concerns ...

ACOG issues guidelines for routine HIV testing for women

April 29, 2014
(HealthDay)—Females aged 13 to 64 years should undergo HIV testing at least once in their lifetime, with annual testing thereafter recommended based on risk factors, according to a Committee Opinion published in the May ...

Recommended for you

Scientists elicit broadly neutralizing antibodies to HIV in calves

July 20, 2017
Scientists supported by the National Institutes of Health have achieved a significant step forward, eliciting broadly neutralizing antibodies (bNAbs) to HIV by immunizing calves. The findings offer insights for HIV vaccine ...

Heart toxin reveals new insights into HIV-1 integration in T cell genome

July 20, 2017
Human immunodeficiency virus (HIV)-1 may have evolved to integrate its genetic material into certain immune-cell-activating genes in humans, according to new research published in PLOS Pathogens.

Scientists capture first high-resolution image of key HIV protein transitional state

July 13, 2017
A new, three-dimensional snapshot of HIV demonstrates the radical structural transformations that enable the virus to recognize and infect host cells, according to a new study led by scientists at The Scripps Research Institute ...

Barrier to autoimmune disease may open door to HIV, study suggests

July 11, 2017
Researchers from the University of Colorado School of Medicine have discovered that a process that protects the body from autoimmune disease also prevents the immune system from generating antibodies that can neutralize the ...

Team tests best delivery mode for potential HIV vaccine

June 20, 2017
For decades, HIV has successfully evaded all efforts to create an effective vaccine but researchers at The Scripps Research Institute (TSRI) and the La Jolla Institute for Allergy and Immunology (LJI) are steadily inching ...

Mathematical modeling uncovers mysteries of HIV infection in the brain

June 19, 2017
After uncovering the progression of HIV infection in the brain thanks to a new mathematical model developed by a UAlberta research team, clinicians and researchers are developing a nasal spray to administer drugs more effectively.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.