Many ER patients test positive for HIV while in most infectious stage

June 23, 2014, American College of Emergency Physicians

Human Immunodeficiency Virus (HIV) screening for emergency patients at an institution with a large number of ethnic minority, underinsured and uninsured people reveals few are HIV positive, but of those who are, nearly one-quarter are in the acute phase and more than one-quarter have infections that have already advanced to Acquired Immune Deficiency Syndrome (AIDS). The results of the study were reported online yesterday in Annals of Emergency Medicine ("Identification of Acute HIV Infection Using Fourth Generation Testing in an Opt-Out Emergency Department Screening Program").

"People may believe that HIV and AIDS are diseases of the 20th century, but our results show that many people continue to be infected without being aware of it," said lead study author Kara Iskyan Geren, MD, MPH, of Maricopa Integrated Health System in Phoenix, Ariz. "Proper diagnosis before HIV progresses to AIDS allows for interventions that can extend life as well as minimize the risk of transmission to other people. Of the with confirmed HIV diagnosis, we were able to connect 72 percent with HIV care within 90 days."

Of 22,468 patients who were tested for HIV, 78 (0.28 percent) had new HIV diagnoses. Of those, 23 percent had acute HIV infections and 28 percent had a T-cell count below 200 or an opportunistic infection (in other words, had AIDS). Eight-two percent of patients with confirmed HIV did not have health insurance. Patients excluded from testing included those who had an altered level of consciousness and had higher risk profiles, such as prison inmates.

Dr. Geren and her team used a fourth generation antigen/antibody HIV test with rapid results which has only been available since 2009. The relatively new test allows for earlier and easier detection of HIV.

"In 2006, the Centers for Disease Control and Prevention (CDC) suggested universal screenings for patients in populations with a prevalence of undiagnosed infections greater than 0.1 percent, which would include our patient population" said Dr. Geren. "However, it is difficult to ask an already overburdened, underfunded emergency department and its staff to perform a public health function. The reality is that the lack of organizational support and upfront costs will likely be major barrier to implementing this type of testing in many emergency departments across the country."

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