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Opt-out HIV testing in ED identified acute infections
A fourth-generation test for HIV detected acute infections among patients with undiagnosed HIV who were screened as part of an opt-out ED screening program, according to research published in Annals of Emergency Medicine.
“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,” Kara Iskyan Geren, MD, MPH, of Maricopa Integrated Health System in Phoenix, said in a press release. “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 patients with confirmed HIV diagnosis, we were able to connect 72% with HIV care within 90 days.”
Kara Iskyan Geren
Geren and colleagues assessed the prevalence of acute and chronic unrecognized HIV among eligible patients aged 18 to 64 years who were screened as part of a nontargeted, opt-out HIV screening program in the ED. From July 11, 2011, through Jan. 5, 2014, there were 27,952 screenings performed for 22,468 patients with a fourth-generation antigen/antibody combination assay test (Architect HIV Ag/Ab Combo Test, Abbott Laboratories).
There were 78 confirmed HIV infections, for a prevalence of 0.28% (95% CI, 0.22-0.35). Eighteen of these infections (23.1%) were acute HIV infections. Twenty-two of the patients (28.2%) presented with AIDS. Among the patients with confirmed HIV, 82% did not have health insurance, but 72% were linked to care.
“In 2006, the CDC suggested universal screenings for patients in populations with a prevalence of undiagnosed infections greater than 0.1%, which would include our patient population,” Geren said. “However, it is difficult to ask an already overburdened, underfunded ED and its staff to perform a public health function. The reality is that the lack of organizational support and upfront costs will likely be a major barrier to implementing this type of testing in many EDs across the country.”
Disclosure: The researchers report no relevant financial disclosures.