TY - JOUR
T1 - Prevalence and correlates of unknown HIV infection among patients seeking care in a public hospital emergency department
AU - Zetola, Nicola M.
AU - Kaplan, Beth
AU - Dowling, Teri
AU - Jensen, Trevor
AU - Louie, Brian
AU - Shahkarami, Mahtab
AU - Colfax, Grant
AU - Klausner, Jeffrey D.
PY - 2008
Y1 - 2008
N2 - Objectives. Screening for human immunodeficiency virus (HIV) infection in the emergency department (ED) has been proposed as an effective approach to increase early HIV diagnosis. To evaluate the potential for the implementation of routine screening, we determined the prevalence of unknown HIV infection among patients being seen in an urban public hospital ED. Methods. We conducted a cross-sectional study among patients presenting to the San Francisco General Hospital's ED during March 2007. We reviewed patients' medical records to determine HIV infection status. In patients with unknown or negative HIV-infection status, we tested de-identified remnant blood specimens by HIV-antibody and nucleic-acid assays. We used a sensitive/ less sensitive testing algorithm to determine the duration of HIV infection. Results. During the study period, 1,820 patients had blood collected for clinical evaluation. Of those patients, 146 (8.0%) were known to be HIV-infected. Among the remaining 1,674 patients with unknown HIV-infection status, HIVinfection prevalence was 0.9% (15 of 1,674, 95% confidence interval [CI] 0.55, 1.47). In addition, one case of acute HIV infection (HIV-antibody negative, HIV RNA detected) was identified. Patients with unknown HIV infection vs. those who were uninfected were more likely to be homeless (odds ratio [OR] 5 3.89, 95% CI 1.32, 11.45, p,0.05) and 18 to 30 years of age (OR53.15, 95% CI 1.03, 9.61, p,0.05). Conclusions. In a sample of patients visiting a county ED, the relative prevalence of unknown HIV infection (10%) was modest and less than national estimates (25%). Acutely HIV-infected patients might account for a significant proportion of those with unknown HIV infection in an ED setting.
AB - Objectives. Screening for human immunodeficiency virus (HIV) infection in the emergency department (ED) has been proposed as an effective approach to increase early HIV diagnosis. To evaluate the potential for the implementation of routine screening, we determined the prevalence of unknown HIV infection among patients being seen in an urban public hospital ED. Methods. We conducted a cross-sectional study among patients presenting to the San Francisco General Hospital's ED during March 2007. We reviewed patients' medical records to determine HIV infection status. In patients with unknown or negative HIV-infection status, we tested de-identified remnant blood specimens by HIV-antibody and nucleic-acid assays. We used a sensitive/ less sensitive testing algorithm to determine the duration of HIV infection. Results. During the study period, 1,820 patients had blood collected for clinical evaluation. Of those patients, 146 (8.0%) were known to be HIV-infected. Among the remaining 1,674 patients with unknown HIV-infection status, HIVinfection prevalence was 0.9% (15 of 1,674, 95% confidence interval [CI] 0.55, 1.47). In addition, one case of acute HIV infection (HIV-antibody negative, HIV RNA detected) was identified. Patients with unknown HIV infection vs. those who were uninfected were more likely to be homeless (odds ratio [OR] 5 3.89, 95% CI 1.32, 11.45, p,0.05) and 18 to 30 years of age (OR53.15, 95% CI 1.03, 9.61, p,0.05). Conclusions. In a sample of patients visiting a county ED, the relative prevalence of unknown HIV infection (10%) was modest and less than national estimates (25%). Acutely HIV-infected patients might account for a significant proportion of those with unknown HIV infection in an ED setting.
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U2 - 10.1177/00333549081230s306
DO - 10.1177/00333549081230s306
M3 - Article
C2 - 19166088
AN - SCOPUS:60549093204
SN - 0033-3549
VL - 123
SP - 41
EP - 50
JO - Public Health Reports
JF - Public Health Reports
IS - SUPPL. 3
ER -