Detection of HIV-1 by polymerase chain reaction and culture in seronegative intravenous drug users in an inner-city emergency department.
BACKGROUND
After a health care worker's unprotected exposure to a patient's blood, the current recommendation is to obtain consent from the source for serologic testing for HIV. If the test is negative, no further follow-up of the exposed provider is usually indicated.


OBJECTIVE
To determine if patients testing negative for HIV-1 antibody on routine serology harbor occult HIV-1 infection.


METHODS
Cross-sectional, identity-unlinked, patient-related data and blood sample procurement for HIV-1 infection.


METHODS
Inner-city university hospital emergency department with high HIV-1 seroprevalence among patients.


METHODS
IV drug users not known to have HIV-1 infection.


METHODS
Serum samples were analyzed for HIV-1 antibodies by enzyme immunoassay and Western blot. Peripheral mononuclear cells were analyzed for HIV-1 provirus by polymerase chain reaction and viral culture.


RESULTS
Of 131 patients, 36 (27.5%) were Western blot-confirmed seropositive for HIV-1. Of the 95 seronegative patients, six (6.3%) were polymerase chain reaction positive, and one of these was confirmed with culture. The negative predictive value of standard serology was 93.5% with polymerase chain reaction alone and 98.9% with concordant polymerase chain reaction and culture results.


CONCLUSIONS
There may be a significant number of ED patients in HIV-1 prevalent populations who have occult HIV-1 infection not detectable by serology at the time of a health care provider exposure. Although these data suggest that further prospective study is warranted to better quantify the frequency of this phenomenon, these preliminary data suggest that current Centers for Disease Control recommendations regarding provider exposures may need to be reappraised for certain situations.
Kelen
G D
GD
Division of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Chanmugam
A
A
Meyer
W A
WA
Farzadegan
H
H
Stone
D
D
Quinn
T C
TC
D000328:Adult; D015142:Baltimore; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000032:analysis; D004636:Emergency Service, Hospital; D005260:Female; D015483:HIV Antibodies / Q000097:blood*; D006679:HIV Seropositivity / Q000150:complications / Q000175:diagnosis*; D015497:HIV-1 / Q000235:genetics / Q000276:immunology*; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D015819:Substance Abuse, Intravenous / Q000150:complications*; D014505:Urban Population
D004279:DNA, Viral; D015483:HIV Antibodies