title: Trends in human immunodeficiency virus (HIV) infection among a patient population of an inner-city emergency department: implications for emergency department-based screening programs for HIV infection.
abstract: Personnel of inner-city emergency departments (EDs), which are frequently the only source of medical care for many patients, may be in a unique position to detect human immunodeficiency virus (HIV) infection earlier than personnel at other recommended screening sites. To assist development of ED-based screening strategies for HIV infection, we undertook a serosurvey of HIV infection in adult patients attending an ED during a 6-week period in 1992 using an identity-unlinked technique and compared our findings with data collected similarly in 1988. Of 1,606 patients, 183 (11.4%) were HIV-positive, compared with 6.0% in 1988. Seroprevalence rates of HIV infection among patients only at risk of heterosexual transmission increased more than fourfold (7% to 30.3%). CD4+ cell counts were higher in those patients with undiagnosed HIV infection than in those with known HIV infection. Targeting minority patients aged 25-44 years, intravenous drug users, and those patients at heterosexual risk would have identified 87% of patients with new HIV infection, while requiring screening of 41% of the study sample. Targeted voluntary screening programs in certain EDs would likely detect significant numbers of new early HIV infections.
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
authors.forename: G D
authors.initials: GD
authors.lastname: Kelen
authors.forename: D A
authors.initials: DA
authors.lastname: Hexter
authors.forename: K N
authors.initials: KN
authors.lastname: Hansen
authors.forename: N
authors.initials: N
authors.lastname: Tang
authors.forename: S
authors.initials: S
authors.lastname: Pretorius
authors.forename: T C
authors.initials: TC
authors.lastname: Quinn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D003376:Counseling; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006679:HIV Seropositivity; D015528:HIV Seroprevalence; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D014505:Urban Population