title: Patients unaware of their HIV status present to inner city accident and emergency department with respiratory complications.
abstract: OBJECTIVE
  To examine the clinical presentations and management of patients presenting to an accident and emergency (A&E) department with an AIDS defining illness (ADI).
  
  
  METHODS
  Presentations of patients in the A&E department with ADI were reviewed retrospectively. The age, sex, ethnic origin, risk factor for HIV infection, route of referral to hospital, presenting complaint, triage category, referral from A&E, admission under medical specialists, diagnosis, and survival from ADI were noted for each patient.
  
  
  RESULTS
  133 patients were registered at St Mary's Hospital in London with ADI during 1994. A significant minority of these patients (25/133) presented to the hospital without prior knowledge of their HIV positive status. Thirty two patients presented to the A&E department with their ADI. Of these, 13/32 (41%) were unaware of the HIV serostatus. All 13 patients had an acute respiratory disease (Pneumocystis carinii pneumonia or pulmonary tuberculosis). In contrast, patients aware of their HIV positive status (19/32) presented to the A&E department with a wide range of non-pulmonary ADI.
  
  
  CONCLUSIONS
  The study emphasises the importance of respiratory complications in patients who present with a ADI to emergency departments but are unaware of their HIV positivity. These patients presented solely with Pneumocystis carinii pneumonia or pulmonary tuberculosis, conditions in which early diagnosis and treatment significantly reduce morbidity and mortality.
authors.affiliation: Department of Accident and Emergency Medicine, St Mary's Hospital, London W2 1NY, UK.
authors.forename: R
authors.initials: R
authors.lastname: Landau
authors.forename: R
authors.initials: R
authors.lastname: Coker
authors.forename: E
authors.initials: E
authors.lastname: Vermeulen
authors.forename: R
authors.initials: R
authors.lastname: Touquet
authors.forename: J
authors.initials: J
authors.lastname: Fothergill
authors.forename: M C
authors.initials: MC
authors.lastname: Poznansky
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000628:therapy; D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008131:London; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000628:therapy; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D014342:Truth Disclosure; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000628:therapy