title: Prevalence and characteristics of patients with undiagnosed HIV infection in an urban emergency department.
abstract: The Centers for Disease Control and Prevention (CDC) recommends offering HIV testing to persons admitted to emergency departments (EDs). Whether by opt-in or opt-out, many EDs (including our own) have found a seroprevalence of 0.8-1.5% when rapid testing is offered. The true seropositivity rate is unknown. We performed a retrospective chart analysis upon all patients presenting to our ED over a 2-week period in the fall of 2007 who had serum drawn as a part of their emergency care. Demographics and clinical characteristics were linked via de-identified serum, which was sent for HIV testing. Nine hundred fifty nine patients had sera available for rapid HIV testing. One hundred twenty one (13%) samples were reactive via the OraQuick(®) test (OraSure Technologies, Bethlehem, PA), a point of care rapid antibody test. Due to concerns about the appropriateness of sera as substrate for the OraQuick(®) technology, reactive samples were retested via standard enzyme immunoassay (EIA)/Western blot. One hundred twelve analyzable samples were retested-38 were positive and 27 of these were from patients who reported a history of HIV infection. The rate of undiagnosed HIV infection was 1.2% (11/914 potentially analyzable samples). Of all patients with HIV in our ED, 29% of them were presumably unaware of their diagnosis. In conclusion, HIV seroprevalence in our urban ED is high, and a large fraction of the patients appears to be unaware of the infection.
authors.affiliation: Section of Infectious Diseases, Temple University , Philadelphia, Philadelphia 19140, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Clauss
authors.forename: Julie M
authors.initials: JM
authors.lastname: Collins
authors.forename: Shaden
authors.initials: S
authors.lastname: Eldakar-Hein
authors.forename: Brandon
authors.initials: B
authors.lastname: Palermo
authors.forename: Nina
authors.initials: N
authors.lastname: Gentile
authors.forename: Sunil
authors.initials: S
authors.lastname: Adige
authors.forename: William
authors.initials: W
authors.lastname: Pace
authors.forename: Chad
authors.initials: C
authors.lastname: Duffalo
authors.forename: Jose
authors.initials: J
authors.lastname: Menajovsky
authors.forename: Jaime
authors.initials: J
authors.lastname: Zambrotta
authors.forename: Dalila
authors.initials: D
authors.lastname: Zachary
authors.forename: Peter
authors.initials: P
authors.lastname: Axelrod
authors.forename: Rafik
authors.initials: R
authors.lastname: Samuel
authors.forename: Robert
authors.initials: R
authors.lastname: Bettiker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015153:Blotting, Western; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D015528:HIV Seroprevalence; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D010349:Patient Compliance; D015143:Philadelphia / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult