title: Identification of acute HIV infection using fourth-generation testing in an opt-out emergency department screening program.
abstract: OBJECTIVE
  Acute HIV infection is a clinical diagnosis aided by technology. Detecting the highly infectious acute stage of HIV infection is critical to reducing transmission and improving long-term outcomes. The Maricopa Integrated Health System implemented nontargeted, opt-out HIV screening with a fourth-generation antigen/antibody combination HIV assay test in our adult emergency department (ED) at Maricopa Medical Center to assess the prevalence of both acute and chronic unrecognized HIV.
  
  
  METHODS
  Eligible patients aged 18 to 64 years were tested for HIV if they did not opt out and had blood drawn as part of their ED care. Patients were not eligible if they had a known HIV or AIDS diagnosis, exhibited altered mental status, were a current resident of a long-term psychiatric or correctional facility, or prompted a trauma activation. Reactive test results were delivered by a physician with the assistance of a linkage-to-care specialist. Specimens with a reactive fourth-generation assay result underwent confirmatory testing.
  
  
  RESULTS
  From July 11, 2011, through January 5, 2014, 27,952 HIV screenings were performed for 22,468 patients tested for HIV; 78 (0.28%) had new HIV diagnoses. Of those, 18 (23% of all new diagnoses) were acute HIV infections, and 22 patients (28%) had a CD4 count of less than 200 cells/mL, or an opportunistic infection.
  
  
  CONCLUSIONS
  HIV testing with a fourth-generation antigen/antibody laboratory test producing rapid results is feasible in an ED. Unexpectedly, nearly one fourth of patients with undiagnosed HIV had acute infections, which would have been more difficult to detect with previous testing technology.
authors: Department of Emergency Medicine, Maricopa Integrated Health System, Phoenix, AZ. Electronic address: kara_geren@dmgaz.org.
authors: Kara I
authors: KI
authors: Geren
authors: Department of Emergency Medicine, Maricopa Integrated Health System, Phoenix, AZ.
authors: Frank
authors: F
authors: Lovecchio
authors: Department of Emergency Medicine, Maricopa Integrated Health System, Phoenix, AZ.
authors: Jason
authors: J
authors: Knight
authors: Department of Internal Medicine, Maricopa Integrated Health System, Phoenix, AZ.
authors: Robert
authors: R
authors: Fromm
authors: Department of Grants Administration, Maricopa Integrated Health System, Phoenix, AZ.
authors: Eric
authors: E
authors: Moore
authors: Department of Grants Administration, Maricopa Integrated Health System, Phoenix, AZ.
authors: Cheri
authors: C
authors: Tomlinson
authors: Department of Academic Research, Maricopa Integrated Health System, Phoenix, AZ.
authors: André
authors: A
authors: Valdez
authors: Department of Pathology, Maricopa Integrated Health System, Phoenix, AZ.
authors: Dan
authors: D
authors: Hobohm
authors: Department of Emergency Medicine, Maricopa Integrated Health System, Phoenix, AZ.
authors: J Stephan
authors: JS
authors: Stapczynski
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods* / Q000706:statistics & numerical data; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001130:Arizona / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016312:Treatment Refusal; D055815:Young Adult