title: Prevalence of undiagnosed acute and chronic HIV in a lower-prevalence urban emergency department.
abstract: OBJECTIVE
  We estimated the seroprevalence of both acute and chronic HIV infection by using a random sample of emergency department (ED) patients from a region of the United States with low-to-moderate HIV prevalence.
  
  
  METHODS
  This cross-sectional seroprevalence study consecutively enrolled patients aged 18 to 64 years within randomly selected sampling blocks in a Midwestern urban ED in a region of lower HIV prevalence in 2008 to 2009. Participants were compensated for providing a blood sample and health information. After de-identification, we assayed samples for HIV antibody and nucleic acid.
  
  
  RESULTS
  There were 926 participants who consented and enrolled. Overall, prevalence of undiagnosed HIV was 0.76% (95% confidence interval [CI] = 0.30%, 1.56%). Three participants (0.32%; 95% CI = 0.09%, 0.86%) were nucleic acid-positive but antibody-negative and 4 (0.43%; 95% CI = 0.15%, 1.02%) were antibody-positive.
  
  
  CONCLUSIONS
  Even when the absolute prevalence is low, a considerable proportion of undetected HIV cases in an ED population are acute. Identification of acute HIV in ED settings should receive increased priority.
authors.affiliation: Phillip C. Moschella, Kimberly W. Hart, Andrew H. Ruffner, Christopher J. Lindsell, D. Beth Wayne, Matthew I. Sperling, Alexander T. Trott, and Michael S. Lyons are with the Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH. Carl J. Fichtenbaum is with the Division of Infectious Diseases, University of Cincinnati College of Medicine.
authors.forename: Phillip C
authors.initials: PC
authors.lastname: Moschella
authors.forename: Kimberly W
authors.initials: KW
authors.lastname: Hart
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Ruffner
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.forename: D Beth
authors.initials: DB
authors.lastname: Wayne
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Sperling
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Trott
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Fichtenbaum
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lyons
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D015528:HIV Seroprevalence; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015483:HIV Antibodies