title: Acute Infections, Cost per Infection and Turnaround Time in Three United States Hospital Laboratories Using Fourth-Generation Antigen-Antibody Human Immunodeficiency Virus Immunoassays.
abstract: Background.  To improve clinical and public health outcomes through early human immunodeficiency virus (HIV) detection, fourth-generation antigen/antibody immunoassay (4IA) and supplemental testing results must be returned rapidly. Methods.  We examined HIV testing data at Harborview Medical Center (HMC), Massachusetts General Hospital (MGH), and the Medical University of South Carolina (MUSC), which used 4IA and supplemental antibody and nucleic acid tests (NATs). At MGH and MUSC, HIV-1 Western blot (WB) and HIV-2 testing were conducted at a reference laboratory. We compared time from specimen collection to laboratory result for established (positive WB) and acute infections (reactive 4IA, negative/indeterminate WB, detectable NAT), and we calculated testing cost per positive-test result. Results.  From 3731 (MUSC) to 19 774 (MGH) tests were conducted; 0.01% (MGH) to 0.05% (HMC) were acute infections. Each laboratory had reactive 4IA, WB-negative, or indeterminate specimens without NAT (ie, potential acute infections). Time to result was 1.5 (HMC) to 5.2 days (MGH) for acute and 1.0 (HMC) to 5.2 days (MGH) for established infections. Costs were $1054 (MGH) to $1521 (MUSC). Conclusions.  Conducting supplemental testing in-house lowered turnaround times, which may be further reduced with rapid HIV-1/HIV-2 differentiation tests. Hospitals may benefit from quantitative NATs not requiring physician orders, so all potential acute infections receive NAT.
authors.affiliation: Division of HIV/AIDS Prevention , National Center for HIV, Hepatitis, STD & TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia.
authors.forename: Laura G
authors.initials: LG
authors.lastname: Wesolowski
authors.affiliation: Division of HIV/AIDS Prevention , National Center for HIV, Hepatitis, STD & TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia.
authors.forename: Muazzam
authors.initials: M
authors.lastname: Nasrullah
authors.affiliation: Departments ofLaboratory Medicine; Medicine, Harborview Medical Center, Seattle, Washington.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Coombs
authors.affiliation: Departments ofMedicine; Pathology, Massachusetts General Hospital, Boston.
authors.forename: Eric
authors.initials: E
authors.lastname: Rosenberg
authors.affiliation: Division of HIV/AIDS Prevention , National Center for HIV, Hepatitis, STD & TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Ethridge
authors.affiliation: Division of HIV/AIDS Prevention , National Center for HIV, Hepatitis, STD & TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia.
authors.forename: Angela B
authors.initials: AB
authors.lastname: Hutchinson
authors.affiliation: Departments of Laboratory Medicine.
authors.forename: Joan
authors.initials: J
authors.lastname: Dragavon
authors.affiliation: Pathology , Massachusetts General Hospital , Boston.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rychert
authors.affiliation: Department of Pathology and Laboratory Medicine , Medical University of South Carolina , Charleston.
authors.forename: Frederick S
authors.initials: FS
authors.lastname: Nolte
authors.affiliation: Department of Pathology and Laboratory Medicine , Medical University of South Carolina , Charleston.
authors.forename: James E
authors.initials: JE
authors.lastname: Madory
authors.affiliation: Bureau of Infectious Disease, Massachusetts Department of Public Health, Boston.
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Werner
keywords: HIV; acute infection; cost; laboratory