Clinical case of the month. A 50-year-old man with a persistent rash

In September 2006, the United States Centers for Disease Control and Prevention (CDC) published updated recommendations for routine opt-out human immunodeficiency virus (HIV) testing in all healthcare settings. As late diagnosis of infection increases individual and societal risks, a goal of the 2010 National HIV/AIDS Strategy is to increase the percentage of those aware of their infection. In 2008, two years following changes in the CDC testing recommendations, 44.6% of individuals 18-64 years of age reported a history of having a HIV test, resulting in close to 40,000 new HIV diagnoses. Emergency departments accommodate more than 120 million patient visits per year in the United States and can be the only point of contact individuals have with the healthcare system, particularly in uninsured and marginalized groups. Further implementation of opt-out testing can result in earlier diagnosis and improved health outcomes at the both the individual and public health levels.