Misdiagnosis of Treatable Stroke Mimic: The Case for HIV Screening in Practice Guidelines

Notably absent from current practice guidelines for common neurologic diseases as stroke and seizure is the revised Centers for Disease Control (CDC) recommendation for human immunodeficiency virus (HIV) testing of all clinical encounters. During a 9-month period 2 patients with treatable stroke mimics related to HIV type 1 infection were misdiagnosed resulting in delay in beginning antiretroviral therapy and increased cost and morbidity. This study was conducted to determine the frequency of HIV-1 screening in our stroke center population and consider the implications of such testing on neurologic disease. We surveyed our stroke center database to determine the frequency of HIV screening in ischemic strokes from January 2005 through May 2011. Of 2806 ischemic strokes, 27 (0.96%) patients were HIV-tested during the 6.5-year study period. We suggest that incorporating the CDC recommendations for HIV screening into neurology practice guidelines can impact diagnosis and treatment of unsuspected HIV-related neurologic disease with reduction in cost of care and morbidity.