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Identification of acute HIV infection using fourth-generation testing in an opt-out emergency department screening
Kara I Geren1, Frank Lovecchio1, Jason Knight1
1Department of Emergency Medicine, Maricopa Integrated Health System, Phoenix, AZ.
Annals of Emergency Medicine
|June 28, 2014
Summary
Emergency department HIV screening using a fourth-generation assay identified a significant number of acute HIV infections. This rapid testing approach is crucial for early detection and reducing transmission.
Area of Science:
- Public Health
- Infectious Diseases
- Diagnostic Medicine
Background:
- Detecting acute Human Immunodeficiency Virus (HIV) infection is vital for reducing transmission and improving patient outcomes.
- The Maricopa Integrated Health System initiated opt-out HIV screening in an adult emergency department (ED) to determine the prevalence of undiagnosed HIV.
Purpose of the Study:
- To assess the prevalence of acute and chronic unrecognized HIV infections within the ED population.
- To evaluate the feasibility of implementing rapid HIV testing in an emergency department setting.
Main Methods:
- Nontargeted, opt-out HIV screening was performed on eligible patients aged 18-64 years using a fourth-generation antigen/antibody combination assay.
- Reactive results were confirmed, and linkage-to-care specialists assisted with result delivery.
Main Results:
- Over 27,000 screenings identified 78 new HIV diagnoses (0.28%).
- Of these, 18 cases (23%) represented acute HIV infections.
- A notable 28% of newly diagnosed patients had advanced disease (CD4 < 200 cells/mL or opportunistic infection).
Conclusions:
- Fourth-generation HIV testing is feasible and effective in the ED setting, providing rapid results.
- The high proportion of acute infections underscores the value of this screening strategy for early detection.
- This approach can identify infections that might be missed by older testing methods.
