The questionable utility of mandatory screening for the human immunodeficiency virus

Trauma patients have been identified as a high-risk group for human immunodeficiency virus (HIV) infection, particularly those patients with penetrating injuries from urban violence. We prospectively evaluated more than 2,000 trauma patients for HIV infection at our ACS-certified trauma center and report the results. Between September 1987 and December 1991, 2,004 patients were admitted to our trauma unit. All patients underwent HIV antibody assay by protocol. Three patients had positive test results, and all were confirmed as true positives. Two patients were known at the time of their trauma to be HIV positive, and the third had engaged in high-risk behavior. No health care worker reported inoculation with or mucosal exposure to HIV from any of these patients. In our trauma unit, the prevalence of HIV infection was only 0.15%. More than $74,000 was spent on screening without demonstrable benefit to the patients or increased protection for the trauma team. Routine testing of patients for HIV can be justified to establish epidemiologic parameters and in the case of high-risk groups, but it is not cost-effective in low-risk groups. Persistent testing of populations at low risk is a futile expenditure of precious health care dollars and is of questionable utility.