Research Article
Volume 5 Issue 4 - 2021
Assessing the Need for Acute HIV Testing in the Emergency Department
Lisa Moreno-Walton1*, Erin M Simmers2, Stacey Rhodes3 and Peter MC DeBlieux1
1Department of Medicine, Section of Emergency Medicine, Louisiana State University Health Science Center New Orleans, USA
2Department of Emergency Medicine, Northern Nevada Medical Center, Renown Regional Medical Center, USA
3Louisiana State University Health Science Center New Orleans, USA
*Corresponding Author: Lisa Moreno-Walton, Department of Medicine, Section of Emergency Medicine, Louisiana State University Health Science Center New Orleans, USA.
Received: January 20, 2021; Published: March 17, 2021




Abstract

Background: Acute HIV Infection (AHI) is a period during which patients are at their most infectious during a time when, by routine HIV antibody test, they are diagnosed as uninfected [1]. While there have been advances in HIV detection a signification portion of patients remain undiagnosed. This is most frequently the case in countries where antigen testing is still not widely available or not widely chosen by the institution as the preferred method of testing. Many of these undiagnosed patients are acutely infected. A contributing factor is that patients do not always present with complaints of STI exposure or flu-like symptoms of acute infection, and even when they do, these symptoms can be easily misinterpreted or completely missed in the Emergency Department (ED). Even when patients are diagnosed there are still significant delays in linkage-to-care (LTC). The proportion of HIV-infected individuals who are misdiagnosed will increase unless sensitive tests are used to mitigate the expected greater number of false-negative antibody test results during acute and early infection [2]. Once identified more robust LTC needs to be implemented.

Hypothesis: We hypothesize that there have been a significant number of patients presenting to the ED with symptoms of Acute HIV Infection but, due to limitations in testing methods, receive a negative HIV test result.

Methods: This is a retrospective chart review of the medical records of all ED patients that received a first-time diagnosis of HIV using the Oraquick™ screening test and a positive Western Blot confirmatory test during the twelve-month period prior to initiation of acute testing in our ED. Patients were included in the study if they had a minimum of one non-reactive HIV screening test in the ED in the three months prior to the time of HIV diagnosis. Patients with previously documented HIV disease were excluded from the study. One hundred and twenty-five patients were confirmed HIV positive during the study period and 20 met the inclusion criteria. Nineteen patients were stratified into groups based on the chief complaint at the time of the first visit (viral symptoms or other) and interval visits between the visit on which the negative test result and the visit on which the positive test result was obtained. There was incomplete data on the first visit for one of the patients in the cohort. We recorded the laboratory studies that were ordered at the time of those visit(s).

Results: 15.2% of patients who were diagnosed with HIV in a one-year period had made a previous visit to the ED during which they received a negative result on an HIV antibody assay. 40% of the cohort were seen in the ED with viral symptoms prior to their HIV positive result. Males, individuals who self-identify as Black, and patients between the ages of 20 - 40 were more likely to present to the ED with viral syndrome at some point prior to a positive HIV antibody test.

Conclusion: It is impossible to determine how many patients may have presented in the acute phase of infection but did not re-present to our ED after the initial visit. This limitation would underestimate the number of cases of acute HIV that are missed each year, and thus lends support for the need for fourth generation HIV testing in the ED. It can be inferred that the availability of antigen-based testing during the “window period” will result in an increase in detection of Acute HIV infection, and thus a decrease in forward transmission of the virus. Even fourth generation HIV testing the LTC rate are still suboptimal.

 

Keywords: Acute HIV; HIV Testing; HIV Screening; Testing Modalities; Emergency Department

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Citation: Lisa Moreno-Walton., et al. “Assessing the Need for Acute HIV Testing in the Emergency Department”. EC Emergency Medicine and Critical Care 5.4 (2021): 33-41.

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