Journal of the Louisiana State Medical Society
Table 2: Reason for visit to emergency room on day of new HIV diagnosis Shortness of Breath/Cough/Cold 12 (12%) Abscess 7 (7%) Chest Pain 7 (7%) Limb Pain 6 (6%) Abdominal Pain 6 (6%) Neurologic Complaint (numbness/weakness/dizzy) 6 (6%) Headache 4 (4%) Fever 3 (3%) Psych Evaluation/Bizarre Behavior 3 (3%) Flank Pain 3 (3%) HIV test 1 (1%)
53%): eight for Pneumocystis jirovecii pneumonia (PCP), and nine for other types of pneumonia. Table 3 summarizes the initial clinical and laboratory findings and details of the hospital admissions. The initial CD4 cell count of patients with a new HIV diagnosis was available for 71 of the 99 patients. The mean CD4 count was 214 cells/mm 3 (95% CI 170-258). At diagno- sis, 85 (86%) of the patients were referred to an infectious disease specialist. The majority of the referrals were to the HIV clinic at the same institution (88%). Fifty-nine patients had a documentedHIV clinic visit within 12 months follow- ing their positive test (60%). Fifty-four patients presented to the HIV clinic at ILPH, 25 (46%) within the first month, 17 (31%) within one to three months, and the remainder greater than three months, which represents delayed entry into care. Forty-five patients were started on highly active antiretroviral therapy (45% of the total); the majority, 30 (30%), were started on a fixed-dose combination prepara- tion containing efavirenz, emtricitabine, and tenofovir. At last clinical record, two (2%) of the patients were deceased. One of them went to hospice for cerebral toxoplasmosis and the other one died in the ICU of acute respiratory fail- ure and sepsis. Of the 40 patients not linked to care within one year, the majority (21 patients, 53%) were referred to our HIV clinic. Five (13%) were referred elsewhere; three were referred out of state because the patient lived out of state, and two were referred to a community HIV clinic. Of the remaining patients, one patient refused referral, one patient went to hospice, and the others (12 patients) were not referred. DISCUSSION The point prevalence of HIV was 1.2% for this opt-in emergency room-based patient population and was con- sistent with prevalence rates seen in other studies. 2 One hundred thirty-eight patients tested positive for HIV with only three false positives; however, 36 had a previous diag-
emergency room staff, either the physician or nurse. All positive samples were sent for a confirmatoryWestern blot. A retrospective chart review of adult patients agreeing to a rapidHIV test at the Emergency Department fromFebruary 2008 through February 2009 was conducted. IRB approval was obtained prior to data collection. Statistical software (SPSS 18.0) was used for analysis. RESULTS During the 57,891 patient encounters in the first year of institution of the rapid HIV test from February 2008 to Feb- ruary 2009, 8,204 patients were tested (14%). 14 One hundred and thirty-eight patients (1.7%) out of 8,204 patients tested positive for HIV by rapid testing with the Oraquick. Three (2%) were false positives, which were not confirmed by Western Blot. The false positive rate was 0.03%. Themajority of the rapid tests were performed on oral fluid (89%), which became available in April of 2008. Thirty-six (26%) upon chart review had a previous history of HIV. Ninety-nine of the positives were new HIV diagnoses, resulting in a 1.2% prevalence of newly diagnosedHIV in the tested population. The demographics of the patients newly diagnosed with HIV are provided in Table 1. Most of the patients were male (69%) and African-American (79%). Very few had any insurance, includingMedicaid (23%). The patients presented with a broad range of chief complaints, which are listed in Table 2. Hypertension was the most common co-morbidity. Fifty-seven (58%) of the newly diagnosed patients had been seenwithin the past five years in the ILPH systemprior to their diagnosis. The majority of those visits were in the emergency room (41 patients; 71%). Twenty-seven patients had been seen three or more times in the ILPH system in the five years prior to diagnosis (27%). Only four of the 99 patients with a newdiagnosis of HIV had a previously docu- mented negative HIV test at ILPH. On initial presentation, thirty-three patients were admitted to the hospital (33%). The majority was admitted for pneumonia (17 patients,
30 J La State Med Soc VOL 166 January/February 2014
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