Table 3: Laboratory and clinical outcomes Mean CD4 Count (range) in Cells/mm 3
214 [2 to 715]
CD4 Count Less Than 200
35 (49%) 19 (27%) 14 (14%) 13 (13%)
CD4 Count Less Than 50
Positive RPR
Hepatitis C Antibody Positive
Hepatitis B Surface Antigen Positive
3 (3%)
Admission to Hospital
33 (33%)
Reason for Admission
Opportunistic Infection
14 (44%)
PCP
8 (25%)
Cerebral Toxoplasmosis
2 (6%)
Pneumonia (all types excluding PCP)
9 (28%) 3 (9%) 2 (6%)
Trauma
Meningitis
Median Length of Hospital Stay (range) Referred to Infectious Disease Specialist
5 (1 to 42) 85 (86%) 76 (88%)
Referred to ILPH HIV Clinic
Referred to Other Clinic
9 (12%)
Attended Any HIV Clinic Within 1 Year
59 (60%) 54 (55%) 42 (78%) 12 (22%) 45 (45%) 30 (67%)
Attended ILPH HIV Clinic Within 1 Year
Early Entry to Care (less than 3 months)
Delayed Entry to Care (greater than 3 months)
Started on HAART
Efavirenz/Tenofovir/Emtricitabine
Atazanavir/Ritonavir/Tenofovir/Emtricitabine
7 (16%)
RPR = Rapid Plasma Reagin; PCP = Pneumocystis Jirovecii Pneumonia; ILPH = Interim LSU Public Hosptial New Orleans; HAART = Highly Active Antiretroviral Therapy.
The emergency department was an effective location to find patients with HIV in this study, but the late stage of disease implies that improved access to HIV testing in other venues, while patients are asymptomatic, may detect patients at an earlier stage of the disease. The high numbers of new positives found in this populationmay be the result of this type of opt-in screening program since themajority of the patients did not have tradi- tional risk behaviors. This opt-in programoffered tests to all patients at triage without regard to a clinician’s assessment of their risk, which resulted in increased screening of pa- tients without traditional risk factors. The American College of Emergency Physicians Board of Directors has determined HIV testing in the emergency department to be feasible as
nosis of HIV. The false-positive rate was very low (0.03%), compared with the post-marketing surveillance which reported false-positive rates of 0.05% for blood and 0.22% for oral fluid, 15 especially considering the majority of the tests were performed on oral fluid (89%). Almost half of the newly diagnosed patients met diagnostic criteria for AIDS (49%), which was a higher percentage than was typically seen among those newly diagnosed in NewOrleans, which was 24%; 13 however, this was an emergency room popula- tion, which is more likely to have advanced disease because the patient presented with an acute illness or trauma. This high percentage of patients meeting the criteria for AIDS implies late diagnosis and may reflect the lack of access to medical care in this primarily uninsured patient population.
J La State Med Soc VOL 166 January/February 2014 31
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