Factors Associated With No or Delayed Linkage to Care in Newly Diagnosed Human Immunodeficiency Virus (HIV)-1-Infected Patients Identified by Emergency Department-based Rapid HIV Screening Programs in Two Urban EDs

Abstract Background In our urban, underserved patient population, Human Immunodeficiency Virus (HIV) is hyper-endemic, and HIV screening is frequently performed. Although HIV screening tests have high specificity, false positives can occur. Numerous reasons for false positive testing have been cited, including vaccinations, autoimmune diseases, and viral infections. In 2019, Philadelphia experienced a large Hepatitis A outbreak, during which time false positive HIV screening tests were discovered. Our aim was to further describe these patients who had been diagnosed with acute Hepatitis A infection and in whom false positive HIV testing had occurred. Methods We conducted a retrospective chart review of adult patients admitted to our hospital between January 2017 and December 2019 who had a positive Hepatitis A Virus (HAV) IgM. Demographics, HIV tests, viral hepatitis tests, and liver tests were recorded. False positive HIV was defined as a positive HIV screen (p24 antigen and HIV-1 and 2 antibody combo), followed by a negative differentiation assay for HIV-1 and 2 antibodies, combined with a negative HIV PCR. Results A total of 156 unique patients were found to have acute HAV, with 138 cases identified in 2019. Of these, 3 patients had confirmed false positive HIV testing, and 1 patient had suspected false positive HIV testing (HIV-2 differentiation assay indeterminate, with very low local prevalence of HIV-2), for a false positive test rate of 2.6% (4/156). Ages ranged from 36-47 years, 3 were male, and 2 were persons who injected drugs (PWID). Three patients had prior negative HIV testing. Two patients had fevers during admission, but none of the four were febrile at the time of HIV test collection. Three patients had elevated transaminases, and two had abnormal coagulation testing. Coinfection with Hepatitis C was found in three patients. One patient had follow-up HIV testing performed, which was negative. Conclusion To our knowledge, this is the first report of false positive HIV testing related to acute HAV. Prevalence of false positives was low, but awareness can facilitate patient counseling. With low sample size, conclusions cannot be drawn about risk factors related to false positive testing. Disclosures All Authors: No reported disclosures

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Routine HIV Screening in Cancer Patients in the Emergency Department

Acute Medicine Journal ◽

10.52964/amja.0705 ◽

2018 ◽

Vol 17 (2) ◽

pp. 91-95

Author(s):

Terry W Rice ◽

◽

Patricia A. Brock ◽

Carmen Gonzalez ◽

Kelly W Merriman ◽

...

Keyword(s):

Emergency Department ◽

Hiv Testing ◽

Cancer Patients ◽

Linkage To Care ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Hiv Screening ◽

Immunodeficiency Virus ◽

Routine Hiv Screening ◽

Incident Cases

Treatment of human immunodeficiency virus(HIV) in cancer patients improves outcomes and reduces transmission of this oncogenic virus. HIV testing rates of cancer patients are similar to the general population (15-40%), despite the association with cancer. Our aim was to increase HIV screening in the Emergency Department(ED) of a comprehensive cancer center through a quality initiative. Testing increased significantly during the intervention (p<0.001; 0.15/day to 2.69/day). Seropositive HIV rate was 1.4% (12/852), with incidence of 0.3%. All patients were linked to care. Incident cases were between 36 and 55 years of age. Barriers encountered included confusion regarding the need for written consent for HIV testing, failure to consider ordering the test, and concerns regarding linkage to care.

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Trends in Human Immunodeficiency Virus (HIV) Infection Among a Patient Population of an Inner-City Emergency Department: Implications for Emergency Department--Based Screening Programs for HIV Infection

Clinical Infectious Diseases ◽

10.1093/clinids/21.4.867 ◽

1995 ◽

Vol 21 (4) ◽

pp. 867-875 ◽

Cited By ~ 51

Author(s):

G. D. Kelen ◽

D. A. Hexter ◽

K. N. Hansen ◽

N. Tang ◽

S. Pretorius ◽

...

Keyword(s):

Emergency Department ◽

Human Immunodeficiency Virus ◽

Hiv Infection ◽

Inner City ◽

Patient Population ◽

Screening Programs ◽

Immunodeficiency Virus

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Changing to an Internal Staff/Routine Offer Emergency Department Human Immunodeficiency Virus (HIV) Screening Strategy Was Associated With Increased Testing Rates and Improved Testing Efficiency

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.386 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Michael Waxman ◽

Ashar Ata ◽

Adam Frisch ◽

Lisa Sutton

Keyword(s):

Emergency Department ◽

Human Immunodeficiency Virus ◽

Screening Strategy ◽

Hiv Screening ◽

Immunodeficiency Virus ◽

Testing Efficiency

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Late diagnosis of human immunodeficiency virus infections in high-risk groups in Karachi, Pakistan

International Journal of STD & AIDS ◽

10.1177/0956462418785264 ◽

2018 ◽

Vol 29 (14) ◽

pp. 1400-1406

Author(s):

Zahra Hasan ◽

Sharaf Shah ◽

Rumina Hasan ◽

Shoaib Rao ◽

Manzoor Ahmed ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

High Risk ◽

Early Diagnosis ◽

Hiv Infection ◽

Hiv Infections ◽

Risk Groups ◽

Newly Diagnosed ◽

Immunodeficiency Virus ◽

Hiv 1

Human immunodeficiency virus (HIV) infection prevalence in Pakistan has been increasing in high-risk groups, including people who inject drugs (PWID) and transgender hijra sex workers (TG-HSWs) nationwide. Effective control of HIV requires early diagnosis of the infection. We investigated recency of HIV infections in newly-diagnosed cases in PWID and TG-HSWs. This was an observational study with convenience sampling. Overall, 210 HIV-positive subjects comprising an equal number of PWID and TG-HSWs were included. Antibody avidity was tested using the Maxim HIV-1 Limiting Antigen Avidity (LAg) EIA (Maxim Biomedical, Inc. Rockville, Maryland, USA). The mean age of study subjects was 29.5 years: PWID, 28.5 years and TG-HSWs, 30.4 years. Study subjects were married, 27%, or unmarried. Eighteen percent of individuals had recently-acquired HIV infections: 19% of PWID and 17% of TG-HSWs. Eighty-two percent of individuals had long-term HIV infections: 81% of PWID and 83% of TG-HSWs. This is the first study identification of recent HIV-1 infections in Pakistan. We show that most newly-diagnosed HIV patients in the high-risk groups studied had long-term infections. There is an urgent need for intervention in these groups to facilitate early diagnosis and treatment of HIV infection to reduce transmission in Pakistan.

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Screening for antiretroviral drug resistance among treatment-naive human immunodeficiency virus type 1-infected individuals in Lebanon

The Journal of Infection in Developing Countries ◽

10.3855/jidc.3593 ◽

2014 ◽

Vol 8 (03) ◽

pp. 339-348

Author(s):

Jacques M Mokhbat ◽

Nada M. Melhem ◽

Ziad El-Khatib ◽

Pierre Zalloua

Keyword(s):

Human Immunodeficiency Virus ◽

Drug Resistance ◽

Viral Load ◽

Reverse Transcriptase ◽

Human Immunodeficiency Virus Type ◽

Newly Diagnosed ◽

Reverse Transcriptase Inhibitors ◽

Immunodeficiency Virus ◽

Hiv 1

Introduction: Antiretroviral therapy (ART) has been successful at decreasing the morbidity and mortality associated with human immunodeficiency virus type 1 (HIV-1) infection. HIV-1 drug resistance (HIVDR) among ART-naive patients has been documented to compromise the success of initial therapy. This study was conducted to determine the prevalence of HIVDR mutations among newly diagnosed drug-naive HIV-infected individuals in Lebanon. Methodology: Plasma samples from 37 newly diagnosed participants at various stages of HIV-1 infection were used to determine HIV-1 RNA viral load, isolate viral RNA, and amplify DNA by RT-PCR. Purified PCR products were used to perform genotypic resistance tests. Results: The prevalence of resistance mutations to nucleoside reverse transcriptase inhibitors (NRTI), non-nucleoside reverse transcriptase inhibitors (NNRT), and protease inhibitors (PI) were 5.4%, 10.8%, and 8%, respectively. The major mutations detected in the study participants conferred resistance to NRTIs and NNRTIs recommended for HIV-1 treatment. No significant relationship between HIV-1 viral load of participants and the mode of HIV-1 transmission or between the occurrence of HIVDR and the mode of transmission was found. Conclusions: To our knowledge, this is the first study on HIVDR mutations among newly diagnosed HIV-infected persons in Lebanon. The overall prevalence of HIVDR mutations detected in our study was 16%. Our results are important for evaluating the utility of the standard first-line regimens in use, determining the feasibility of HIVDR testing before the initiation of ART, as well as minimizing the emergence and transmission of HIVDR.

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Covariates and Spatial Interpolation of HIV Screening in Mozambique: Insight from the 2015 AIDS Indicator Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17165630 ◽

2020 ◽

Vol 17 (16) ◽

pp. 5630

Author(s):

Pascal Agbadi ◽

Jerry John Nutor ◽

Ernest Darkwah ◽

Henry Ofori Duah ◽

Precious Adade Duodu ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Spatial Interpolation ◽

Regional Level ◽

Hiv Screening ◽

Sample Design ◽

Cross Sectional ◽

Factors Associated ◽

Lifetime Sexual Partner ◽

Immunodeficiency Virus ◽

Regional Estimates

We examined the factors associated with human immunodeficiency virus (HIV) screening and developed a HIV screening prevalence surface map using spatial interpolation techniques to identify the geographical areas with the highest and lowest rates of HIV screening in Mozambique. We analyzed the cross-sectional 2015 Mozambique AIDS Indicator Surveys with an analytic sample of 12,995 participants. Analyses were conducted on SPSS-21, STATA-14, and R freeware 3.5.3. We adjusted for the sample design and population weights. Results indicated that 52.5% of Mozambicans had undergone HIV screening. Mozambicans with these characteristics have a higher probability of undergoing HIV screening: females, those with a primary education or higher, urban dwellers, residents of wealthy households, having at least one lifetime sexual partner, and dwelling in these provinces—Niassa, Tete, Manica, Sofala, Inhambane, Gaza, Maputo Provincia, and Maputo Cidade. The spatial map revealed that the national and regional estimates mask sub-regional level estimates. Generally, zones with the highest HIV screening prevalence are found in southern provinces while the lowest prevalence was found in the northern provinces. The map further revealed intraregional differences in HIV screening estimates. We recommend that HIV screening be expanded, with equitable screening resource allocations that target more nuanced areas within provinces which have a low HIV screening prevalence.

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