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Leveraging a Rapid, Round-the-Clock HIV Testing System to Screen for Acute HIV Infection in a Large Urban Public Medical Center

Christopoulos, Katerina A. MD, MPH*; Zetola, Nicola M. MD, MPH; Klausner, Jeffrey D. MD, MPH; Haller, Barbara MD, PhD§; Louie, Brian BA; Hare, C. Bradley MD*; Pandori, Mark PhD; Nassos, Patricia PhD§; Roemer, Marguerite BA§; Pilcher, Christopher D. MD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: February 1st, 2013 - Volume 62 - Issue 2 - p e30–e38
doi: 10.1097/QAI.0b013e31827a0b0d
Implementation and Operational Research: Clinical Science

Objective: To describe the prevalence and location of new and acute HIV diagnoses in a large urban medical center. Secondary objectives were to evaluate rapid HIV test performance, the added yield of acute HIV screening, and linkage-to-care outcomes.

Design: Cross-sectional study from November 1, 2008, to April 30, 2009.

Methods: The hospital laboratory performed round-the-clock rapid HIV antibody testing on venipuncture specimens from patients undergoing HIV testing in hospital and community clinics, inpatient settings, and the emergency department (ED). For patients with negative results, a public health laboratory conducted pooled HIV RNA testing for acute HIV infection. The laboratories communicated positive results from the hospital campus to a linkage team. Linkage was defined as 1 outpatient HIV-related visit.

Results: Among 7927 patients, 8550 rapid tests resulted in 137 cases of HIV infection [1.7%, 95% confidence interval (CI): 1.5% to 2.0%], of whom 46 were new HIV diagnoses (0.58%, 95% CI: 0.43% to 0.77%). Pooled HIV RNA testing of 6704 specimens (78.4%) resulted in 3 cases of acute HIV infection (0.05%, 95% CI: 0.01% to 0.14%) and increased HIV case detection by 3.5%. Half of new HIV diagnoses and two thirds of acute infections were detected in the ED and urgent care clinic. Rapid test sensitivity was 98.9% (95% CI: 93.8% to 99.8%) and the specificity 99.9% (95% CI: 99.7% to 99.9%). More than 95% of newly diagnosed and out-of-care HIV-infected patients were linked to care.

Conclusions: Patients undergoing HIV testing in EDs and urgent care clinics may benefit from being simultaneously screened for acute HIV infection.

*HIV/AIDS Division, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA

Botswana-UPenn Partnership, Infectious Diseases Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA

Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA

§Department of Laboratory Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA

San Francisco Department of Public Health, San Francisco, CA.

Correspondence to: Katerina A. Christopoulos, MD, MPH, HIV/AIDS Division, San Francisco General Hospital, University of California, San Francisco, 995 Potrero Avenue, Building 80, Ward 84, Box 0874, San Francisco, CA 94114 (e-mail:

Supported by (funding and materials for the implementation of pooled HIV RNA testing) the California HIV Research Program Grants RN07-SF-722 and CH05-SMCHC-612, and Gen-Probe Inc. This publication was made possible by Grant UL1 RR024131 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and the NIH Roadmap for Medical Research. This work was also supported by NIH Grants T32 AI60530 and K23 MH 09220 (K.A.C.) and R34 MH 096606 (C.D.P).

Presented in part at the 2009 National HIV Prevention Conference, Atlanta, GA, and the XVIII International AIDS Conference, July 18–23, 2010, Vienna, Austria.

Outside of this work, K.A. Christopoulos has received grant funding from Bristol-Myers Squibb; C.D. Pilcher has received funding from Gen-Probe and given lectures for Bio-Rad; B. Haller has served as a consultant to Ortho Diagnostics and has received research support from Cepheid; C.B. Hare has been a consultant to Bristol-Myers Squibb, Abbott, Gilead, Merck, and Tibotec/Janssen, and on the lectures/speakers’ bureau of Bristol-Myers Squibb, Gilead, Merck, ViiV, and Tibotec/Janssen. All other authors declare no conflicts of interest. The funding sponsors had no role in the design or conduct of the study, collection, management, analysis, and interpretation of the data, or the preparation, review, and approval of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official view of NCRR. Information on NCRR is available at Information on Reengineering the Clinical Research Enterprise can be obtained from

K.A. Christopoulos had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: N.M. Zetola, J.D. Klausner, B. Louie, C.B. Hare, and C.D. Pilcher. Acquisition of data: K.A. Christopoulos, B. Haller, B. Louie, M. Pandori, P. Nassos, M. Roemer, and C.D. Pilcher. Analysis and interpretation of data: K.A. Christopoulos, N.M. Zetola, J.D. Klausner, B. Haller, C.B. Hare, P. Nassos, M. Roemer, and C.D. Pilcher. Drafting of manuscript: K.A. Christopoulos and C.D. Pilcher. Critical revision of the manuscript for important intellectual content: N.M. Zetola, J.D. Klausner, B. Haller, B. Louie, M. Pandori, C.B. Hare, P. Nassos, and M. Roemer. Statistical analysis: K.A. Christopoulos and N.M. Zetola. Obtaining funding: N.M. Zetola, J.D. Klausner, and C.D. Pilcher. Administrative, technical, or material support: J.D. Klausner, B. Haller, B. Louie, M. Pandori, P. Nassos, and M. Roemer. Study supervision: J.D. Klausner, C.B. Hare, and C.D. Pilcher.

Received May 04, 2012

Accepted October 18, 2012

© 2013 Lippincott Williams & Wilkins, Inc.