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Risk-Based Human Immunodeficiency Virus (HIV) Testing Fails to Detect the Majority of HIV-Infected Persons in Medical Care Settings

Jenkins, Timothy C. MD*†; Gardner, Edward M. MD*†; Thrun, Mark W. MD*†; Cohn, David L. MD*†; Burman, William J. MD*†

Sexually Transmitted Diseases: May 2006 - Volume 33 - Issue 5 - pp 329-333
doi: 10.1097/01.olq.0000194617.91454.3f

Objectives: To evaluate opportunities for earlier human immunodeficiency virus (HIV) diagnosis within a comprehensive public health care system.

Study Design: Retrospective review of newly diagnosed HIV-infected patients between September 2001 and December 2003.

Results: One hundred twenty of 348 (34%) newly diagnosed HIV-infected patients had medical care within our system in the 3 years before diagnosis. One hundred five of 120 (88%) patients had at least 1 prior encounter in the emergency department or urgent care center, whereas just 12 (10%) HIV diagnoses were made in these 2 sites. Only 33 (28%) patients previously presented with an HIV clinical indicator condition or sexually transmitted infection.

Conclusions: Although one-third of newly diagnosed HIV-infected patients had clinical visits in the 3 years before diagnosis, few presented with clinical conditions typically associated with HIV infection. Targeted testing based on clinical presentations is not likely to result in substantially earlier HIV diagnosis. Routine screening in high prevalence settings could be more effective.

One-third of patients newly diagnosed with HIV had prior medical care. Most were seen in the urgent care center or emergency department, yet few new diagnoses were made in these locations.

From *Denver Public Health, Denver, Colorado; and the †Department of Medicine, Division of Infectious Diseases, University of Colorado Health Sciences Center, Denver, Colorado

This research was presented in part at the 12th Conference on Retroviruses and Opportunistic Infections held in Boston, MA, on February 24, 2005.

Dr. Gardner was supported through NIH funding in the University of Colorado HIV Research Training Program (2 T32 AI07447-12 PI: Schooley).

Correspondence: Edward M. Gardner, MD, 605 Bannock Street, MC 2600, Denver, CO 80204. E-mail:

© Copyright 2006 American Sexually Transmitted Diseases Association