Program Schedule

Seek and Ye Shall Find: Successful Implementation of Hospital Laboratory-based 4th Generation HIV Screening

Session: Poster Abstract Session: HIV: Testing and Changing Demographics
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Acute HIV infection (AHI) contributes significantly to ongoing HIV transmission. In Washington, DC, an urban center with high HIV prevalence, the rate of HIV among men who have sex with men (MSM) is higher than other demographic groups. Furthermore, in Southeast DC, the region with the highest rates of poverty, chronic diseases and least access to healthcare services, HIV diagnoses are common among both heterosexuals and MSM. However, upon implementation of 4th generation HIV testing, AHI has been found exclusively among black MSM. We reviewed the presentation and clinical findings of these cases.

Methods: In November 2013, the Abbot Architect which detects HIV p24 antigen was installed in our hospital laboratory. To support HIV testing expansion, standardized clinical pathways were modified to include the addition of HIV serology to all standing order sets. In addition, HIV serology was added for all patients undergoing phlebotomy. The hospital laboratory HIV testing algorithm was modified to facilitate same day, on-site confirmation of positive results. 

Results: Since November 2013, five cases of AHI have been identified in the emergency department. In four cases, AHI was not considered by the evaluating provider. All but one presented with a febrile illness. One patient left AMA and is lost-to-follow-up. Of the four remaining cases, the median age was 23 (range 20-26). The median CD4 at diagnosis was 376 (288-769). Median viral load was 3 million (range 750,000-8.6 million). All were able to determine the source and timing of their infection. Three elected to initiate antiretroviral therapy. Of those treated upon AHI diagnosis, viral suppression was achieved within 4 weeks of treatment initiation. 

Conclusion: Identifying acute HIV infection within the timing of an emergency room visit is possible. However, emergency department providers must be educated to consider AHI, particularly among sexually-active MSM. Given the public health urgency to identify black MSM with AHI, access to and implementation of 4th generation testing technology in areas of HIV prevalence is imperative.

Lisa Fitzpatrick, MD, MPH, Infectious Diseases, United Medical Center, Washington, DC; Epidemiology and Biostatistics, George Washington University School of Public Health and Health Services, Washington, DC, Norman Brown, MD, MBA, Emergency Department, United Medical Center, Washington, DC, Sharon Kennedy-Dews, MA, United Medical Center, Washington, DC and David Reagin, MD, Laboratory Services, United Medical Center, Washington, DC


L. Fitzpatrick, None

N. Brown, None

S. Kennedy-Dews, None

D. Reagin, None

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