121. HIV Testing Among Patients Admitted with Pneumonia
Session: Oral Abstract Session: HIV Prevention, Early Diagnosis, STDs
Thursday, October 8, 2015: 11:30 AM
Room: 25--ABC
Background: Since 2006, testing for human immunodeficiency virus (HIV) has been recommended as a routine part of medical care for persons in the United States aged 15 to 64 years. HIV infection is a risk factor for bacterial pneumonia and patients requiring admission for bacterial pneumonia should be prioritized for HIV screening. There is a paucity of data evaluating inpatient HIV screening among patients admitted with pneumonia. 

Methods: We examined a retrospective cohort of patients aged 18-64 years admitted to Duke University Health System (which includes a tertiary care center and two regional community hospitals) from January 1, 1996 through December 31, 2014 with a primary diagnosis of pneumonia. Relevant outcomes included: documented HIV testing in the health system, HIV testing during the pneumonia admission, and new HIV diagnosis.

Results: During the study period 6,858 persons were admitted to the health system with a primary diagnosis of pneumonia. Median age was 50 years (interquartile range [IQR] 40-58) and patients were primarily Caucasian (53%) or African American (41%). Of the cohort, 345 (5.0%) patients were known to have HIV prior to admission and 19 patients (0.3%) had a new positive HIV test result during the pneumonia admission. Furthermore, another 46 patients (0.7%) who were not tested during admission were subsequently diagnosed with HIV a median of 807 (IQR 244-1557) days after pneumonia admission. Of a simple random sample of 207 patients without a prior diagnosis of HIV, 34 (16%, 95% confidence interval [CI] 11-22%) had HIV testing during the pneumonia admission and 83 (40%, 95% CI 33-47%) had an HIV test result ever documented in the health system. HIV testing rates (ever or during pneumonia admission) did not change significantly after 2006 (p > 0.05).

Conclusion: Despite recommendations for universal HIV screening in all healthcare settings since 2006, inpatient HIV testing rates remain low in a population at high risk for HIV infection. Furthermore, a number of persons were subsequently diagnosed with HIV after a prolonged delay, representing a potential missed opportunity for earlier HIV diagnosis. Opt-out HIV testing among pneumonia patients should be implemented to improve testing rates in this high-risk population.

Dana Clifton, MD, Meredith Clement, MD, Thomas Holland, MD, MSc-GH, Gary Cox, MD, Kristen V. Dicks, MD and Jason Stout, MD, MHS, FIDSA, Duke University Medical Center, Durham, NC


D. Clifton, None

M. Clement, None

T. Holland, None

G. Cox, None

K. V. Dicks, None

J. Stout, None

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