Methods: Retrospective chart review of 60 patients diagnosed with AHI from 7/2012 to 4/2017 at two county hospitals emergency departments in Houston, TX. We compared the interval between diagnosis and initiation of ART before and after implementation of an AHI protocol in 11/2014 comprised of trained service linkage workers and use of the 4th generation Ag/Ab combination assay as newly recommended by the CDC in 6/2014. AHI was defined as 1) detectable HIV RNA or reactive 4th generation Ag/Ab combination assay with non-reactive HIV-1 antibody, 2) reactive 3rd generation Ab assay and negative/indeterminate Western blot (WB), or 3) positive WB that is negative for p31 band. CDC and DHHS definitions were used for linkage to and retention to care respectively.
Results: 10 patients were diagnosed prior to AHI protocol (25-month period) and 50 after (31-month period). 92% established care with 78% retention. Median age 34 years (IQR 25-42), with 78% men, 58% Hispanic, 36% Black non-Hispanic, 50% men having sex with men. Presenting symptoms include fever 78%, chills 47%, malaise/fatigue 47%, nausea 38%, sore throat 37%, and headache 37%. Physical exam findings include rash 20%, pharyngeal edema/erythema 14%, cervical lymphadenopathy 8%, and thrush 7%. Baseline median CD4+ T cell count was 205 cells/µl (IQR 123-350), median HIV RNA 4.75 x 106 copies/mL (IQR 1.1-10.0 x 106). 56% had leukopenia, 47% thrombocytopenia, 37% syphilis, 12% aseptic meningitis and 8% K103N mutation. Median time to ART initiation decreased from 17 days (IQR 11.75-23.5) to 7 days (IQR 4.0-13.25) after protocol implementation (p=0.011).
Conclusion: Employing trained service linkage workers and the new CDC testing algorithm significantly decreased time to initiating ART, which may improve long-term outcomes in these patients. However, 14% of patients were lost to follow-up, highlighting the need for a strategy to maintain engagement of care.
H. Miao, None
O. Gutierrez, None
C. Martinez, None
K. Vigil, None
N. S. Utay, None
R. Arduino, None